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Salih N, Amin U, Hamza K, Ghani N, Ali S, Sarfaraz H, Khan MF. Idiopathic Chronic Pancreatitis Presenting as Hemorrhagic Ascites: A Case Report. Cureus 2023; 15:e45303. [PMID: 37846267 PMCID: PMC10576976 DOI: 10.7759/cureus.45303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
This report presents a perplexing case involving a 16-year-old adolescent presenting with persistent upper abdominal pain and distention. The patient had no history of substance abuse or animal-related encounters. Clinical examination revealed abdominal tension, distention, and localized tenderness. Laboratory analysis indicated elevated white blood cell count, mildly reduced hemoglobin and platelet levels, and notably heightened amylase and lipase levels. Serum albumin displayed a minor decrease. Despite repeated consultations and ultrasound evaluations, the underlying cause remained elusive. Advanced imaging unveiled substantial abdominopelvic ascites, a shrunken pancreas with an expanded main duct, and thickening at the ileocecal junction. Ascitic fluid analysis unveiled hemorrhagic fluid with elevated cell and neutrophil counts. Notably, the fluid accumulation extended into the omental apron covering the intestines. Biopsy results ruled out malignancy and chronic infections. We diagnosed him as a case of idiopathic chronic pancreatitis presenting as hemorrhagic ascites. This case underscores the intricacies of diagnosing complex abdominal disorders. A comprehensive approach, involving multidisciplinary collaboration, rigorous diagnostic assessments, and meticulous patient evaluation, is essential for elucidating such challenging clinical scenarios.
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Affiliation(s)
- Noman Salih
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Umair Amin
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Khizer Hamza
- Pathology, Gajju Khan Medical College, Swabi, PAK
| | - Numan Ghani
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Shahid Ali
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Haider Sarfaraz
- Internal Medicine, Lady Reading Hospital, Peshawar, PAK
- Internal Medicine, Khyber Medical College, Peshawar, PAK
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Thunnissen FM, Comes DJ, Geenen RWF, Riviere D, Latenstein CSS, Lantinga MA, Schers HJ, van Laarhoven CJHM, Drenth JPH, Atsma F, de Reuver PR. Patients with Clinically Suspected Gallstone Disease: A More Selective Ultrasound May Improve Treatment Related Outcomes. J Clin Med 2023; 12:4162. [PMID: 37373855 DOI: 10.3390/jcm12124162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to quantify the confirmation of gallstones on ultrasound (US) in patients with suspicion of gallstone disease. To aid general practitioners (GPs) in diagnostic workup, a model to predict gallstones was developed. A prospective cohort study was conducted in two Dutch general hospitals. Patients (≥18 years) were eligible for inclusion when referred by GPs for US with suspicion of gallstones. The primary outcome was the confirmation of gallstones on US. A multivariable regression model was developed to predict the presence of gallstones. In total, 177 patients were referred with a clinical suspicion of gallstones. Gallstones were found in 64 of 177 patients (36.2%). Patients with gallstones reported higher pain scores (VAS 8.0 vs. 6.0, p < 0.001), less frequent pain (21.9% vs. 54.9%, p < 0.001), and more often met criteria for biliary colic (62.5% vs. 44.2%, p = 0.023). Predictors for the presence of gallstones were a higher pain score, frequency of pain less than weekly, biliary colic, and an absence of heartburn. The model showed good discrimination between patients with and without gallstones (C-statistic 0.73, range: 0.68-0.76). Clinical diagnosis of symptomatic gallstone disease is challenging. The model developed in this study may aid in the selection of patients for referral and improve treatment related outcomes.
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Affiliation(s)
- Floris M Thunnissen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Daan J Comes
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, 1815 JD Alkmaar, The Netherlands
| | - Deniece Riviere
- Department of Radiology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch, The Netherlands
| | - Carmen S S Latenstein
- Department of Surgery, Amsterdam UMC, Location VUMC, 1081 HV Amsterdam, The Netherlands
| | - Marten A Lantinga
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Henk J Schers
- Department of General Practice, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Cornelis J H M van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Chao KH, Lin CY, Wang CT. A Rare Presentation of Chronic Appendicitis in the Right Upper Quadrant: A Case Report. Cureus 2023; 15:e40772. [PMID: 37485188 PMCID: PMC10362377 DOI: 10.7759/cureus.40772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Chronic appendicitis is a rare cause of chronic abdominal pain that can be difficult to diagnose. We present a patient with chronic right upper quadrant pain that was finally diagnosed as chronic appendicitis. This 71-year-old male had no systemic diseases and presented to our outpatient clinic with right upper quadrant pain for one month. The pain tended to worsen in the early morning but could be relieved by bowel movements, sitting up, or walking. The findings of a physical examination, laboratory data, and abdominal ultrasound were not significant. Upper endoscopy revealed a shallow gastric ulcer at the antrum. However, the abdominal pain was not relieved by esomeprazole. A computed tomography (CT) scan revealed a dilated appendix with some appendicoliths in the retrocecal region. Due to chronic appendicitis, the patient underwent laparoscopic appendectomy, and the histopathological examination of the removed appendix confirmed the diagnosis. The abdominal pain completely resolved after the surgery. Chronic appendicitis should be kept in mind in patients with chronic abdominal pain without a definite diagnosis. This case illustrates that in addition to right lower quadrant pain, chronic appendicitis can also present with right upper quadrant pain or vague abdominal pain. A CT scan is invaluable in the diagnosis of abdominal pain when medical treatment fails to yield improvement.
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Affiliation(s)
- Ko-Han Chao
- Department of Internal Medicine, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, New Taipei, TWN
| | - Chien-Yi Lin
- Department of Medical Imaging, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, New Taipei, TWN
| | - Chih-Tang Wang
- Department of Surgery, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, New Taipei, TWN
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Kim SK, Ko SH, Jeong KY, Lee JS, Choi HS, Hong HP. Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess. J Emerg Med 2020; 60:e49-e52. [PMID: 33303274 DOI: 10.1016/j.jemermed.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare and potentially fatal disease characterized by bacterial infection of the gastric wall. However, its clinical features are nonspecific, which may delay its diagnosis and treatment. CASE REPORT We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.
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Affiliation(s)
- Sung Kyoo Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seok Hoon Ko
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jong Seok Lee
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hoon Pyo Hong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Vakil N, Wernersson B, Ohlsson L, Dent J. Prevalence of gastro-oesophageal reflux disease with upper gastrointestinal symptoms without heartburn and regurgitation. United European Gastroenterol J 2014; 2:173-8. [PMID: 25360300 DOI: 10.1177/2050640614532458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/13/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Symptomatically 'silent' gastro-oesophageal reflux disease (GORD) may be underdiagnosed. OBJECTIVE To determine the prevalence of untreated GORD without heartburn and/or regurgitation in primary care. METHODS Patients were included if they had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the previous 2 months (Diamond study: NCT00291746). GORD was diagnosed based on the presence of reflux oesophagitis, pathological oesophageal acid exposure, and/or a positive symptom-acid association probability. Patients completed the Reflux Disease Questionnaire (RDQ) and were interviewed by physicians using a prespecified symptom checklist. RESULTS GORD was diagnosed in 197 of 336 patients investigated. Heartburn and/or regurgitation were reported in 84.3% of patients with GORD during the physician interviews and in 93.4% of patients with GORD when using the RDQ. Of patients with heartburn and/or regurgitation not identified at physician interview, 58.1% (18/31) reported them at a 'troublesome' frequency and severity on the RDQ. Nine patients with GORD did not report heartburn or regurgitation either at interview or on the RDQ. CONCLUSIONS Structured patient-completed questionnaires may help to identify patients with GORD not identified during physician interview. In a small proportion of consulting patients, heartburn and regurgitation may not be present in those with GORD.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - John Dent
- Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia, Australia
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