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Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, Bautista-Coronado UA, Moran-Guerrero JA, Guzman EA. Epiploic Appendagitis: Systematic Review of a Distinctive Pathology. Am Surg 2024:31348241256062. [PMID: 38756087 DOI: 10.1177/00031348241256062] [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] [Indexed: 05/18/2024]
Abstract
Introduction: Epiploic appendagitis (EA) is an essential cause of abdominal pain that can be confused with more typical causes such as acute diverticulitis and appendicitis. Epiploic appendagitis accounts for 1% of all cases of abdominal pain in adults. The scarcity of information has limited its recognition as an essential nonsurgical cause of acute abdominal pain.Methods: We performed a systematic review of all EA cases published. We searched Scopus, Medline, Web of Science, and Google Scholar to retrieve all available studies from January 2000 to November 2023.Results: 196 case reports and case series were analyzed, with 371 patients with EA included. The mean age at the time of diagnosis was 39 years. Most patients were male (59%). The primary presenting symptoms were pain (100%), tenderness (59.5%), and rebound tenderness (27.4%). The left abdomen was the most common localization of pain (53%). The most frequently identified differential diagnoses were acute appendicitis (26.4%) and acute diverticulitis (16.1%). Most patients (53%) were treated conservatively, and 98 (26.4%) underwent surgical treatment. A significant difference in the choice of treatment was found for signs and symptoms such as rebound tenderness, nausea, anorexia, and diarrhea.Conclusions: Acute EA is an essential clinical condition of rare occurrence that might present a diagnostic challenge, as it can masquerade as another acute abdominal pain etiology. The optimal management of EA is conservative, so a higher recognition by surgeons and emergency physicians is essential to avoid unnecessary surgical interventions and their associated consequences.
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Affiliation(s)
| | - Hannia M Macias-Cruz
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, México
| | | | | | - Jose A Moran-Guerrero
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, México
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2
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Green J, Biglione A. Fibroid Degeneration During Pregnancy Presenting as Appendicitis. Cureus 2024; 16:e57660. [PMID: 38707152 PMCID: PMC11070206 DOI: 10.7759/cureus.57660] [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: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Uterine fibroid degeneration is a rare cause of abdominal pain during pregnancy. It can cause complications during pregnancy, including placental abruption, fetal growth restriction, and preterm delivery. Myxoid degeneration is an unusual form of fibroid degeneration. We present a case of a 38-year-old female, G1P0, who presented at 13 weeks gestation to the emergency department at the request of her obstetrician due to abdominal pain with concern about appendicitis. A diagnosis of myxoid degeneration was made. The patient was treated with analgesics and discharged to continue her management in the outpatient setting.
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Affiliation(s)
- Jamie Green
- College of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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3
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Ahmed RA, Yaseen FA, Aljudaibi RS, Ahmed NA. A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia. Cureus 2024; 16:e58246. [PMID: 38745793 PMCID: PMC11093405 DOI: 10.7759/cureus.58246] [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: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
A spontaneous rupture of the spleen during pregnancy or post-delivery is an exceptionally rare but potentially fatal maternal complication that poses a significant challenge in diagnosis and management. Herewith, we present a case of a 31-year-old female patient who experienced a spontaneous splenic rupture following a singleton vaginal delivery. Despite lacking any history of trauma or a predisposing factor, she developed symptoms of dizziness and postpartum abdominal pain, progressing rapidly to unconsciousness. Urgent abdominal ultrasound revealed significant intraperitoneal bleeding with a large peri-splenic hematoma, necessitating emergency exploratory laparotomy. Histopathological examination of a frozen section ruled out malignancy, and thus, a complete splenectomy was done, which confirmed the diagnosis of spontaneous splenic rupture. This case emphasizes the importance of close monitoring of all postpartum women, even those with low-risk pregnancies, for the early detection of any complication. Healthcare providers should maintain a high index of suspicion for rare but potentially life-threatening events to ensure timely intervention and optimal outcomes.
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Affiliation(s)
- Ruqayyah A Ahmed
- Department of General Medicine and Surgery, Batterjee Medical College for Science and Technology, Jeddah, SAU
- Department of Obstetrics and Gynecology, Aya Specialist Hospital, Jeddah, SAU
| | - Faten A Yaseen
- Department of General Medicine and Surgery, Batterjee Medical College for Science and Technology, Jeddah, SAU
- Department of Obstetrics and Gynecology, Aya Specialist Hospital, Jeddah, SAU
| | - Reem S Aljudaibi
- Department of General Medicine and Surgery, Batterjee Medical College for Science and Technology, Jeddah, SAU
- Department of Obstetrics and Gynecology, Aya Specialist Hospital, Jeddah, SAU
| | - Nabata A Ahmed
- Department of Obstetrics and Gynecology, Saudi Board in Obstetrics and Gynecology, Aya Specialist Hospital, Jeddah, SAU
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4
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Abdallah S, Tarchichi J, Alabidin Ammasri HZ, Tarchichi A, Moufawad G. Emergency laparoscopy in underserved settings: optimizing diagnosis and management of appendicitis with ruptured hemorrhagic ovarian cyst. Ann Med Surg (Lond) 2024; 86:1716-1719. [PMID: 38463095 PMCID: PMC10923281 DOI: 10.1097/ms9.0000000000001736] [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] [Received: 10/20/2023] [Accepted: 01/08/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Laparoscopy is an established widely available technique for diagnosis and management. However, due to its high maintenance and expensive use, it is not readily available in emergency settings especially in underserved area hospitals. The coincidence of gynecologic and nongynecologic surgical emergencies incurs a diagnostic dilemma especially in women of reproductive age presenting with acute abdominal pain. Case presentation This article is a case report about a woman presenting with acute abdominal pain in an underserved area and diagnosed as appendicitis. Clinical discussion Emergency laparoscopy is so rare in underserved areas due to its high maintenance costs as well as the lack of availability of well-trained surgeons and personnel. The exceptional availability of emergency laparoscopy in her case has allowed the codiagnosis of a ruptured hemorrhagic ovarian cyst with the optimal surgical management preventing the complications that could have occurred from misdiagnosing the coincident ruptured hemorrhagic cyst. Conclusion Emergency laparoscopy is not always available in such clinical settings and has, in our case, optimized the management and prevented an undiagnosed ruptured hemorrhagic cyst together with its complications.
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Affiliation(s)
| | - Jana Tarchichi
- Obstetrics and Gynecology Department, Beirut Arab University
| | | | - Alaa Tarchichi
- Balamand University, School of Medicine, Beirut, Lebanon
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, School of Medicine, Lebanese American University
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5
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Al-Faifi JJ, Alruwaili KA, Alkhenizan AH, Alharbi MF, Alammar FN. Level of Knowledge and Attitude Toward Acute Abdomen Among the Public: A Nationwide Study. Cureus 2024; 16:e52416. [PMID: 38371134 PMCID: PMC10869998 DOI: 10.7759/cureus.52416] [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: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Treatment of patients suffering from acute abdominal pain (AAP) is often challenging due to its wide range of associated illnesses, which could delay or prevent the identification of the correct diagnosis. Multiple diagnoses should be considered, particularly those in life-threatening situations needing urgent intervention. Aim This study aimed to assess the level of knowledge among the general population related to acute abdomen and which specialty should be sought for consultation in AAP situations. Subject and methods This cross-sectional study was conducted among the general population living in Saudi Arabia. A self-administered questionnaire was sent to the Saudi population through the Google survey. The questionnaire included basic demographic characteristics (i.e., age, gender, etc.), perceived causes, barriers, the most common symptoms of AAP, and a five-item questionnaire to assess the general population's knowledge about AAP. Results Of the 2,703 respondents, 68.1% were females, and 42.4% were aged between 18 and 25 years old. The digestive system disorders (esophagus, stomach, intestine, and colon) were the most perceived causes that led to AAP (76.6%). The overall mean knowledge score was 1.35 (SD 1.07) out of five points. Accordingly, nearly all (87.2%) were considered to have poor knowledge, 9.5% were considered to have moderate knowledge, and only 3.3% were considered to have good knowledge. Being younger, being a male, and living in the Central Region were the factors associated with increased knowledge. Conclusion There was a lack of knowledge about AAP among the general population in Saudi Arabia. Younger age, gender males, and living in the Central Region were identified as the significant factors of increased knowledge. It is necessary to increase the knowledge of the population regarding acute abdomen. Media awareness campaigns may play a significant role in providing the necessary information to the general public.
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Affiliation(s)
- Jubran J Al-Faifi
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Khalid A Alruwaili
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdulhakeem H Alkhenizan
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Mohammed F Alharbi
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Faisal N Alammar
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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6
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Al Mubarak HA, Alshalan SM, Alkhunaizi NB, Alorabi AH, Abdulfatah AM. A Case Report on Fibromuscular Dysplasia With Extrarenal Involvement. Cureus 2023; 15:e50358. [PMID: 38213346 PMCID: PMC10781897 DOI: 10.7759/cureus.50358] [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: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
Fibromuscular dysplasia is a vascular disorder characterized by nonatherosclerotic, noninflammatory arterial abnormalities, primarily affecting renal arteries. While extrarenal involvement is rare, it poses diagnostic challenges due to diverse clinical presentations. We present the case of a middle-aged female who presented with sudden-onset severe abdominal pain and hypertension. Physical examination revealed tenderness, guarding, and hypertensive urgency. Diagnostic workup, including laboratory investigations and computed tomography, identified multifocal arterial stenosis in both renal and mesenteric arteries, consistent with fibromuscular dysplasia. A multidisciplinary team initiated antihypertensive medications and performed angioplasty to address vascular stenosis. The patient showed significant improvement post intervention, highlighting the efficacy of a comprehensive management strategy. This case underscores the clinical complexities of fibromuscular dysplasia, emphasizing the diagnostic challenges posed by extrarenal manifestations. The successful multidisciplinary intervention highlights the importance of timely and targeted measures in addressing both renal and extrarenal complications.
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Affiliation(s)
| | | | | | - Abdullah H Alorabi
- General Practice, Ibn Sina National College for Medical Studies, Jeddah, SAU
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7
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Zijun L, Yaqin Z, Weiwen P. A rare case of isolated fallopian tubal torsion in adolescent girls: A case report and system review of literature. SAGE Open Med Case Rep 2023; 11:2050313X231215207. [PMID: 38047268 PMCID: PMC10691320 DOI: 10.1177/2050313x231215207] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Isolated torsion of a fallopian tube in adolescent girls is a very rare acute abdomen. How to early diagnose and treatment isolated torsion of a fallopian tube has always been one of key points. We reported a rare case of isolated torsion of a fallopian tube in a 14-year-old girl and conducted a systematic review of the literature over the past 21 years. We collected data on clinical characteristics, diagnosis and treatment, prognosis and follow-up outcomes. According to our research strategies, 43 reported cases were included. The results (Mean ± SD) showed that the onset age was 14.09 ± 2.49, the cycle torsion was 2.79 ± 1.18, and the cyst size was 6.43 ± 2.25. The main clinical symptoms (percentage) are 100% lower abdominal pain, 67.44% nausea, 51.16% vomiting, and 50.00% right side lesions. And the accurate rate of preoperative diagnosis was only 27.91%, in which laparoscopic exploration, tubal necrosis, and tubal preservation accounted for 79.07%, 41.86%, and 32.56%, respectively. Extremely difficult diagnosis of isolated torsion of a fallopian tube, because of non-specific clinical manifestations, led to the adverse clinical outcome of salpingectomy. However, the accuracy of preoperative diagnosis can be improved by improving acknowledge of ultrasound diagnosis and the awareness of clinical gynecologists. However, the accuracy of preoperative diagnosis can be improved by improving knowledge of ultrasound diagnosis and awareness of clinical gynecologists. The laparoscopic exploration is sole gold standard for diagnosis and treatment. The operation of preserving the fallopian tube may be the first choice, especially in the early stage of isolated torsion of a fallopian tube.
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Affiliation(s)
- Li Zijun
- Department of Gynecology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Zheng Yaqin
- Longquan Regional Medicine Inspection Center, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Pang Weiwen
- Department of Pathology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Lishui, Zhejiang Province, China
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8
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Avallin T, Jangland E, Kitson A, Muntlin Å. Measuring person-centred pain management: Development of a questionnaire using the fundamentals of care framework. J Adv Nurs 2023; 79:3923-3934. [PMID: 37209376 DOI: 10.1111/jan.15697] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/21/2023] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
Abstract
AIM To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management. DESIGN Cross-sectional exploratory descriptive design. METHODS Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital. RESULTS The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement. CONCLUSION This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain. PATIENT OR PUBLIC CONTRIBUTION Patients and providers were involved in testing the questionnaire.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Åsa Muntlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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9
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Tondro Anamag F, Hashemi N, Sanaat Z, Khadivi Heris H, Moslemi M. Arteriovenous thrombosis, a complication of induction therapy with all-trans retinoic acid for acute promyelocytic leukemia: A case report. Clin Case Rep 2023; 11:e7856. [PMID: 37720706 PMCID: PMC10500047 DOI: 10.1002/ccr3.7856] [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] [Received: 01/24/2023] [Revised: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
We report a case of arterial and venous thrombosis during induction therapy. This case emphasizes considering some degree of caution for thrombotic events in APL patients which was represented in our case as abdominal pain. Rapid initiation of anticoagulation and preventive measures is suggested for better management of the condition.
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Affiliation(s)
- Farhad Tondro Anamag
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
| | - Negin Hashemi
- Department of Pharmacology and Toxicology, Faculty of PharmacyTabriz University of medical sciencesTabrizIran
| | - Zohreh Sanaat
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
| | | | - Mohammadreza Moslemi
- Hematology and Oncology Research CenterTabriz University of medical sciencesTabrizIran
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10
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McNellage L, Pacheco ZS, Shufflebarger EF. Massive Hiatal Hernia With Acute Gastric Volvulus Masked as a Suspected Food Poisoning: A Case Report. Cureus 2023; 15:e44943. [PMID: 37818520 PMCID: PMC10561523 DOI: 10.7759/cureus.44943] [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: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
We describe the case of a 69-year-old female who thought she had "food poisoning", which prompted her visit to the Emergency Department for evaluation of her vomiting and abdominal discomfort. Contrasted computed tomography imaging with contrast of the abdomen subsequently revealed the diagnosis of gastric volvulus, and the patient was promptly taken for surgical intervention. Gastric volvulus is rare and presents with a nonspecific history, exam, and laboratory findings. In the acute care setting, it is important to maintain a high clinical suspicion for this diagnosis, as timely imaging and intervention are crucial to decreasing patient morbidity and mortality.
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Affiliation(s)
- Landon McNellage
- College of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Zachary S Pacheco
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Erin F Shufflebarger
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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11
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Boulos P, Kadou J. Spontaneous Renal Artery Thrombosis: An Unusual Cause of Acute Abdominal Pain in the Emergency Department. Cureus 2023; 15:e43707. [PMID: 37724198 PMCID: PMC10505476 DOI: 10.7759/cureus.43707] [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: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Abdominal pain is a frequent complaint in the Emergency Department and thrombosis of the renal artery is an uncommon diagnosis for abdominal pain. Although the diagnosis is rare and can be difficult to make, a delayed diagnosis can lead to grave complications. This is the case of a middle-aged man who presented in the Emergency Department with left iliac fossa pain; the clinical features were not specific, and he was diagnosed with a left renal infarction. With this case, we want to remind emergency practitioners of the diagnosis and show that even late (more than six hours) thrombolysis can improve kidney perfusion and function.
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Affiliation(s)
- Paul Boulos
- Emergency Department, Centre Hospitalier Interrégional Edith Cavell, Brussels, BEL
| | - Joe Kadou
- Emergency Department, Centre Hospitalier Interrégional Edith Cavell, Brussels, BEL
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12
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Alsolami FN, Alfraidi LS, Alharbi IM, Alsayafi SI, Alharbi A. Large Ovarian Cystadenoma in an Adolescent Girl: A Case Report. Cureus 2023; 15:e43108. [PMID: 37692598 PMCID: PMC10483259 DOI: 10.7759/cureus.43108] [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] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Ovarian cystadenomas are rare neoplastic tumors arising from the ovarian surface epithelium. While commonly observed in adult women, their occurrence in adolescents is exceedingly uncommon. The management of large ovarian cystadenomas in this age group poses unique challenges due to acute presentations and potential complications. We present the case of a 16-year-old girl who presented with sudden, severe abdominal pain and distension. Imaging revealed a 15 cm complex cystic mass originating from the right ovary, consistent with a cystadenoma. Urgent surgical intervention led to the right salpingo-oophorectomy, confirming the benign nature of the tumor. This report highlights the importance of a comprehensive approach to diagnosing and managing rare ovarian neoplasms in adolescents. Timely recognition, appropriate imaging, histopathological evaluation, and surgical intervention are crucial for optimal outcomes and reducing potential complications.
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Affiliation(s)
| | | | | | | | - Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
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13
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Yang R, Zhao Y, Ji Q. Primary Necrosis of the Ligamentum Teres Hepatis: A Rare Cause of Acute Abdominal Pain. J Belg Soc Radiol 2023; 107:54. [PMID: 37483990 PMCID: PMC10360970 DOI: 10.5334/jbsr.3232] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Primary necrosis of the ligamentum teres hepatis (PNLTH) is an extremely rare disease which presents with acute abdominal pain. It has easily been misdiagnosed due to lack of clinical manifestations. Early recognition of PNLTH is crucial for treatment while CT is a good methed to diagnose and differential diagnose PNLTH. Teaching Point: Primary necrosis of the ligamentum teres hepatis (PNLTH) is an extremely rare disease characterized with acute abdominal pain, while computed tomography is the recommended technique to diagnose and differential diagnose this disease.
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Affiliation(s)
- Rui Yang
- The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, China
| | - Ying Zhao
- The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, China
| | - Qingyu Ji
- The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, China
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14
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Tempel DG, Balk DS, Schafer JM, Hoffmann B. A brief review of diagnostic properties of point-of-care ultrasound for adult bowel intussusception: Making the case for ultrasound. J Ultrason 2023; 23:e90-e96. [PMID: 37520744 PMCID: PMC10379853 DOI: 10.15557/jou.2023.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/30/2023] [Indexed: 08/01/2023] Open
Abstract
Undifferentiated abdominal pain in adults is a common chief complaint in acute care clinics and emergency departments worldwide, representing up to 10% of visits to emergency departments. Many patients have a non-specific presentation and an initial workup with labwork, urine analysis or X-ray might not reveal a specific diagnosis. Although bowel intussusception is a primarily pediatric disease, adult intussusception is a recognized but rare cause of bowel obstruction often requiring surgical intervention. However, recent data from advanced multi-detector computed tomography imaging shows that milder or recurring cases in adults have been underrecognized. Multi-detector computed tomography is still the imaging gold standard for detecting intussusception in adults, but new data showed that sonographers with basic training using the point-of-care ultrasound approach have a reasonable accuracy in detecting this pathology. As the point-of-care ultrasound for undifferentiated abdominal pain is an emerging core skill in the acute care setting, knowledge of sonographic signs of intestinal intussusception should be included in the skill set of physicians. Sonographic findings in adults mimic pediatric cases, but different location patterns and higher malignancy rates exist in adults. In this manuscript, we will review the current literature on adult intussusception and summarize key knowledge of intestinal intussusception in adults. We will present four adult patients diagnosed with different types of adult acute bowel intussusception using the point-of-care ultrasound and describe a focused scanning approach with typical sonographic findings.
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Affiliation(s)
- David G. Tempel
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Daniel S. Balk
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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15
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Zhang AY, Griffin GM, Karrington BA, Tamura GS. Case Report: A Child With Omental Infarction. J Emerg Med 2023; 64:638-640. [PMID: 37032205 DOI: 10.1016/j.jemermed.2023.02.008] [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: 08/29/2022] [Revised: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Omental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis. CASE REPORT Here, we present a case of OI in a child with acute severe right upper quadrant pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Correct diagnosis of OI via imaging can prevent unnecessary surgery.
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Affiliation(s)
- Angela Y Zhang
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Georgia M Griffin
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Baer A Karrington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Glen S Tamura
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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16
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Habbash ZE. Herlyn-Werner-Wunderlich Syndrome: A Rare Case Report. Cureus 2023; 15:e35003. [PMID: 36938199 PMCID: PMC10022840 DOI: 10.7759/cureus.35003] [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] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Müllerian anomalies are a complex spectrum of congenital defects of the female reproductive tract caused by an interruption in the normal development of Müllerian ducts and their associated structures. The clinical presentation of these anomalies varies and includes acute presentations. In this report, a case of a 16-year-old girl who attended the emergency department with severe colicky abdominal pain and nausea has been presented. The patient was on the fifth day of the menstrual cycle, and her pain was not completely relieved by the administration of non-steroidal anti-inflammatory drugs. The patient had menarche at the age of 14 years and used to have a regular menstrual cycle every 30 days. Her menstrual flow was average with a cycle duration of five days. An abdominal ultrasound examination was performed to rule out ovarian torsion, which demonstrated normal appearance and ovary size, and a large heterogeneous collection in the rectouterine pouch with unclear uterine morphology. Subsequently, magnetic resonance imaging revealed a duplication of the uterus, cervix, and vagina. The right hemivagina and right endometrial cavity were distended, consistent with hematometrocolpos. Right renal agenesis with compensatory hypertrophy of the left kidney was observed. The constellation of uterus didelphys obstructed hemivagina, and ipsilateral renal agenesis represented the diagnosis of Herlyn-Werner-Wunderlich syndrome. Herlyn-Werner-Wunderlich syndrome is a rare and complex type of congenital uterine abnormality. Although rare, this syndrome should be considered in the differential diagnosis of severe dysmenorrhea in adolescent girls with renal anomalies. In this case, the patient underwent vaginoplasty with resection of the vaginal septum to relieve the obstruction. At follow-up visits, she did not have a recurrence of symptoms.
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17
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Muacevic A, Adler JR, Al Doaibel KA, Nesaif FM, Alharbi AS. Wandering Spleen: A Rare Case From the Emergency Department. Cureus 2023; 15:e33246. [PMID: 36741617 PMCID: PMC9890613 DOI: 10.7759/cureus.33246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal ligament, and the phrenicocolic ligament. Abnormalities within these ligaments result in the mobility of the spleen, so it may be located in the pelvis or iliac region, which is termed a wandering spleen. We present a case of a middle-aged man who presented to the emergency department with generalized abdominal pain and diffuse guarding and tenderness. The patient had a previous history of peptic ulcer disease and multiple emergency department visits for gastritis. Given the assumed diagnosis of perforated viscus, the patient underwent a computed tomography scan that demonstrated the absence of the spleen in its usual location and showed an ectopic pelvic spleen. The patient underwent successful surgical treatment with splenopexy. The wandering spleen is a rare medical condition that presents a clinical diagnostic challenge and requires a high index of suspicion. Despite its rarity, the wandering spleen should be considered in patients with recurrent abdominal pain.
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18
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Aiob A, Lowenstein L, Borik I, Naskovica K, Mikhail SM, Odeh M. The value of clinical symptoms, the neutrophil-to-lymphocyte ratio, and ultrasonographic features in predicting adnexal torsion: A case-control study. J Obstet Gynaecol Res 2023; 49:289-295. [PMID: 36268674 DOI: 10.1111/jog.15474] [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: 06/23/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 01/19/2023]
Abstract
AIM Adnexal torsion remains a diagnostic challenge due to the nonspecific symptoms, sonographic features, and laboratory findings. The value of combining clinical, sonographic, and laboratory features is not well established, and controversy continues regarding their value in diagnosis. This study aimed to review sonographic, clinical, and laboratory features and to analyze their value separately and in combination, in managing and diagnosing adnexal torsions. METHODS The study included 278 women who underwent urgent laparoscopic surgery due to suspected adnexal torsion, according to clinical suspicion, with or without sonographic concordance. Laparoscopy findings confirmed the definitive diagnosis of torsion. Clinical laboratory and sonographic features were compared between those with and without adnexal torsion. RESULTS Adnexal torsion was confirmed in 110/278 (39.6%) women. In the torsion compared to nontorsion group, proportions were higher of women with acute abdominal pain in the preceding 24 h ([50] 45.5% vs. [35] 20.8%, p < 0.001), with vomiting ([45] 40.9% vs. [24] 14.3%, p < 0.001) and with suspected torsion by transvaginal sonography ([49] 44.5% vs. [23] 13.7%, p < 0.001). A high neutrophil-to-lymphocyte ratio (>3) was identified in 65 (59.1%) of the study group and 60 (35.7%) of the control group (p < 0.001). Combining the latter three findings, the predicted probability of torsion was 58%-85%, depending on the combinations. CONCLUSIONS A simple predictive model based on combinations of clinical, laboratory, and sonographic findings can contribute to preoperative diagnosis of adnexal torsion, with predicted probability of 85%. Our model may assist clinicians in evaluating women with suspected adnexal torsion, and improve preoperative diagnostic accuracy.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inna Borik
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Karina Naskovica
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Susana Mustafa Mikhail
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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19
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Minten L, Messiaen P, Van der Hilst J. Acute abdominal pain: a challenging diagnosis. Acta Gastroenterol Belg 2022; 85:646-7. [PMID: 35770291 DOI: 10.51821/85.4.9860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT showed a dissection of the coeliac trunk and infarction of the spleen. Because of a presumed diagnosis of vasculitis he was started on high dose IV steroids. However, after additional testing the diagnosis of segmental arteriolar Mediolysis (SAM) was made. In this case report we describe the presentation, diagnosis, treatment and follow-up of this patient and provide the readers with background about common differential diagnosis and criteria for diagnosing SAM.
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20
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Faikhongngoen S, Chenthanakij B, Wittayachamnankul B, Phinyo P, Wongtanasarasin W. Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department. Diagnostics (Basel) 2022; 12. [PMID: 36140646 DOI: 10.3390/diagnostics12092246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/07/2022] Open
Abstract
We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67−0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9−12 with a positive likelihood ratio of 3.79 (95% CI, 1.68−8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated.
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21
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Torun BC, Gök AFK, İlhan M, Yegen G, Başaran S, Ertekin C, Günay MK, Yanar H. A rare cause of acute abdominal pain: Actinomyces infection of colon mimicking a malignant neoplasm due to intrauterine device. ULUS TRAVMA ACIL CER 2022; 28:537-540. [PMID: 35485507 PMCID: PMC10520999 DOI: 10.14744/tjtes.2020.45672] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/12/2020] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a rare, chronic granulomatous disease that is challenging to diagnose because the clinical symptoms and signs are nonspecific. Usage of intrauterine device (IUD) or being immunocompromised is facilitating factors. Clinical and radiological findings can mimic malignant neoplasm, inflammatory bowel disorder, or acute diverticulitis. We report a case of actinomyces infection of the colon secondary to IUD, which is a rare cause of acute abdominal pain and can mimic a malignant neoplasm. We also provide a review of the literature. Unnecessary surgery can be avoided with the correct diagnosis of granulomatous infectious diseases that can be treated with antibiotics.
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Affiliation(s)
- Bahar Canbay Torun
- Department of General Surgery, Sultangazi Haseki Training and Research Hospital, İstanbul-Turkey
| | - Ali Fuat Kaan Gök
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mehmet İlhan
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Gülçin Yegen
- Department of Pathology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Seniha Başaran
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Cemalettin Ertekin
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Mustafa Kayıhan Günay
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
| | - Hakan Yanar
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey
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22
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Albaqami AM, Al-Salam HA, Alhagbani MA, Fallatah RA, Aljarboa AM, Alghassab MA, Alghamdi SS, Kadhem KA, Alsaileek YT, Albarakati HA, Gadah ZI, Babhair AS, Alshammari MY, Abuidrees MA, Al-Hawaj FM. Laparoscopic Port Site Hernia: A Rare Etiology of Intestinal Obstruction. Cureus 2021; 13:e19681. [PMID: 34976469 PMCID: PMC8681890 DOI: 10.7759/cureus.19681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Small intestinal obstruction is a common indication for hospitalization and emergency surgeries. The most frequent etiologies are adhesions, hernia, and benign or malignant neoplasms. Abdominal imaging plays an important role in making the diagnosis and evaluating the complications of the obstruction. We report a case of a young woman who presented with sudden abdominal pain and vomiting. She had a relevant past medical history of sickle cell disease and multiple episodes of biliary colic for which she underwent laparoscopic cholecystectomy two months before her current presentation. Laboratory findings indicated mild inflammation in the form of elevated C-reactive protein and erythrocyte sedimentation rate with the leukocytes count in the upper normal limits. Abdominal computed tomography demonstrated a knuckle of small bowel incarcerated in the port location of the previous laparoscopy. The bowel was reduced and the defect was repaired. The patient had complete resolution of her symptoms following the surgery. The case highlighted the importance of considering port-site hernia as an etiology of bowel obstruction in the relevant clinical settings since laparoscopic operations are being increasingly performed.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yahya T Alsaileek
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Ziyad I Gadah
- College of Medicine, Umm Al-Qura University, Mecca, SAU
| | | | | | | | - Faisal M Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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23
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Alnashri YA, Alhuzali AM, Edrees EA, Almuraykhi RA, Majrashi RA, Alhomidan RA, Alharbi SB, Alassaf FA, Alsuhaibani AN, Sufyani RS, Alkhars AS, Mallawi MM, Alkhotani RY, Qattan MM, Alshammari M. Cecal Lipoma: A Rare Etiology of Acute Appendicitis in Adults. Cureus 2021; 13:e19423. [PMID: 34926016 PMCID: PMC8654060 DOI: 10.7759/cureus.19423] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Acute appendicitis is the most common indication for abdominal surgeries worldwide. Obstruction of the appendiceal orifice is thought to be the primary pathology of appendicitis. The obstruction leads to an increase in the intraluminal pressure resulting in ischemia and inflammatory process. Several pathologies could cause obstruction of the appendix lumen. These pathologies include hard fecal masses, stones, lymphoid hyperplasia, and neoplasia. We present the case of a 42-year-old man who presented to the emergency department with a complaint of abdominal pain and diarrhea for 3 days. The abdominal pain started in the periumbilical region and was shifted to the right lower quadrant of the abdomen. The pain started gradually and had been progressing in severity. He described the pain as a stabbing in nature. Abdominal examination revealed a soft abdomen with diffuse tenderness. However, the tenderness was more pronounced in the right iliac fossa with a positive rebound sign. Further, the Rovsing sign was positive. Initial laboratory investigation revealed elevated leukocyte count and elevated inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein. The CT scan demonstrated well-defined homogenous fat density endoluminal lesion in the cecum with an average size of 6 cm with associated thickened wall appendix. The patient was prepared for an emergency laparoscopy for limited segmental rection of the cecum with appendectomy. Lipoma is a rare benign tumor of the gastrointestinal tract. Clinicians should maintain a high index of suspicion for benign and malignant neoplasms when they encounter patients with suspected acute appendicitis in the adult population.
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Affiliation(s)
| | | | | | - Razan A Almuraykhi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | | | | | | | - Rami S Sufyani
- Medicine, King Salman Abdul Aziz Medical City, Madinah, SAU
| | - Ahmed S Alkhars
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Maisa M Mallawi
- College of Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
| | - Rawan Y Alkhotani
- College of Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
| | - Mustafa M Qattan
- College of Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
| | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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24
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Almuqamam M, Ebrahim M, Nassar G, Kaplan M. Atypical Posterior Nutcracker Syndrome in a 17-Year-Old Male Without Hematuria. Cureus 2021; 13:e17221. [PMID: 34540448 PMCID: PMC8442634 DOI: 10.7759/cureus.17221] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
Retro-aortic left renal vein (RLRV) is an anatomical variation, where the left renal vein (LRV) courses posterior to the aorta and anterior to the vertebrae before it eventually drains into the inferior vena cava (IVC). RLRV is a rare finding, with a prevalence of around 1%-2%, and only a small minority of RLRVs cause symptoms. RLRV symptoms occur secondary to compression of the LRV between the abdominal aorta and vertebrae, otherwise known as posterior nutcracker syndrome (PNCS). The most common symptoms of PNCS are hematuria and flank pain. We present a 17-year-old male, who came in with recurring left flank pain without hematuria, initially thought to be renal colic secondary to nephrolithiasis. On further investigations, an aberrant posterior renal vein was seen on CT suggestive of PNCS. The patient was treated successfully with RLRV vascular stent placement by interventional radiology. This case report adds to the limited number of PNCS cases observed in children and to the even rarer cases of PNCS without hematuria. This case also acts as a reminder for pediatricians to keep a wide scope of differentials in patients presenting with flank pain and provides an outline of both diagnostic and treatment modalities available for these patients.
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Affiliation(s)
| | | | - George Nassar
- Pediatrics, The Brooklyn Hospital Center, New York, USA
| | - Matthew Kaplan
- Pediatric Nephrology, The Brooklyn Hospital Center, New York, USA
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25
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Thapa S, Gautam K, Chand S, Khadka A, Neupane R. Successful Conservative Management of Uncomplicated Gallbladder Ascariasis. Cureus 2021; 13:e17160. [PMID: 34532187 PMCID: PMC8435240 DOI: 10.7759/cureus.17160] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
Ascariasis is one of the common diseases in human beings worldwide. Most cases are asymptomatic. However, the high parasitic load can present with organ-specific symptoms due to the migration of worms to various regions of the body such as the lungs, nasal cavity, oral cavity, and biliary system, and sometimes with surgical emergencies like intestinal and biliary tree obstruction. Treatment modalities depend on the presentation and the complication associated with it. Uncomplicated cases can be initially managed conservatively and followed up subsequently. However, most cases of biliary ascariasis may require surgical intervention or endoscopic management due to failed management or complications. We report a case of a young male with gallbladder ascariasis diagnosed with ultrasonography and successfully treated with a single dose of albendazole 400 mg. Follow-up ultrasonography was done to evaluate the management.
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Affiliation(s)
- Sangharsha Thapa
- Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, NPL
| | - Kushal Gautam
- Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Swati Chand
- Internal Medicine, Rochester Regional Health, Rochester, USA
| | - Akanchha Khadka
- Dermatology, MedStar Washington Hospital Center, Washington, USA
| | - Rasik Neupane
- Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, NPL
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26
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Owedah RJ, Alshehri OA, Alfneekh NI, Alasmari AH, Hafiz DW, Alburayh YA, Alabdullah MA, Altarteer AA, Alharbi MF, Almutairi MF, Aljohani SS, Boudal IS, Alshammari MA. Acute Omental Infarction Mimicking Acute Appendicitis. Cureus 2021; 13:e18053. [PMID: 34671532 PMCID: PMC8520696 DOI: 10.7759/cureus.18053] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
Acute abdominal pain is a common cause of visits to the emergency department. Acute appendicitis remains the most common indication for abdominal surgical intervention in the pediatric age group. However, several conditions may present with a clinical picture similar to that of acute appendicitis. We report the case of a 7-year-old girl with a history of right lower quadrant abdominal pain of two days in duration. The pain was associated with vomiting and was exacerbated by movement. Abdominal examination revealed a localized tenderness in the right iliac fossa with guarding, giving the impression of acute appendicitis. After a thorough investigation, the patient was diagnosed as having acute omental infarction given the radiological findings seen in the computed tomography scan. The patient was successfully managed conservatively with analgesics and anti-inflammatory drugs. Physicians should keep a high index of suspicion for this condition when encountering a patient presenting with an acute right lower quadrant abdominal pain. Imaging modalities play a pivotal role in making the diagnosis.
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Affiliation(s)
| | | | | | | | - Dina W Hafiz
- Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | | | - Maram F Almutairi
- Family Medicine, Ministry of National Guard - Health Affairs, Riyadh, SAU
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27
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Li J, Hu FY, Zhong G. Clinical therapeutic effects of opioid analgesia for acute abdominal pain in children and young adults: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26402. [PMID: 34397791 PMCID: PMC8341341 DOI: 10.1097/md.0000000000026402] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nearly 10% of all patients who visit the emergency department report severe abdominal pain. Out of these, almost one-third are not diagnosed accurately. The conventional practice to care for such inpatients involves actively managed observation and repetitive clinical assessments at regular intervals. The aim of this study is to assess the clinical therapeutic effects of opioid analgesia in the treatment of severe abdominal pain in kids and adolescents. METHODS A comprehensive electronic search will be done on Web of Science, EMBASE, PubMed, WanFang database, Chinese National Knowledge Infrastructure, and the Cochrane Library from their establishment to May 2021. The search will identify and retrieve all randomized controlled trials that describe the clinical therapeutic effects of opioid analgesia to treat severe abdominal pain in adolescents and children. Two independent authors will shortlist studies that meet the inclusion criteria, extract data from selected studies, and evaluate the risk associated with bias in the selected articles. We will use RevMan (v: 5.3) to conduct all the data synthesis. RESULTS This meta-analysis will conduct a high-quality synthesis on present evidence related to the usage of opioid analgesia to treat severe abdominal pain in both kids and adolescents. CONCLUSION Our findings will summarize the present evidence and help judge whether opioid analgesia is an effective and safe line of treatment for severe abdominal pain. ETHICS AND DISSEMINATION This study will use pre-published data, and as such, it does not require ethics approval. OSF REGISTRATION NUMBER May 29, 2021.osf.io/fp9ym (https://osf.io/fp9ym/).
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Affiliation(s)
- Jie Li
- Department of Emergency Surgery, Tianyou Hospital Affiliated to Wuhan University of Science & Technology
| | - Fei-Yan Hu
- Department of Geratology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Guo Zhong
- Department of Emergency Surgery, Tianyou Hospital Affiliated to Wuhan University of Science & Technology
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28
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Tudosie MS, Caragea G, Popescu DM, Avram O, Serban D, Smarandache CG, Tudor C, Badiu CD, Socea B, Sabau AD, Comandasu M, Spataru R, Costea DO, Tanasescu C, Dascalu AM. Optimization of a GF-AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency. Exp Ther Med 2021; 22:985. [PMID: 34345267 DOI: 10.3892/etm.2021.10417] [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: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
Suspicion of lead poisoning is confirmed by its concentration in blood and protoporphyrin red blood cells. At low concentrations, lead influences the synthesis of the heme in the sense of lowering it. Acute and chronic lead intoxication is extremely polymorphic in regards to its clinical manifestations, with digestive, hematological, cardiovascular, renal hepatic and neurological features. The aim of the study was to evaluate the presence of lead in human whole blood and urine harvested before and during chelation treatment in the case of lead poisoning. An atomic absorption spectroscopic method for the analysis of lead was developed using graphite furnace atomic absorption spectrophotometer (GF-AAS), Varian Spectra AA-880 with a hollow cathode lead lamp and a deuterium lamp for background correction, coupled to a GTA-100 atomizer and a programmable sample dispenser. Standard calibration solutions were used for the range 10-100 µg/l. The linearity range was 10.0 to 100.0 µg/l with the correlation coefficient of 0.999. We established that the method can be applied for the determination of lead in whole blood and urine, and the results obtained are useful for monitoring chelation therapy in cases of acute lead poisoning, a neglected cause of abdominal colic pain in an emergency situation.
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Affiliation(s)
- Mihail Silviu Tudosie
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,ICU II Toxicology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Genica Caragea
- Military Medical Research Center, 010919 Bucharest, Romania
| | - Dragos Marian Popescu
- Faculty of Medicine, The University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Oana Avram
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,ICU II Toxicology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Catalin Gabriel Smarandache
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Corneliu Tudor
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Cristinel Dumitru Badiu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,General Surgery, Emergency Clinical Hospital 'Prof. Dr. Bagdasar Arseni', 041915 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Alexandru Dan Sabau
- Third Department, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550169 Sibiu, Romania
| | - Meda Comandasu
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Radu Spataru
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Department of Pediatric Surgery, Emergency Clinic Hospital for Children 'Marie S. Curie', 077120 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University, 900470 Constanta, Romania.,First Surgery Department, Emergency County Hospital, 900591 Constanta, Romania
| | - Ciprian Tanasescu
- Third Department, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550169 Sibiu, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
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Eskelinen M, Meklin J, Syrjänen K, Eskelinen M. A Diagnostic Score (DS) Is a Powerful Tool in Diagnosis of Acute Appendicitis in Elderly Patients With Acute Abdominal Pain. Anticancer Res 2021; 41:1459-1469. [PMID: 33788738 DOI: 10.21873/anticanres.14904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/06/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. PATIENTS AND METHODS A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). RESULTS In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. CONCLUSION Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.
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Affiliation(s)
- Maaret Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jannica Meklin
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari Syrjänen
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,SMW Consultants, Ltd., Kaarina, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland;
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30
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Javidi A, Niazkar HR, Jalili J, Haji Vosugh N. Primary omental torsion in a pediatric patient. Clin Case Rep 2021; 9:1808-1809. [PMID: 33768949 PMCID: PMC7981644 DOI: 10.1002/ccr3.3842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022] Open
Abstract
Omental infarction although infrequent should be considered as a possible cause of acute abdomen precisely in those with negative appendectomy.
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Affiliation(s)
- Ali Javidi
- Department of MedicineFaculty of General SurgeryGonabad University of Medical SciencesGonabadIran
| | - Hamid Reza Niazkar
- Student Research CommitteeGonabad University of Medical SciencesGonabadIran
| | - Jelveh Jalili
- Department of MedicineFaculty of Obstetrics and GynecologyGonabad University of Medical SciencesGonabadIran
| | - Negin Haji Vosugh
- Department of PediatricsSabzevar University of Medical SciencesSabzevarIran
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31
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Pan HM, Li HL, Shen ZS, Guo H, Zhao Q, Li JG. Observation of the Effectiveness of a Diagnostic Model for Acute Abdominal Pain Based on the Etiology Checklist and Process Thinking. Risk Manag Healthc Policy 2021; 14:835-845. [PMID: 33664605 PMCID: PMC7924112 DOI: 10.2147/rmhp.s295142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aimed to explore the effectiveness of the etiology checklist and process thinking in the differential diagnosis for acute abdominal pain. Methods A retrospective design was used to include 5,403 patients with acute abdominal pain in the Emergency Department of Hebei Provincial People's Hospital. The patients with acute abdominal pain between July and December 2017 in whom the etiology checklist and process thinking were not implemented were selected as the traditional group. Those with acute abdominal pain between July and December 2018 in whom the etiology checklist and process thinking were implemented were selected as the process thinking group. The clinical data, such as the emergency length of stay, hospitalization expenses, hospitalization length of stay, diagnostic accuracy, and outcome, were compared between the two groups. Results For patients at emergency level 2 and above, the average emergency length of stay was shorter in the process thinking group than in the traditional group, while the average emergency length of stay was longer for patients at emergency level 3. For hospitalized patients at emergency level 2 and above and patients at emergency level 3, those in the process thinking group had improved diagnostic accuracy, shorter average hospitalization length of stay, reduced average hospital expenses, and improved outcomes. In the comparison among six physicians, the results in the traditional group were inconsistent and statistically different in terms of the average emergency length of stay and diagnostic accuracy, while the results in the process thinking group tended to be consistent. The differences were not statistically different. Conclusion The diagnostic model for acute abdominal pain based on the etiology checklist and process thinking could improve the diagnostic accuracy and outcomes for patients with acute abdominal pain.
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Affiliation(s)
- Hong-Ming Pan
- Graduate School of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hong-Ling Li
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Zhang-Shun Shen
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Hui Guo
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Qian Zhao
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Jian-Guo Li
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
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32
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Bianchi F, Leganés Villanueva C, Brun Lozano N, Goruppi I, Boronat Guerrero S. Epiploic Appendagitis and Omental Infarction as Rare Causes of Acute Abdominal Pain in Children. Pediatr Rep 2021; 13:76-85. [PMID: 33562670 PMCID: PMC7931071 DOI: 10.3390/pediatric13010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Omental infarction and epiploic appendagitis are rare causes of acute abdominal pain in the pediatric population. Radiological evaluation is necessary to establish a specific diagnosis and to differentiate appendicitis from these conditions as they can be often managed conservatively without surgical intervention.
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Affiliation(s)
- Federica Bianchi
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Carlos Leganés Villanueva
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Núria Brun Lozano
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Ilaria Goruppi
- Pediatric Surgery Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (C.L.V.); (N.B.L.); (I.G.)
| | - Susana Boronat Guerrero
- Pediatric Unit, Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
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33
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Eskelinen M, Meklin J, SyrjÄnen K, Eskelinen M. Pediatric Acute Appendicitis Score in Children With Acute Abdominal Pain (AAP). Anticancer Res 2021; 41:297-306. [PMID: 33419824 DOI: 10.21873/anticanres.14776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
AIM The aim of the study was to compare the accuracy of common clinical findings, laboratory tests and diagnostic score (DS) in diagnosis of clinically confirmed acute appendicitis (AA) in children. PATIENTS AND METHODS A cohort of 188 children under the age of 15 years presenting with acute abdominal pain (AAP) were included in the study. The clinical history (n=21), signs (n=14) and tests (n=3) were recorded in each child. RESULTS The significant independent diagnostic predictors (disclosed by multivariate logistic regression model) were used to construct the DS formulas for AA diagnosis. These formulas were tested at six different cut-off levels to establish the most optimal diagnostic performance for clinically confirmed AA. In the receiver operating characteristic curve (ROC) comparison test, there was a statistically significant difference (p=0.0055) in the area under curve (AUC) values between i) clinical history and symptoms (AUC=0.594), and ii) signs and laboratory tests (AUC=0.734), whereas both were significantly inferior (p=0.0001) to the AUC value of the DS (AUC=0.952). CONCLUSION In diagnosis of clinically confirmed AA in children, the DS formula is superior to both the clinical history/symptoms and signs/lab tests, justifying the use of DS as an integral part of the diagnostic algorithm of AA in all children presenting with AAP.
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Affiliation(s)
- Maaret Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jannica Meklin
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari SyrjÄnen
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,SMW Consultants, Ltd., Kaarina, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland;
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34
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Zaboli A, Ausserhofer D, Pfeifer N, Magnarelli G, Ciccariello L, Siller M, Turcato G. Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system's validity. J Clin Nurs 2021; 30:942-951. [PMID: 33434346 DOI: 10.1111/jocn.15635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/09/2020] [Revised: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Roughly 5% to 10% of patients admitted to the emergency department suffer from acute abdominal pain. Triage plays a key role in patient stratification, identifying patients who need prompt treatment versus those who can safely wait. In this regard, the aim of this study was to estimate the performance of the Manchester Triage System in classifying patients with acute abdominal pain. METHODS A total of 9,851 patients admitted at the Emergency Department of the Merano Hospital with acute abdominal pain were retrospectively enrolled between 1 January 2017 and 30 June 2019. The study was conducted and reported according to the STROBE statement. The sensitivity and specificity of the Manchester Triage System were estimated by verifying the triage classification received by the patients and their survival at seven days or the need for acute surgery within 72 h after emergency department access. RESULTS Among the patients with acute abdominal pain (median age 50 years), 0.4% died within seven days and 8.9% required surgery within 72 hours. The sensitivity was 44.7% (29.9-61.5), specificity was 95.4% (94.9-95.8), and negative predictive value was 99.7% (99.2-100) in relation to death at seven days. CONCLUSIONS The Manchester Triage System shows good specificity and negative predictive value. However, its sensitivity was low due to the amount of incorrect triage prediction in patients with high-priority codes (red/orange), suggesting overtriage in relation to seven-day mortality. This may be a protective measure for the patient. In contrast, the need for acute surgery within 72 h was affected by under-triage. RELEVANCE TO CLINICAL PRACTICE The triage nurse using Manchester Triage System can correctly prioritise the majority of patients with acute abdominal pain, especially in low acuity patients. The Manchester Triage System is safe and does not underestimate the severity of the patients.
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Affiliation(s)
- Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Dietmar Ausserhofer
- College of Health Care Professions Claudiana, Bolzano-Bozen, Italy.,Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | - Laura Ciccariello
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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35
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Akubudike JTE, Egigba OF, Kobalava B. Epiploic Appendagitis: A Commonly Overlooked Differential of Acute Abdominal Pain. Cureus 2021; 13:e12807. [PMID: 33628675 PMCID: PMC7894223 DOI: 10.7759/cureus.12807] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Epiploic appendagitis is an unusual and very commonly overlooked source of acute abdominal pain. Its incidence is highest in middle-aged obese males. It presents clinically as a focal lower quadrant abdominal pain, usually in the absence of pyrexia, nausea, vomiting or change in bowel habit, and unremarkable laboratory markers. Due to its vague presentation, epiploic appendagitis may be mistaken for other more severe causes of acute abdominal pain like diverticulitis and appendicitis, thereby causing patients to undergo unwarranted management interventions and hospital stay. Epiploic appendagitis is usually diagnosed through imaging, most commonly computed tomography (CT). This condition is largely self-resolving and can be managed conservatively with nonsteroidal anti-inflammatory drugs (NSAIDs). Operative intervention is usually employed when symptoms persist or when complications arise. We present a case of epiploic appendagitis in a patient who presented with right lower quadrant pain initially misdiagnosed as acute appendicitis.
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Abstract
Introduction Acute pancreatitis (AP) causes a cascade of complex inflammatory responses following an initial insult. Hence, the scoring systems include white blood cell count (WBC) as a marker of severity of acute pancreatitis. C-reactive protein (CRP) was also shown to be useful in predicting the course of pancreatitis. This study analyses role of inflammatory markers in predicting gallstone aetiology of AP and length of hospital stay (LOS). Materials and methods A total of 143 patients with acute pancreatitis between October 2016 and 2017 were included in this study and relevant parameters were collected from the electronic patient database. The parameters were WBC, CRP, and LOS. Results Among 143 patients with AP, 50 patients had gallstone pancreatitis (GP) and remaining of 93 patients suffered nongallstone pancreatitis (NGP). The WBC count at admission, 24 hours and 72 hours in GP versus NGP were 11.6± 5 versus 13.7±17; P = 0.24; 12.6±20 versus 10.1±17; P = 0.21; and 13.2±22 versus 9.2±4.7; P = 0.15, respectively. Similarly, the serum CRP levels at admission, 24 hours and 72 hours were 30.4± 73 versus 47.6±79; P = 0.25; 71.9±20 versus 92.2±97; P = 0.35; and 89±106 versus 122.7±107; P = 0.05, respectively. More number of patients with elevated WBC in GP arm compared to NGP (12/50±7/93; P = 0.0008) was noted. In GP arm, patients with elevated CRP at admission (10.5±8.67 versus 5.4±5.8 days; P = 0.02) and 24 hours (9.8±8.3 versus 4.2±4.7 days; P = 0.001) had long LOS. However, patients with elevated CRP at 72 hours (89±106 versus 122.7±107; P = 0.05) had longer LOS in NGP. Conclusion Significantly high CRP level at 72 hours was associated with NGP and longer length of hospital stay. In GP, patients with elevated CRP level at admission and 24 hours predicts long LOS.
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Affiliation(s)
- Umasankar Mathuram Thiyagarajan
- Department of Hepatobiliary and Pancreatic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | | | - Rhys Thomas
- Department of General Surgery, Croydon University Hospital, Thornton Heath, GBR
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37
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Taskovska M, Hawlina S. Intra-Abdominal Testicular Torsion as a Cause of Acute Abdominal Pain in Patient with Silver-Russell Syndrome: First Case of Robot-Assisted Laparoscopic Surgical Exploration with Orchidectomy. J Endourol Case Rep 2020; 6:332-335. [PMID: 33457667 DOI: 10.1089/cren.2020.0065] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction and Background: Silver-Russell syndrome is a rare genetic disorder, occurring in ∼1/50,000 to 1/100,000 births. Anomalies of the urogenital tract such as hypospadias and cryptorchidism can be present. Testicular torsion is a urologic emergency that is most common in prepubertal boys. In patients with cryptorchidism, it can present with abdominal pain and nonspecific symptoms and can mimic other intra-abdominal emergency conditions. Case presentation: A 21-year-old man presented in emergency room at our hospital with acute right lower abdominal pain. Abdominal ultrasonography excluded acute appendicitis, atypical mass on the right side of the bladder was identified. Later, he reported history of inguinal exploration caused by undescended right testis in infancy where testis was not found, and Silver-Russell syndrome. Contrast-enhanced abdominal CT scan revealed an atypical mass on the right side of the bladder, suspicious for torsion of undescended testis, or tumor. Tumor markers for testicular cancer were negative. The patient underwent robot-assisted laparoscopic orchidectomy for torsion of undescended intra-abdominal testis. Histopathologic examination excluded malignancy. Conclusion: Testicular torsion should be considered as the cause of acute abdominal pain in patients with undescended testis and rare genetic disorders. Robot-assisted laparoscopic surgical exploration has the advantage of better exposure and visibility and should be considered in such cases.
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Affiliation(s)
- Milena Taskovska
- Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Division of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simon Hawlina
- Department of Urology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Division of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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38
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Eskelinen M, Meklin J, SyrjÄnen K, Eskelinen M. Performance of a Diagnostic Score in Confirming Acute Cholecystitis Among Patients With Acute Abdominal Pain. Anticancer Res 2020; 40:6947-6956. [PMID: 33288589 DOI: 10.21873/anticanres.14719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/25/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Although acute cholecystitis (AC) is quite a frequent clinical cause of acute abdominal pain (AAP), the accuracy of a diagnostic score (DS) in confirming AC is rarely considered. The aim of the study was to conduct a detailed analysis comparing the accuracy of common clinical findings, laboratory tests and DS in AC diagnosis. PATIENTS AND METHODS A cohort of 1,333 patients presenting with AAP were included in the study. The clinical history and diagnostic symptoms (n= 21), signs (n=14) and laboratory tests (n=3) were recorded in each patient. RESULTS The significant independent diagnostic predictors (disclosed by multivariate logistic regression model) were used to construct the DS formulas for AC diagnosis. These formulas were tested at five different cut-off levels to establish the most optimal diagnostic performance for clinically confirmed AC. In the ROC comparison test, there was no statistically significant difference in the AUC values of i) clinical history and symptoms (AUC=0.542), and ii) signs & laboratory tests (AUC=0.580), whereas both were significantly inferior (p=0.0001) to the AUC value of the DS (AUC=0.962). CONCLUSION In the diagnosis of clinically confirmed AC, the DS formula is superior to clinical symptoms and signs, justifying the use of DS as an integral part of the diagnostic algorithm of AC in all patients presenting with AAP.
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Affiliation(s)
- Maaret Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jannica Meklin
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari SyrjÄnen
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,SMW Consultants, Ltd., Kaarina, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
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39
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Meklin J, Eskelinen M, SyrjÄnen K, Eskelinen M. Gender-specific Performance of a Diagnostic Score in Acute Appendicitis. In Vivo 2020; 34:3687-3703. [PMID: 33144486 DOI: 10.21873/invivo.12217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/15/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Although a negative appendectomy in female patients with acute abdominal pain (AAP) can be twice as frequent as in male patients, the accuracy of diagnostic scores (DSs) in acute appendicitis (AA) is rarely considered among patients with AAP. The aim was to study the gender-specific performance of a DS in AA. PATIENTS AND METHODS As an extension of the World Organisation of Gastro-Enterology Research Committee (OMGE) AAP study, 1,333 patients presenting with AAP were inclu ded in the study. The clinical history and diagnostic symptoms (n=22), signs (n=14) and laboratory tests (n=3) were recorded in each patient. RESULTS The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis, separately for both genders. The formulas were tested at 6 different cut-off levels to find the best diagnostic performance for AA in females and males. The highest specificities of the DSLC- [DS without leucocyte count (LC)] and DSLC+ (DS with LC) scores in detecting AA were 98% (95% CI=97-99%) and 98% (95% CI=96-99%), respectively. In the ROC comparison test, there was no statistically significant difference in the performance of DSLC- and DSLC+ in female and male patients. CONCLUSION Our gender-specific DS reached very high AUC values for AA (0.948-0.956) in both genders, and there was no statistically significant difference in the AUC values of DSLC- and DSLC+ between women and men with AAP.
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Affiliation(s)
- Jannica Meklin
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maaret Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Kari SyrjÄnen
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,SMW Consultants, Ltd., Kaarina, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland
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40
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Uddin AF, Menon G, Menon A, Saad Abdalla Al-Zawi A, Menon J. Epiploic Appendagitis Masquerading as Acute Appendicitis: A Report of Two Cases. Cureus 2020; 12:e10689. [PMID: 33133854 PMCID: PMC7593212 DOI: 10.7759/cureus.10689] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epiploic appendagitis (EA) is a rare clinical entity caused by an inflammatory/ischemic process involving the serosal outpouchings of the colon. Its clinical presentation of acute, localised, lower abdominal pain often mimics more common conditions like diverticulitis or appendicitis. The diagnosis of EA is challenging due to the lack of pathognomic clinical features. The definitive diagnosis primarily relies on cross-sectional imaging modalities like abdominal ultrasound or computed tomography (CT). Being a benign and self-limiting condition, it can be managed conservatively with analgesic and anti-inflammatory drugs. We present two cases to highlight EA as an important differential diagnosis for cases of acute lower abdominal pain, crucial to prevent unnecessary antibiotic therapy and surgical interventions.
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Affiliation(s)
- Aaliya F Uddin
- General Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
| | - Gautam Menon
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Chelmsford, GBR
| | | | - Abdalla Saad Abdalla Al-Zawi
- Breast Surgery, Anglia Ruskin University, Chelmsford, GBR.,Breast Surgery, Basildon and Thurrock University Hospital, Basildon, GBR.,General Surgery, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Jay Menon
- Vascular Surgery, Basildon and Thurrock University Hospital, Basildon, GBR
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41
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Inoue A, Furukawa A, Nitta N, Takaki K, Ohta S, Murata K. Optimization of pulse sequences in ultrafast magnetic resonance imaging for the diagnosis of acute abdominal pain caused by gastrointestinal disease. Acta Radiol Open 2020; 9:2058460120949246. [PMID: 32884839 PMCID: PMC7440738 DOI: 10.1177/2058460120949246] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is widely used to diagnose acute abdominal pain; however, it remains unclear which pulse sequence has priority in acute abdominal pain. Purpose To investigate the diagnostic accuracy of MRI and to assess the conspicuity of each pulse sequence for the diagnosis of acute abdominal pain due to gastrointestinal diseases Material and Methods We retrospectively enrolled 60 patients with acute abdominal pain who underwent MRI for axial and coronal T2-weighted (T2W) imaging, fat-suppressed (FS)-T2W imaging, and true-fast imaging with steady-state precession (True-FISP) and axial T1-weighted (T1W) imaging and investigated the diagnosis with endoscopy, surgery, histopathology, computed tomography, and clinical follow-up as standard references. Two radiologists determined the diagnosis with MRI and rated scores of the respective sequences in assessing intraluminal, intramural, and extramural abnormality using a 5-point scale after one month. Diagnostic accuracy was calculated and scores were compared by Wilcoxon-signed rank test with Bonferroni correction. Results Diagnostic accuracy was 90.0% and 93.3% for readers 1 and 2, respectively. Regarding intraluminal abnormality, T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in both readers. FS-T2W imaging was superior to True-FISP in reader 2 (P < 0.0083). For intramural findings, there was no significant difference in reader 1, whereas T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in reader 2 (P < 0.0083). For extramural findings, FS-T2W imaging was superior to T2W, T1W, and True-FISP imaging in both readers (P < 0.0083). Conclusion T2W and FS-T2W imaging are pivotal pulse sequences and should be obtained before T1W and True-FISP imaging.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, National Hospital Organization, Higashi-Ohmi General Medical Center, Shiga, Japan.,Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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Mabrouk M, Borghese G, Esposti ED, Raimondo D, Remorgida V, Arena A, Zupi E, Mattioli G, Ambrosio M, Seracchioli R. Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review. J OBSTET GYNAECOL 2020; 41:7-20. [PMID: 32312121 DOI: 10.1080/01443615.2019.1700946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis, defined as the presence of functional endometrial tissue outside the uterine cavity, presents mainly with pelvic pain and infertility. Acute abdominal pain in non-pregnant patients with endometriosis might be minimised as a typical feature of the disease, while endometriosis is rarely considered in the differential diagnosis of acute abdominal pain. Our objective was to conduct a systematic review of the current literature of cases of acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. We performed a PubMed/MEDLINE search of studies published from January 1990 to December 2018, selecting English language reports and series of non-pregnant patients with acute abdomen and histological confirmation of endometriosis. The studies were revised by two independent authors. Data were abstracted and compiled for analysis. Fifty articles reporting 62 patients were identified. The complications were classified according to anatomical sites in bowel, urinary tract, and genital organs emergencies. Rarely was the first diagnostic hypothesis endometriosis, misdiagnosis was frequent. The time frame from symptoms onset to management was often long. This is the first systematic review evaluating acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. These conditions are rare but possibly life-threating and require prompt diagnosis and emergent medical or surgical treatment.
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Affiliation(s)
- Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Cambridge, UK
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentino Remorgida
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynaecology, University of Genova, Genova, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Obstetrics and Gynaecology Clinic, Department of Biomedicine and Prevention, University of Roma "Tor Vergata", Roma, Italy
| | - Giulia Mattioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
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Ploner M, Gardetto A, Ploner F, Scharl M, Shoap S, Bäcker HC. Foreign rectal body - Systematic review and meta-analysis. Acta Gastroenterol Belg 2020; 83:61-65. [PMID: 32233273] [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] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Self-inserted foreign rectal bodies are an infrequent occurrence, however they present a serious dilemma to the surgeon, due to the variety of objects, and the difficulty of extraction. The purpose of this study is to give a comprehensive review of the literature regarding the epidemiology, diagnostic tools and therapeutic approaches of foreign rectal body insertion. METHODS A comprehensive systematic literature review on Pubmed/ Medline and Google for 'foreign bodies' was performed on January 14th 2018. A meta-analysis was carried out to evaluate the epidemiology, diagnostics and therapeutic techniques. 1,551 abstracts were identified, of which 54 articles were included. RESULTS The motivation of foreign rectal body insertion is mostly sexual stimulation. Patients are typically young and predominantly male, with a male to female ratio of 6:1. Sexual devices (35.7%, n=108) and glass objects (17.5%, n=53) are the most commonly self-inserted rectal foreign bodies. Patient history should be taken sensitively after diagnostic evaluation and identification of the object. Removal was performed under general anesthesia in 45.2% (n=95) and sedation in 29.0% (n=61). The total complication rate was described to be 30.4%. CONCLUSIONS Diagnostics must be performed with caution in order to rule out perforation and establish a treatment algorithm. Manual transanal extraction under sedation or general anesthesia may be performed in conjunction with cautious abdominal compression. Because of the variety of objects, i.e. in form and material, each case must be treated individually. Sometimes creativity and surgeon imagination may be required, although different algorithms have been established.
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Affiliation(s)
- M Ploner
- Department of Anesthesiology and Intensiver Care, Cantonal Spital Lucerne, Lucerne, Switzerland
| | - A Gardetto
- Department of Plastic Surgery, Hospital Sterzing, Sterzing, South Tirol, Italy
| | - F Ploner
- Department of Anesthesiology and Emergency Medicine, Hospital Sterzing, South Tirol, Italy
| | - M Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Swetzerland
| | - S Shoap
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA
| | - H C Bäcker
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, USA
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Erkut B, Ates A. Left renal artery thrombosis in a 78-year-old patient with atrial fibrillation. ACTA ACUST UNITED AC 2019; 76:198-200. [PMID: 31833740 DOI: 10.31053/1853.0605.v76.n4.23479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/27/2019] [Indexed: 11/21/2022]
Abstract
Renal artery thrombosis is a rare clinical condition. Often, there is a delay in diagnosis due to non-specific clinical complaints. We presented a woman with an elderly atrial fibrillation who developed thrombosis of the left renal artery. Despite the anticoagulant treatment given, patient did not benefit and the kidney was fully damaged.
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45
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Erkek A, Yılmaz Aydın Y, Çiftçi H, Ramadan H, Temiz K, Aydınuraz K, Coskun F. Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain. Cureus 2019; 11:e5948. [PMID: 31799089 PMCID: PMC6860703 DOI: 10.7759/cureus.5948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of the study was to evaluate the diagnostic process and clinical course in adult patients who presented to the emergency department (ED) with acute abdominal pain (AAP) and were found to have intra-abdominal free fluid (FF) on ultrasonography (USG). Methods This prospective observational study was conducted in a training and research hospital adult emergency department between March 15, 2013, and April 15, 2013. The study included 252 patients aged above 18 years, who were admitted to the emergency room complaining of non-traumatic acute abdominal pain and provided consent for the study. Results The most common diagnoses were acute, nonspecific abdominal pain (37.3%), acute appendicitis (19%), and urinary tract pathology (15.9%). Intra-abdominal free fluid was detected with ultrasonography in 42.5% of patients. Patients with intra-abdominal free fluid were younger than the other patients. The emergency department length of stay was longer in patients with intra-abdominal free fluid (p=0.011). Of the 252 patients enrolled in the study, 32.9% were admitted to the hospital, 21.4% of whom underwent surgery and 11.5% received medical therapy. Most of the patients (64.5%) who were discharged home had no intra-abdominal free fluid in the ultrasonography (p<0.001). Conclusion The presence of intra-abdominal free fluid alone did not guide the clinical decision regarding the diagnostic evaluation of adult patients that presented to the emergency department complaining of non-traumatic acute abdominal pain.
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Affiliation(s)
- Aylin Erkek
- Emergency Medicine, SBU Kocaeli Derince Training and Research Hospital, Kocaeli, TUR
| | - Yasemin Yılmaz Aydın
- Emergency Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, TUR
| | - Handan Çiftçi
- Emergency Medicine, Kars Kafkas University Faculty of Medicine, Kars, TUR
| | - Hayri Ramadan
- Emergency Medicine, Ankara Education and Research Hospital, Ankara, TUR
| | - Kerim Temiz
- Radiology, Samsun Vezirköprü State Hospital, Samsun, TUR
| | - Kuzey Aydınuraz
- General Surgery, Kırıkkale University Faculty of Medicine, Kırıkkale, TUR
| | - Figen Coskun
- Emergency Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, TUR
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Güney C, Coskun A. A Fifteen-Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series. Diagnostics (Basel) 2019; 9:diagnostics9030110. [PMID: 31487839 PMCID: PMC6787606 DOI: 10.3390/diagnostics9030110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023] Open
Abstract
Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12-17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility.
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Affiliation(s)
- Cengiz Güney
- Cumhuriyet University Medical Faculty, Department of Pediatric Surgery, 58140 Sivas, Turkey.
| | - Abuzer Coskun
- Sivas Numune Hospital, Department of Emergency, 58030 Sivas, Turkey.
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Bagguley D, Fordyce A, Guterres J, Soares A, Valadares E, Guest GD, Watters D. Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste's national referral hospital. BMJ Open 2019; 9:e029812. [PMID: 31446414 PMCID: PMC6720142 DOI: 10.1136/bmjopen-2019-029812] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Our objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving Bellwether procedures. SETTING The study was conducted at Timor Leste's national referral hospital in Dili, the country's capital. PARTICIPANTS All patients requiring a Bellwether procedure over a 2-month period were included in the study. Participants whose procedure was undertaken more than 24 hours from initial hospital presentation were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Data pertaining to the patient journey from onset of symptoms to emergency procedure was collected by interview of patients, their treating surgeons or anaesthetists and the medical records. Timelines were then calculated against the Three Delays Framework. RESULTS Fifty-six patients were entered into the study. Their mean delay from symptom onset to entering the anaesthesia bay for a procedure was 32.3 hours (+/-11.6). The second delay (4.1+/-2.5 hours) was significantly less than the first (20.9+/-11.5 hours; p<0.005) and third delays (7.2+/-1.2 hours; p<0.05). Additionally, patients with acute abdominal pain (of which 18/20 ultimately had open appendicectomy and two emergency laparotomies) had a delay time of 53.3 hours (+/-21.3), significantly more than that for emergency caesarean (22.9+/-18.6 hours; p<0.05) or management of an open long-bone fracture (15.5+/-5.56 hours; p<0.05). CONCLUSIONS Substantial delays were observed for all three stages and each Bellwether procedure. This study methodology could be used to measure access and the three delays to emergency surgical care in low/middle-income countries, although the actual reasons for delay may vary between regions and countries and would require a qualitative study.
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Affiliation(s)
- Dominic Bagguley
- Department of Surgery, Northern Health, Epping, Victoria, Australia
| | - Andrew Fordyce
- Department of Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Jose Guterres
- Department of Surgery, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Alito Soares
- Department of Surgery, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Edgar Valadares
- Department of Surgery, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Glenn Douglas Guest
- Department of Surgery, University Hospital Geelong, Geelong, Victoria, Australia
| | - David Watters
- Royal Australasian College of Surgeons, Geelong, Victoria, Australia
- Surgery, Deakin University Faculty of Health, Geelong, Victoria, Australia
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Abstract
RATIONALE Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction. PATIENT CONCERNS In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening. DIAGNOSES He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan. INTERVENTIONS He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use. OUTCOMES The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up. LESSONS In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.
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Affiliation(s)
- Lan Yang
- Department of Ultrasound, the Fifth People's Hospital of Nanchong
| | - Min Jia
- Department of radiology, Nanchong Central Hospital, Nanchong
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tegelberg A, Jangland E, Juhlin C, Muntlin Athlin Å. Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain. J Clin Nurs 2019; 28:3641-3650. [PMID: 31190406 DOI: 10.1111/jocn.14962] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/26/2018] [Revised: 03/13/2019] [Accepted: 05/26/2019] [Indexed: 01/30/2023]
Abstract
AIM AND OBJECTIVES To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care. BACKGROUND Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high-quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high-quality fundamental care across the acute care chain. DESIGN Qualitative descriptive semi-structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used. METHODS Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro- and macrolevels across the acute care chain. RESULTS The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models. CONCLUSIONS The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal. RELEVANCE TO CLINICAL PRACTICE Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence-based and high-quality care.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden.,Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
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Chong V, Schultz TJ, Donnelly F. Clinical protocols for adults with acute abdominal pain in Australian emergency departments. J Eval Clin Pract 2019; 25:412-419. [PMID: 30714279 DOI: 10.1111/jep.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/09/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patients with acute abdominal pain are a common presentation in hospital emergency departments; however, international studies have demonstrated that hospitals often lack clinical protocols to guide care. This study aimed to investigate whether Australian hospital emergency departments have acute abdominal pain clinical protocols, identify hospital-level predictors of the presence of these clinical protocols, and assess the quality of protocols. METHODS A survey was sent to all Australian hospitals with emergency departments, collecting data on hospital characteristics and the presence of acute abdominal pain clinical protocols. Participating hospitals (n = 73, 26% response rate) were also asked to provide a copy of these protocols. The quality of these protocols was assessed using Appraisal of Guidelines for REsearch & Evaluation (AGREE) II. RESULTS Slightly more than half (n = 40) of the hospitals surveyed had acute abdominal pain clinical protocols, while 16 had a general pain protocol. In binomial logistic regression, two independent variables were related to the presence of a protocol, geographic region (P = 0.008) and advanced practice nurses/nurse practitioners' presence on staff (P = 0.024). The mean score for the overall quality assessment of these protocols was 4.2 on a seven-point Likert scale; in terms of the six domains of quality, "Clarity of presentation" and "Scope and purpose" were highest. The overall quality of clinical protocols increased with remoteness, χ2 (3) = 8.341, P = 0.039, and was lower in hospitals with medical staff on site (U = 2.5, P = 0.007). CONCLUSION There is a documented standard for pain management of acute abdominal pain in about three quarters of participating Australian emergency departments. The use and quality of clinical protocols is influenced by the physical location of hospitals and staff and skill mix of clinicians.
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Affiliation(s)
- Vivienne Chong
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Frank Donnelly
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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