Showing papers on "Abdominal pain published in 1976"

Pancreatectomy for chronic pancreatitis.

Abstract: Of one hundred and forty-nine patients (101 male and 48 female) 4-67 years of age, 117 were alcoholics and underwent pancreatectomy because of episodic or continuous abdominal pain or complications or chronic pancreatitis. Nineteen patients underwent pancreaticoduodenectomy, seventy-seven 80-95% distal resection, anf fifty-three 40-80% distal pancreatic resection. There were 3 operative death and 30 late deaths 6 months to 11 years post pancreatectomy. Twenty-one patients were lost to followup, 1 to 11 years post pancreatectomy. Ninety-five patients are known to be alive, 4 of whom are institutionalized. Indications for pancreatectomy in addition to abdominal pain include recurrent or multiple pseudocysts, failure to relieve pain after decompression of a pseudocyst, pseudoaneurysm of the visceral arteries associated with a pseudocyst, recurrent attacks of pancreatitis unrelived by non-resective operations, duodenal stenosis and left side portal hypertension. The choice between pancreaticoduodenectomy or distal resection of 40-80% or 80-95% of the pancreas should be based on the principle site of inflammation whether proximal or distal in the gland, the size of the common bile duct, the ability to rule out carcinoma, and the anticipated deficits in exocrine and endocrine function. The risk of diabetes is very significant after 80-95% distal resection and of steatorrhea after pancreaticoduodenectomy. When the disease process can be encompassed by 40-80% distal pancreatectomy this is the procedure of choice.

Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room.

Abstract: In the majority of patients in this series of 1,000, acute abdominal pain was due to conditions that required neither surgical intervention nor hospitalization. Eleven of the 1,000 patients had an early missed diagnosis in the emergency clinic for which a subsequent operation was needed, and twenty underwent an operation which subsequent diagnosis showed was not required. All false-negative evaluations occurred in patients with early appendicitis or small bowel obstruction. Most false-positive results were due to acute infections of the female genitourinary tract in patients operated on to exclude appendicitis or a tubo-ovarian abscess. The following factors help identify the high risk patient with an acute surgical abdomen: (1) pain for less than 48 hours; (2) pain followed by vomiting; (3) guarding and rebound tenderness on physical examination; (4) advanced age; (5) a prior surgical procedure. The presence of these features demands careful evaluation and a liberal policy of admission and observation. White blood cell counts, body temperature, and abnormal abdominal roentgenograms may add confirmatory evidence but are not particularly helpful as screening devices.

The urgency of diagnosis and surgical treatment of acute suppurative cholangitis

Abstract: Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.

Perforated diverticula of the jejunum and ileum

Abstract: Over a ten year period, four patients with inflammation or perforation of non-Meckelian, small intestinal diverticula were treated on the surgical services of Bellevue Hospital. This entity remains uncommon but may be increasing in incidence. The patients presented with a short history of severe abdominal pain, usually accompanied by nausea and vomiting. Each patient also gave a longer preceding history of less well defined abdominal symptoms. The pathogenesis of the small intestinal diverticula is uncertain but may be related to disturbed muscular peristalsis in the small bowel analogous to the changes implicated in esophageal and colonic diverticular disease. The diverticulum may be difficult to demonstrate at operation, and careful exploration for this possibility should be carried out at the time of operation for peritonitis of obscure origin. Segmental resection and end-to-end anastomosis is the treatment of choice.

Cholecystitis and Cholelithiasis Masking as Abdominal Crises in Sickle Cell Disease

Abstract: A case of sickle cell (HbSS) disease is presented in a patient with a history of recurrent admissions for abdominal pain, jaundice, and abnormal liver function tests Although he was believed to have a sickle cell abdominal crisis, his abdominal X-ray films revealed three calcified stones Each of these stones progressively passed through the common duct and into the duodenum while awaiting surgery He has been followed for two years since his cholecystectomy without further hospitalizations This case led to the investigation of cholelithiasis in sickle cell disease to dispel the following misconceptions Some physicians and pediatricians believe that (1) cholelithiasis and cholecystitis are uncommon in sickle cell disease; (2) the complications of gallstones are not significant; (3) the operative risk in patients with sickle cell disease is high; (4) these patients with HbSS disease do not live long enough to get into trouble with gallstones A review of the literature on cholelithiasis and HbSS disease presents adequate evidence to cause us to urge investigation of the gallbladder in all patients with HbSS disease and abdominal crises, and cholecystectomy as an elective procedure should stones be present

Yersinia enterocolitica infection in patients with acute surgical abdominal disease. A prospective study.

Abstract: The rate of yersiniosis in patients with acute abdominal disease was studied in a 16-month prospective investigation in 1972–1973 of 205 acutely ill patients referred to a surgical clinic of a Copenhagen City hospital with complaints of abdominal pain suggestive of appendicitis. Yersinia enterocolitica, biotype 4, was isolated from 11 patients (5.4%), 8 of whom were children. Yersinia was grown from faeces in 8 cases and from appendix of all 9 patients operated upon. Rising or falling agglutinin titres ≥100, indicative of yersiniosis, were found in 22 patients (10.7%) including all bacteriologically verified cases. Eight additional patients (3.9%) had less significant titres ≥100, suggestive of recent or present infection. 28 patients (13.7%) had insignificant titres, including 3 with antibodies against serotype 9. In all cases except these 3, antibodies were against Y. enterocolitica, serotype 3. A differential diagnosis between Y. enterocolitica infection and other types of appendicitis could no...

The management of infected abdominal aortic grafts and graft-enteric fistulas.

Abstract: Seven cases of infected aortic grafts or aorto-enteric fistulas following resection of an abdominal aortic aneurysm are reviewed. All cases were treated with axillo-femoral bypass and graft removal. Patients had recurrent fever, chills, and abdominal pain (5 patients), or massive gastrointestinal hemorrhage (2 patients). The two patients with massive gastrointestinal hemorrhage died. Three of the 5 long-term survivors had a recurrence of the retroperitoneal abscess after graft removal; one of these died. One axillo-femoral bypass graft required early thrombectomy. There have been no subsequent problems with any of the grafts in the 2.5 to 4 year followup period. Axillo-femoral bypass immediately before graft removal is the treatment of choice for infected or fistulous aortic grafts. Any delay in graft removal after the onset of symptoms should be avoided.

Acute colitis in the renal allograft recipient.

Abstract: Four renal allograft recipients with evidence of ischemic damage to the colon are presented and compared with 11 cases from 5 major series. Similarities in the patients included: deterioration of renal function, multiple immunosuppressive and antibiotic regimens, the use of cadaver renal allografts, and diagnostic and therapeutic measures requiring frequent enemas with barium and ion-exchange resins. Two of our patients underwent surgery for the removal of segments of necrotic colon after several weeks of fever and abdominal pain initially attributed to either acute rejection, viral infection, or pancreatitis. One patient had three days of melena and responded to non-operative therapy. The fourth patient developed ischemic colonic changes 10 weeks after allograft nephrectomy and was receiving no immunosuppression at the time. Broad spectrum antibiotics were used at various times in all patients. Early aggressive evaluation of gastrointestinal complaints--including barium enema, upper gastrointestinal series with small bowel follow-through, proctosigmoidoscopy or colonoscopy, and arteriography--is indicated, in view of the lethality of the complication of colonic ulceration. The clinical pictures presented emphasize the fact that recipients of renal allografts are commonly heir to many complications which may be considered rare in the normal population.

Intussusception secondary to aberrant pancreas in a child.

Abstract: WHILE aberrant pancreas and intussusception are not unusual conditions, the association of the two is seldom seen. A survey of the literature on intussusception from 1960 to 1975 did not uncover any reports in Englishlanguage journals. An occasional case report is found in various foreign journals.1,2,3Two series of 192 cases of intussusception did not give aberrant pancreas as a cause,4,5and another large survey of cases of aberrant pancreas6did not mention intussusception as a complication. A case of intussusception in which the leading part was a mass of aberrant pancreas in the ileum forms the basis of this communication. Report of a Case A 9-year-old boy was well until the day of admission to the hospital, Feb 1, 1975. The sudden onset of abdominal pain accompanied by several episodes of emesis had developed. The pain gradually increased and the patient was brought to the emergency

Carcinoma of the pancreas.

Abstract: Study of hospital records of 146 patients with carcinoma of the pancreas from 1952 to 1971 revealed that 74 per cent had had abdominal pain and 65 per cent jaundice. Abdominal pain was the commonest symptom of carcinoma of the head as well as of the body and tail. Diabetes mellitus was four times as common among the patients with carcinoma of the pancreas as among the population in general. The interval between the onset of symptoms and diagnosis of the disease was the same in both decades of the 20-year period, but the survival time after operation was longer in the second 10-year period. Pancreatoduodenectomy was possible in only four of the 138 patients operated on, and one of them died postoperatively. The three patients who survived the operation survived significantly longer than the 87 in whom an anastomosis had been established between the bile ducts and the intestine. Forty-one patients were subjected to surgical exploration only. No difference in survival time was found between the two last-mentioned groups.

Primary malignant tumors of the small intestine.

Abstract: Primary malignant tumors of the small intestine are uncommon. This infrequency and possible lack of awareness can result in a late diagnosis and a poor survival time. In a period of 34 years, only 55 patients were seen at our cancer institute. The average age of the patients was 56 years, with a male predominance ratio of 2.6:1.0. Twenty-one patients had adenocarcinomas, 19 had sarcomas and 15 had carcinoids. The most common signs and symptoms were abdominal pain and obstruction of the intestine. Preoperative diagnosis was established in 12 of these patients only by roentgenologic barium examination of the small intestine. At the time of diagnosis, 34 of the patients had metastasis to regional lymph nodes or distant organs. The median and five year survival times were one year and 19 per cent, respectively. Patients with carcinoids had better survival rates than those with adenocarcinomas or sarcomas. Palliative resection did not improve survival time. However, if other therapeutic modalities also were used, it might prove beneficial. Patients with palpable abdominal masses or intestinal bleeding, or both, had a worse prognosis than did those presenting with obstruction of the intestine because these are late presenting symptoms. Therefore, recurrent abdominal pain should increase clinical suspicion, and early diagnosis by careful examination of the small intestine with barium contrast material could improve the survival time. Finally, it seemed that these tumors had a high incidence of coexisting malignant conditions, as nine of the patients in our series had a second malignant tumor.

Pyogenic Liver Abscess in Normal Children With Fever of Unknown Origin

Abstract: Solitary pyogenic hepatic abscesses were identified as the cause of fever, abdominal pain, and hepatomegaly in two otherwise normal children who were seen at St. Louis Children9s Hospital during the past year. Liver function tests were normal and blood cultures were negative in both patients. These cases illustrate that pyogenic liver abscess may occur in normal children and should be considered whenever fever of unknown origin is associated with abdominal complaints. Only in this way can we hope to improve upon the results cited previously, namely that the majority of liver abscesses remain undiagnosed during life.

Clinical spectrum of pseudomembranous colitis.

Abstract: Five cases of pseudomembranous colitis (PMC) provided the opportunity for observation of clinical, endoscopic, and histologic features, and evaluation of potential modes of therapy. Although PMC may occur postoperatively or concomitantly with staphylococcal infection, it most frequently occurs following the administration of a variety of antibiotics. Patients with this disorder often have chronic, debilitating diseases. The clinical course may vary from a self-limited diarrheal illness to a fatal process. Onset with abdominal pain, diarrhea, and fever is characteristic. Barium enema contrast findings are nonspecific. Proctoscopy usually permits an accurate diagnosis. In the typical case, multiple elevated nodules formed by cream-colored plaques of pseudomembrane are scattered about the inflamed mucosa. Biopsy of these nodular lesions will confirm the diagnosis. Therapy must be individualized.(JAMA 235:2502-2505, 1976)

Ovarian teratomas in children. A thirty-three year experience.

Abstract: During the thirty-three years from 1941 through 1973, forty-two children with ovarian teratomas were seen. The most common complaint was that of abdominal pain and the most common physical finding was palpable lower abdominal mass. Thirty-seven patients had ovarian teratomas with nature tissues only. Of these, two patients have been lost to follow-up and the remainder are alive and well. One patient had teratoma containing mature and immature tissues (embryonic); this patient has remained well since operation. Four patients had malignant teratoma. Of these, two patients are dead due to the tumor and the two are living and well for six and nine years, respectively.

Gallium citrate Ga 67 accumulation in pseudomembranous colitis.

Abstract: THE TENDENCY for gallium citrate Ga 67 to localize in inflammatory lesions can provide an extremely useful, noninvasive test in the septic patient.1-4As with any diagnostic test, associated conditions that can compromise the diagnostic value of67Ga scanning should be known. We recently had a patient with pseudomembranous colitis with a colonic accumulation of67Ga, which to our knowledge, has not been previously reported. Report of a Case A 71-year-old man was in good health until 24 hours prior to admission, when he first had abdominal pain and vomiting. There was no history of hematemesis, diarrhea, melena, or bright red blood originating from the rectum. On physical examination, the patient had a temperature of 38.5 C (101.3 F) and a distended abdomen with left lower quadrant rebound tenderness. Results of the rest of the examination were unremarkable. All laboratory values were within normal limits. An abdominal

Abdominal pain of unknown etiology

Abstract: The influence of age, sex, duration of symptoms, and exploratory laparotomy on prognosis of adult patients with abdominal pain of unknown etiology was assessed in a retrospective review. Patients with incomplete diagnostic evaluation were excluded. Of the sixty-four patients studied, forty-six were female. Lack of improvement of symptoms in the follow-up period was 67% in females and 22% in males (p less than 0.05). Younger patients tended to have higher improvement rates. Of the patients whose duration of symptoms was less than fourteen days, 65% were improved and 25% were subsequently diagnosed, as compared with 14 and 9%, respectively, of those whose symptoms had been present for more than ninety days (p less than 0.05). Laparotomy did not influence rate of improvement and established a diagnosis in only one of twenty-three patients explored. It is concluded that few of these patients are likely to benefit from laparotomy, especially adult females whose symptoms have been present for more than three months.

Renal angiomyolipoma (hamartoma). Profuse retroperitoneal hemorrhage caused by benign kidney tumour.

Abstract: A case of renal angiomyolipoma in a 38-year-old female is reported. The chief symptoms were abdominal pain and hypovolemia caused by massive retroperitoneal hemorrhage. A brief survey is given of the pathology, symptomatology, and the diagnostic possibilities with special reference to the radiologic diagnosis.

Acute pancreatitis in two cases of infectious mononucleosis.

Abstract: Reports in the literature of acute pancreatitis concomitant with infectious mononucleosis are rare. Two new cases (man, 24, and girl, 12 years) are described. Pancreatitis is of interest mainly in the differential diagnosis versus rupture of the spleen. Abdominal pain in infectious mononucleosis should lead to investigation of amylases in serum and urine.

Complications of amniocentesis.

Abstract: A retrospective survey of 358 consecutive amniocenteses was undertaken. The incidence of failure was 37 (9.6%); most commonly this was due to oligohydramnios. A suprapubic tap was the most likely to be successful, but was accompanied by premature rupture of membranes in 3.8% of the cases. Spontaneous rupture of membranes, followed by delivery of a premature infant, occurred 15 times (4.2%). Blood-stained fluid was obtained on 47 occasions (13%), but, apart from the theoretical risks of fetomaternal haemorrhage and fetal exsanguination, and an association with maternal abdominal pain, there appeared to be no serious sequelae from this complication. Withdrawal of blood-stained fluid was not prevented by prior placental localization and was not related to the site of the tap. There were 14 perinatal deaths (equal to a rate of 50 per 1,000 births) and, although no fetal deaths could be directly attributed to amniocentesis, there were four cases in which the procedure could not be completely absolved. Three patients underwent emergency caesarean section because of severe abdominal pain after anmiocentesis. Two had amniotic fluid peritonism and the third had minor intraperitoneal bleeding. Amniocentesis is not without maternal and fetal complications and should be undertaken with due regard to the risks involved.

Diabetes mellitus and tropical form of chronic calcific pancreatitis in Thailand.

Abstract: Six cases of chronic calcific pancreatitis in Thailand occurring in patients aged 13 to 22 years are reported. Protein malnutrition was a possible aetiologic factor. Abdominal pain was mild to moderate and intermittent and not a presenting feature. Severe diabetes mellitus was present at all. Extensive pancreatic calcification was seeen on abdominal X-ray.

A diagnostic re-evaluation of electric skin resistance, skin temperature and deeper tenderness in patients with abdominal pain.

Abstract: Diagnostic re-evaluation of measurement of electric skin resistance (ESR), skin temperature (ST) and deeper tenderness (DT) was performed in patients with abdominal pain due to pancreatitis, cholecystopathy and duodenal ulcer. These determinations were conducted when the pain was complained of and after the pain ceased by paravertebral anesthesia. ESR was decreased on the opposite tender points of the abdominal walls as compared with those values of the healthy abdominal walls. On the contrary, ESR was increased on the suffered body areas in patients with active myelitis. ESR was decreased on the abdominal walls where visceral pain was induced by inflation of a balloon attached to the apex of a Miller-Abbott double lumen tube. DT tended to show decrease, while ST a slight increase, when the pain was evoked. However, in these pain induced experiments, ST changes were not so remarkable as those of ESR. A viscero-cutaneous reflex machanism and the predominance of sympathetic nerve control might be possible causes to produce these changes. Several important factors influencing the determination of the ESR were also discussed.

Clinical aspects of chronic brucellosis.

Abstract: Twenty-one patients with brucellosis wereinvestigated Four patients with the classical manifestations of acute brucellosis presented no problems in diagnosis The other 17 patients suffered from chronic disease and had no history of any acute episode of brucellosis The most common symptoms in this group were tiredness, fatigue, depression, arthralgia and muscular pains Abdominal pain and pain in the temperomandibular joints were marked in some patients Most of these patients had been receiving psychiatric treatment Clinical examination was largely negative, but lymphadenopathy was found in 9 cases Brucella meningo-encephalitis was diagnosed in 7 patients who complained of severe headache Problems in the diagnosis of chronic brucellosis with an insidious onset are discussed

Case 31-1976

Abstract: Presentation of Case A 42-year-old woman was admitted to the hospital because of abdominal pain. She was well until three weeks previously, when she began to have a constant, sharp pain in the right upper abdominal quadrant that was aggravated by movement or by local pressure and unaffected by food intake or bowel movements. She entered another hospital, where a mass in the right upper abdominal quadrant was found on physical examination. An intravenous pyelographic examination, an oral cholecystographic study, a barium-enema examination and an upper gastrointestinal study were reported to be negative. The pain disappeared spontaneously, and the mass . . .

An Unusual Hernia

Abstract: To the Editor.— We would like to report an unusual case of a giant scrotal hernia containing the distal half of the stomach as well as most of the intestines. An additional feature was that the portion of the stomach retained within the abdomen had perforated. Report of a Case.— A 65-year-old man entered the hospital because of severe abdominal pain and vomiting. He had known of an inguinal hernia for many years, but had always refused surgery. Examination revealed hypotension, tachycardia, and a diffusely tender abdomen with absent bowel sounds. There was a painful, irreducible left scrotal hernia that reached the lower area of the thighs. The hematocrit value was 56%, and the leukocyte count, 14,500/cu mm. After aspiration of the stomach and fluid replacement, we performed exploratory laparotomy through a combined abdominoscrotal incision. The hernia contained the distal half of the stomach, the small bowel, and most of

Masculinizing granulosa cell tumour.

Abstract: A 23-year-old woman had oligomenorrhea, underdevelopment of the breasts, moderate hirsutism and increased serum testosterone values associated with a benign noncystic granulosa cell tumour of the left ovary. She was frail, irritable and apathetic. Since the age of 7 she had had periodic abdominal pain with nausea, vomiting and dizziness; irritability and occipital headache appeared when she was older. Her symptoms resolved and the masculinization did not progress after the tumour was removed. Only six similar well documented cases have been reported.