Showing papers on "Abdominal pain published in 1986"

Severe chronic constipation of young women: 'idiopathic slow transit constipation'.

Abstract: A series of 64 women complaining of severe constipation is described, in each of whom delayed elimination of markers from the colon was demonstrated but a barium enema was normal. All completed a detailed questionnaire and the responses are compared with those obtained in an age-matched series of healthy women with no bowel complaint. In each group 40 women also recorded in a manner suitable for analysis all food eaten over a period of seven days. The patients passed about one stool weekly with the aid of laxatives, and were greatly troubled by abdominal pain, bloating, malaise and nausea, to the extent that the symptoms were a major social disability and many lost time from work. Decreased bowel frequency and other symptoms were often first noticed around the age of puberty and slowly became worse until they were severe by the third decade. In a few, the symptoms began suddenly after an abdominal operation c-accident. Comparison with the control group showed no evidence that the patients had been underweight at any time or that they took less fibre; treatment with a bran supplement did not usually help them. The patients experienced rectal sensation before defaecation less often than the control subjects and they used digital pressure to assist defaecation more frequently. The women with constipation tended to have more painful and irregular menstrual periods, and there was an increased incidence of ovarian cystectomy and hysterectomy. Hesitancy in starting to pass urine was more common, as were some somatic symptoms such as cold hands or blackouts. Attention is drawn to this distinctive combination in young women of slow total gut transit time and a colon of normal width on barium enema, associated with abdominal, anorectal, gynaecological and somatic symptoms, as a disorder which can be disabling and particularly difficult to treat.

A Practical Score for the Early Diagnosis of Acute Appendicitis

Abstract: We conducted a retrospective study of 305 patients hospitalized with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analyzed for specificity, sensitivity, predictive value, and joint probability. The total joint probability, the sum of a true-positive and a true-negative result, was chosen as a diagnostic weight indicative of the accuracy of the test. Eight predictive factors were found to be useful in making the diagnosis of acute appendicitis. Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain. Based on this weight, we devised a practical diagnostic score that may help in interpreting the confusing picture of acute appendicitis.

The medical and surgical management of typhlitis in children with acute nonlymphocytic (myelogenous) leukemia

Abstract: The treatment of acute leukemia in childhood has been increasingly successful. Infectious complications are the major cause of morbidity and mortality among these patients receiving aggressive chemotherapy. In particular, neutropenic enterocolitis or typhlitis has had a reported mortality of 50% to 100%. The authors reviewed a series of 77 previously untreated patients with acute myelogenous leukemia begun on treatment from March 1976 to June 1984 to better define the characteristics of typhlitis and its optimum management. Twenty-five patients had episodes of typhlitis, characterized by fever, abdominal pain, and tenderness, occurring during periods of neutropenia. Ten of these patients had watery diarrhea as a major additional symptom, and nine patients had a significant episode of gastrointestinal bleeding. In seven instances, blood culture results were positive, all for intestinal flora. The episodes of typhlitis occurred most frequently during the induction therapy (19 patients). Five patients experienced typhlitis during maintenance therapy, and one patient had acute appendicitis. Two patients had typhlitis during their reinduction therapy, and of note, one had had abdominal symptoms during her initial induction. All patients were treated initially with broad-spectrum antibiotics and bowel rest. Four criteria have been used for surgical intervention: (1) persistent gastrointestinal bleeding after resolution of neutropenia and thrombocytopenia and correction of clotting abnormalities; (2) evidence of free intraperitoneal perforation; (3) clinical deterioration requiring support with vasopressors, or large volumes of fluid, suggesting uncontrolled sepsis; and (4) development of symptoms of an intra-abdominal process, in the absence of neutropenia, which would normally require surgery. Using these criteria, five patients required surgical intervention for typhlitis or its sequelae and one for acute appendicitis. There was one perioperative death resulting from miliary tuberculosis. Among the 21 patients managed medically, there was 1 death resulting from typhlitis in a patient in whom surgery was deferred because of her multiple failures to enter remission.

Bowel symptoms in an apparently well population.

Abstract: The aim of this study was to determine the prevalence of various kinds of bowel behavior and symptoms thought to be indicative of colorectal cancer in people randomly selected from the community. A probability sample of 330 dwellings in the inner western suburbs of Sydney yielded 202 completed interviews with occupants aged 30 years and older. Eight percent reported annoying abdominal pain that had lasted for two weeks or more in the preceding six months, while 19 percent reported a feeling of incomplete evacuation at least once every two weeks. Blood on the toilet paper was reported by 14 percent and blood in the toilet bowl by 2 percent. Twenty-one percent said they always looked at their stool in the toilet bowl and 34 percent always looked at the toilet paper after using it, but 43 percent seldom or never looked at either their stool or the paper. Of the 75 who said they looked at their stool about half the time or more, two (3.1 percent) reported seeing blood during the preceding six months. Symptoms that may be associated with colorectal cancer are common in apparently well adults. Whilst this includes bleeding from the rectumin toto, it may not be true for blood seen specifically in the toilet bowl. Because this latter symptom has potential discriminating value, it may be worthwhile to promote public education encouraging people to inspect their stools regularly, and to visit their doctor if blood is seen.

Clinical features of acute gastroenteritis associated with rotavirus, enteric adenoviruses, and bacteria.

Abstract: In a prospective one year study, comprising children with acute gastroenteritis admitted to hospital or treated as outpatients, the clinical and laboratory features of rotavirus diarrhoea (168 cases) were compared with those of enteric adenovirus (32 cases), bacterial (42), mixed (16), and non-specific (135) infections. The rotavirus disease was remarkably consistent, with a sudden onset of vomiting, a high frequency of fever and dehydration, and a mean duration of diarrhoea of 5.9 days. Outpatients excreting rotavirus had a similar but milder illness, mainly on account of less pronounced vomiting. The predominant symptom of enteric adenoviruses was long lasting diarrhoea (mean 10.8 days). Abdominal pain, bloody stools, prolonged diarrhoea (mean 14.1 days), leucocytosis, and a raised erythrocyte sedimentation rate strongly suggested a bacterial aetiology. Mixed infections caused longer lasting diarrhoea (mean 8.0 days) than rotavirus alone, but the severity of the illness was not increased. The clinical features of infection with unidentified pathogens most resembled those of bacterial infections. Respiratory symptoms were not significantly associated with any particular pathogen. Hypernatraemia and complications were uncommon. This study showed that the clinical features of gastroenteritis with rotavirus, enteric adenoviruses, and bacteria each exhibited patterns that could guide the experienced clinician to a presumptive diagnosis.

The role of surgical treatment for chronic pancreatitis.

Abstract: During the last 25 years, 134 patients with chronic pancreatitis were treated surgically in our clinic. According to intraoperative measurement of the pancreatic intraductal pressure, both perfusion pressure and residual pressure in the patients with dilated pancreatic duct were significantly higher than those in control patients. Operative procedures included side-to-side pancreaticojejunostomy in 47 patients, 40%-80% caudal pancreatectomy in 28, pancreaticoduodenectomy in 16, pancreatic sphincteroplasty in 10, and others. The effect of operation on abdominal pain was noted in 97% of the patients. The study of operative effect on abdominal pain and follow-up results showed the excellent maintenance of operative benefit. Surgical treatment, however, could not help improve impaired function of the pancreas. Ten of 34 late deaths were related to the failure of controlling diabetes. Therefore, long-term follow-up care to the pancreatic dysfunction is considered to be necessary even after complete relief of abdominal pain.

Crohn's disease in the elderly. A statistical comparison with younger patients matched for sex and duration of disease.

Abstract: To better characterize Crohn's disease in the elderly, 24 patients ranging in age from 64 to 85 years were reviewed and compared with a younger group (20 to 61 years of age) matched for sex and duration of disease. Forty-one variables encompassing clinical, laboratory, and radiologic data and medical and surgical aspects of treatment were analyzed. The older group was characterized by a longer delay in diagnosis, more hematochezia, and a higher incidence of diverticular and cardiovascular disease. Elderly patients had less pain, less often a palpable abdominal mass, less small-bowel disease, less drug treatment, and no family history of inflammatory bowel disease. Otherwise, the disease in the two groups had similar manifestations, and no discriminating features to enable easy diagnosis in the elderly were found. Crohn's disease must be considered when evaluating older patients with diarrhea, abdominal pain, weight loss, and bleeding.

Management of Bile Duct Cysts in Adults

Abstract: • In 31 adult patients with bile duct cysts seen at the Lahey Clinic (Burlington, Mass) during a 20-year period, the median age at time of initial therapy at Lahey Clinic was 34 years. Abdominal pain was the most common presenting symptom, followed by jaundice and fever. The 31 patients underwent a total of 86 biliary tract procedures, of which 37 were performed at Lahey Clinic. Internal drainage was the most common operation, but it frequently resulted in recurrent symptoms requiring reoperation. Cyst excision was associated with a significantly lower incidence of recurrent cholangitis and need for reoperation and was not associated with increased operative mortality. Cystic disease was frequently associated with other hepatobiliary diseases. Biliary carcinoma occurred in five (16%) of our patients, and late deaths from biliary-related disease occurred in seven patients (22%). When technically possible, cyst excision is the treatment of choice. ( Arch Surg 1986;121:410-415)

Internal Ureteral Stents for Conservative Management of Ureteral Calculi during Pregnancy

Abstract: DURING pregnancy, acute problems of the urinary tract, especially urinary calculi, are the most common cause of abdominal pain severe enough to require hospitalization. The incidence of urinary cal...

Abdominal migraine: a childhood syndrome defined

Abstract: It has long been recognized that some cases of recurrent abdominal pain in children are related to migraine, but the diagnostic criteria for abdominal migraine have not been defined. We have identified a group of children with recurrent abdominal pain who had a family history of migraine—in over half the cases in a first-degree relative—and who obtained marked relief from their symptoms from specific anti-migraine therapy. These children had a well-defined syndrome comprising episodes of midline abdominal pain of sufficient severity to interfere with normal activities and lasting for prolonged periods, frequently accompanied by pallor, headache, anorexia, nausea, and vomiting. It is proposed that these children have “abdominal migraine”.

Pancreatic tissue pressure and pain in chronic pancreatitis.

Abstract: Summary Pancreatic tissue pressure (PTP) was measured peroperatively by the needle technique in 14 patients with chronic pancreatitis undergoing drainage operations for pseudocysts (six patients) or dilated ducts (eight patients). All patients suffered from severe abdominal pain before the operation, and a pain evaluation was made at discharge and after 8–18 months of observation. PTP was increased in all patients and was not different in the two groups. PTP decreased significantly in both groups after drainage. Pain relief at discharge was good or fair in 12 patients and poor in one (one patient died postoperatively). During observation, pain returned in four patients. Long-term pain relief was not related to PTP decrease, PTP after operation, type of operation, or patency of anastomosis as seen by endoscopic retrograde pancreaticography.

Abdominal pain in patients with acquired immune deficiency syndrome.

Abstract: The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered.

Associations between symptoms of irritable colon and psychological and social conditions and lifestyle.

Abstract: In a survey of risk factors for coronary heart disease 14 102 middle aged men and women answered a questionnaire on lifestyle, diet, and health, including symptoms of functional abdominal disorders. The overall prevalence of reports of one or both of the abdominal symptoms of "bloating and rumbling" or "cramping abdominal pain" was 28% in men and 35% in women. Only a weak negative association between age and prevalence of reported pain was found in both sexes. Women reported abdominal symptoms, especially cramping abdominal pain, significantly more commonly than men. In a multiple regression analysis abdominal symptoms were much more strongly associated with symptoms of mental stress such as depression, sleeping difficulties, problems of coping, and the use of analgesics than with lifestyle, dietary, and social variables together. The association was stronger in subjects reporting both symptoms. This strong and consistent association between functional abdominal disorders and psychological and social problems suggests that action other than prescribing drugs, diets, or radiography is required.

Volvulus of the small intestine in adults

Abstract: The presentation and subsequent management of 53 patients with volvulus of the small bowel are reviewed. Important features of the presentation are the acute onset of the abdominal pain and its severity which is often inconsistent with the findings on clinical examination. The diagnosis was made preoperatively from plain abdominal x-rays in only 1 patient, although several radiological features are described. In 16 patients there were no obvious predisposing factors, although in the remaining 37 patients the volvulus occurred as a consequence of a predisposing anatomical abnormality. The mortality rate associated with volvulus in the presence of gangrenous small bowel is 47%. In the management of a patient presenting with small bowel obstruction, the possibility of volvulus must be considered in order to reduce this high mortality.

Abdominal pain in neutropenic cancer patients

Abstract: A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.

Neutropenic Enterocolitis in Adults With Acute Leukemia

Abstract: • Neutropenic enterocolitis has been previously described only by case reports and literature reviews. Of 499 adults with acute leukemia seen over a 23-year period (1962 to 1985), 13 cases (2.6%) of neutropenic enterocolitis have been reported. Eleven of these 13 patients were profoundly neutropenic (mean white blood cell count, 472/cu mm) and developed abdominal symptoms during either initial induction or relapse of acute leukemia. Histologic confirmation was available in ten cases, five cases after surgical resection and five cases at autopsy after nonoperative management. Three patients with isolated ileocecal inflammation without infarction at the time of surgery were successfully managed without resection. Five patients treated with surgery died four to 64 weeks postoperatively (mean survival, 21.6 weeks) of nonsurgical complications of leukemia. Three patients were still alive, one patient 42 months after right hemicolectomy and two patients five months after exploration only. All five patients managed medically died an average of 1.4 days (range, zero to four days) after the onset of abdominal pain. Survival in patients with acute leukemia who develop neutropenic enterocolitis is determined by early recognition and appropriate surgical exploration that can be expected to yield an acceptable operative mortality. ( Arch Surg 1986;121:571-574)

Gaucher disease: sonographic appearance of the spleen

Abstract: Ultrasonographic (US) examinations of the upper abdomen were performed in 80 patients with Gaucher disease. Of the 49 patients that had not undergone splenectomy, 47 had splenic enlargement. Sixteen patients had multiple lesions in the spleen. Most patients had discrete hypoechoic lesions that corresponded pathologically to focal homogeneous clusters of Gaucher cells. Several patients had similar lesions that were hyperechoic and were composed of Gaucher cells and fibrosis or infarction. A few patients had a geographic pattern of irregular areas of involvement of Gaucher cells among normal splenic parenchyma. The liver was often enlarged but otherwise sonographically unremarkable. Patients with Gaucher disease often have US examinations of the left upper quadrant for abdominal pain. A variety of US findings in the spleen typical for Gaucher disease should be recognized and not interpreted as acute changes.

Plain film evaluation of patients with abdominal pain: are three radiographs necessary?

Abstract: Current recommendations for the plain radiographic evaluation of abdominal pain suggest a minimum three-film series including an erect and supine abdominal view and an erect chest study. Three film radiographic abdominal "series" were obtained in 252 consecutive emergency-room patients who presented with abdominal pain. The views were analyzed independently for their relative diagnostic value. Radiologic pathologic findings were present in 20% of the abdominal films and in 13% of the chest radiographs. The supine abdominal view and the erect chest study diagnosed normality or abnormality in 98% of these patients. The elimination of the erect abdominal view from the routine abdominal series could result in financial savings, decreased radiation exposure, and a more efficient use of technician time, without significant loss of diagnostic information.

Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease.

Abstract: Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.

Research note: temperament and behaviour in six-year-olds with recurrent abdominal pain: a follow up.

Abstract: Dimensions of temperament and behaviour were measured in a group of infant school children with recurrent abdominal pain and in a control group. Children with recurrent abdominal pain were temperamentally more difficult than those without, and in particular, girls were found to have a more irregular temperamental style and boys to be more likely to withdraw in new situations. Temperamental differences were more persistent than the abdominal pain itself. There was little difference behaviourally between the groups. It is hypothesized that abdominal pain represents an interaction between a vulnerable temperamental style and environmental stresses.

Epidemiology of intestinal functional disorders in an apparently healthy population

Abstract: The characteristics and the prevalence of functional bowel disorders in the general French population are unknown. Based on an epidemiological inquiry in a random population of 1,200 persons who were not seeking care, residents in our country we established: the prevalence of symptoms suggestive of functional bowel disorders; the epidemiological differences between symptomatic subgroups which included abdominal pain with or without bowel dysfunction, diarrhea and constipation. The amount of cases and the prevalence in each subgroup were: abdominal pain, 165, 13.8 p. 100, painless constipation, 75, 6.3 p. 100, diarrhea, 10, 0.8 p. 100. As a whole, functional bowel disorders occurred in 20 p. 100 of our population. The "irritable bowel syndrome" group defined as abdominal pain and/or diarrhea differ from normal subjects by the following higher frequency of age under 50, subjects in active duty, antecedents of diverticulosis, influence of stress on symptoms, nausea, vomiting, migraines, pyrosis and number of visits to a doctor. However neither the sex-ratio nor professional occupation were relevant. The constipation group differed from normal because of the higher frequency of female sex, antecedents of hiatus hernia, use of laxatives but not because of age nor by the number of associated symptoms. In conclusion, functional bowel disorders occurred in 20 p. 100 of our population; two subgroups were clearly different from an epidemiological point of view, the irritable bowel syndrome (13 p. 100) and constipation (7 p. 100); therefore these two groups deserve a specific physiopathological, psychological and therapeutic approach.

Management of the ileocecal syndrome. Neutropenic enterocolitis.

Abstract: Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a recognized complication of the treatment of hematologic malignancies and usually is fatal. The pathologic findings consist of bowel-wall ulcerations and necrosis with bacterial or fungal invasion. These findings are usually limited to the ileum, cecum, ascending colon, and appendix. The syndrome occurs in a select patient population who generally have 1) a hematologic malignancy, 2) neutropenia, 3) thrombocytopenia, 4) a recent course of chemotherapy, and 5) a recent course of antibiotics. This syndrome also can arise spontaneously in patients with aplastic anemia or cyclic neutropenia. The clinical presentation consists of a high fever and right-sided abdominal pain with evidence of peritoneal irritation. Recommended therapy is right hemicolectomy. Experience and a critical review of the literature support this approach.

Depression and functional bowel disorders in gastrointestinal outpatients.

Abstract: Although depression has been linked with both the irritable bowel syndrome and non-organic abdominal pain, which are common in gastrointestinal outpatients, the prevalence of depression in most surveys of outpatient practice has been low. Use of the Beck Depression Inventory to screen new referrals to a general medical and gastrointestinal clinic and to a minor surgical clinic showed that 50 of 100 medical patients were rated as having some degree of depression, compared with 14 of 75 (19%) of the surgical patients in whom abdominal pain and bowel dysfunction were rare (X2 = 9.6, p less than 0.01). In the medical clinic no organic disorder was detected in 64% of the depressed patients, the majority of whom presented with abdominal pain or irritable bowel syndrome. Depression was significantly commoner in this group of patients than in those with other conditions, (X2 = 6.63, p = 0.01). That depression is common in gastrointestinal outpatients is not always appreciated and its symptoms should be sought in all patients with bowel dysfunction and chronic abdominal pain.

Associations between symptoms ofirritable colon and psychological andsocial conditions andlifestyle

Abstract: Inasurvey ofrisk factors forcoronary heart disease 14102 middle agedmenandwomenanswered a questionnaire on lifestyle, diet, andhealth, including symptoms offunctional abdominal disorders. Theoverall prevalence ofreports ofoneor bothoftheabdominal symptoms of"bloating andrumbling" or "cramping abdominal pain" was28"!. inmenand35%inwomen. Onlyaweaknegative association between ageandprevalence of reported painwasfoundinbothsexes. Women reported abdominal symptoms, especially cramping abdominal pain, significantly morecommonly thanmen.Inamultiple regression analysis abdominal symptoms weremuchmorestrongly associated withsymptoms ofmental stress suchasdepression, sleeping difficulties, problems ofcoping, andtheuseofanal