PubMed · 7244794
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L F Rudneva, V N Ivanenko. 1981. [Dissecting aortic aneurysm].. https://pubmed.ncbi.nlm.nih.gov/7244794/
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A total of 3,727 in-patients with acute abdominal symptoms were identified during the first quarter of 1995 at the surgical clinics of the nine hospitals with emergency departments in the county of Stockholm. The diagnoses were: non-specific abdominal pain 24%; cholecystitis 9%; appendicitis 8%; bowel obstruction 7%; intra-abdominal malignancy, diseases of the urinary tract and peptic ulcer 6% each; gastrointestinal hemorrhage, diverticulitis of the colon and pancreatitis 5% each; other diseases as a cause of abdominal symptoms, 19%. 1,601 operations were performed of which 47% were endoscopic procedures. The mean duration of hospital stay was 4.8 days. The length of stay increased significantly with age. The age-related relative frequency of hospitalization due to acute abdominal pain was also dramatically higher in the elderly cohorts. These facts and the prognosis of an 18% increase of inhabitants 50 years of age or older until 2010 in Greater Stockholm signal an increased need of hospital resources for this large group of patients in the coming years.
We present the case of a 17 years old man with fasciola hepatica infection. After initial therapy with Praziquantel and Metronidazole abdominal pain as well as eosinophilia persisted. The diagnosis was made by ERC and examination of the bile, where typical ovulas were found. An analysis of faeces and the serology (ELISA, IFAT) were not diagnosticated. After papillotomy, extraction of the parasites and therapy with Triclabendazole the patient became asymptomatic, the serology turned to negative and the haematology was normalised.
In the large majority of cases, acute appendicitis can be diagnosed on the basis of the medical history and the patient's symptoms. Urine should be drawn from every patient for urinstix and bacteriological testing, as well as blood for a blood count, electrolytes and coagulation parameters. A US should be performed, in particular to exclude possible other diagnoses. Women should be examined by a gynecologist. Once the diagnosis has been established, the patient must be sent for surgery without delay. Should there be reason for doubt, further diagnostic measures (in particular CT) should be carried out as permitted by the urgency of the case. In life-threatening situations, laparoscopy should be done immediately, and preparations made for laparotomy should this be necessary. If the symptoms are such that a wait-and-see attitude is justified, continued observation and follow-up examinations are recommended. The diagnosis of acute appendicitis can be difficult, and every patient who rouses relevant suspicion, should be seen by a surgeon.