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PubMedDate not supplied

[Acute abdomen: emergency laparoscopy or observation?].

Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomised controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation approach. From July 1993 to August 2004, 522 patients consecutively admitted with acute abdomen were randomised to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of child-bearing age, and chest and/or abdominal radiography, if indicated clinically. Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (p < 0.05). In the observation group, 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopy group (p < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (p < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs 7.3 days) (p < 0.01). Eight patients in group 1 required readmission (total readmission: 46 days) compared with 58 patients in group 2 with a total readmission of 201 days (p < 0.05). Early laparoscopy is valuable in the management of acute abdomen. It affords significantly higher diagnostic accuracy and a greater improvement in quality of life than the more traditional observation approach.

Abdomen, Acute↗

PubMed2005

Neurological manifestations of an acute abdomen in children.

The acute abdomen in the pediatric age group is not infrequently fraught with diagnostic pitfalls. The younger the patient, the more problematic the presentation can be. Among the more unusual manifestations of an acute abdomen is an apparent encephalopathic picture. We present 2 cases which serve to illustrate the diagnostic difficulties encountered.

Abdomen, Acute↗

PubMed2002

[Acute abdomen after cardiac surgery].

Acute abdomen after cardiosurgery accounts for a minor group of complications, however, they are associated with a high mortality and morbidity. In 2001 in the authors department 940 cardiac operations were performed. In four patients (0.43%) during the early postoperative period acute abdomen developed which called for urgent surgical intervention. Two patients died. Only early diagnosis and subsequent urgent laparotomy can have a positive impact on the prognosis of this group of patients.

Abdomen, Acute↗

PubMed2003

Anesthesia for the acute abdomen patient.

Patients with acute abdomen often have marked physiologic and pathologic changes, making anesthesia both challenging and potentially hazardous for the patient. A thorough understanding of the pathophysiologic mechanisms of cardiovascular function under anesthesia and selection of appropriate anesthetic protocols are critical to a successful anesthetic outcome. The goal is to produce anesthesia while minimizing depression of the cardiovascular system. Monitoring and management of acid-base and cardiovascular function serve to ensure appropriate oxygen delivery to the tissues during anesthesia. Postoperative management can significantly influence patient outcome following anesthesic recovery, and must therefore be considered in the anesthetic plan. Finally, pain management in all patients is an important aspect of case management, and should not be overlooked. This article serves to educate the clinician in the above-described areas in regard to the acute abdomen patient.

Abdomen, Acute↗

PubMed1990

An experience with diagnostic paracentesis in 100 cases of acute abdomen.

Prognosis of acute surgical conditions of abdomen of both traumatic and non-traumatic origin depends on accurate diagnosis and early surgical intervention. However, the diagnosis in acute abdomen is quite difficult. The problem becomes more complex when 24 hours services of radiology and laboratories are not available. Abdominal tap gives a valuable clue to diagnosis. A 10 ml syringe fitted with a 20 gauge intravenous needle was used for the purpose. Both the flanks and the four quadrants of the abdomen were selected for site of the tap according to the suspected pathology. Results were indicated as positive when abnormal fluid (clear, turbid, purulent, bloody, serosanguinous, bile stained and urine, etc) were aspirated. Accurate diagnosis were made in 84.3% in blunt abdominal trauma and 76.47% in non-traumatic acute abdomen. High incidence of accurate results were obtained in gastroduodenal perforations (92%), ruptured ectopic gestation (100%) and burst amoebic liver abscess (100%). The procedure is very simple which could be done at bed side without much disturbance to the severely ill patients. It is safe and free from any complications even if the bowel is also punctured during the tap.

Abdomen, Acute↗

PubMedDate not supplied

[Laparoscopy in an abdominal emergency: the diagnosis and therapy in 3 clinical cases of acute abdomen].

Authors report three cases of acute abdomen due a probable appendicitis and submit to laparoscopic procedure. In the first case acute abdomen was due to a bowel obstruction secondary to an ectopic pregnancy; in the second case acute appendicitis was associated with a rare congenital malformation (atresia of uterus); in third case acute abdomen was due to a rare case of torsion of accessory spleen in an adult. In all the cases laparoscopy demonstrated the elective procedure in urgency, permitting the diagnosis and the surgical treatment of acute abdomen with the post-operatory advantage of the technique.

Abdomen, Acute↗

PubMed2006

Eosinophilic gastroenteritis presenting as acute abdomen.

Many causes of acute abdomen are diagnosed on computed tomography (CT). We present two cases of eosinophilic gastroenteritis that showed mural thickening of the stomach, duodenum, and/or proximal jejunum on CT. The correct diagnosis was made by checking the eosinophil count, and, in one case, unnecessary surgery was avoided.

Abdomen, Acute↗

PubMed2003

[Ogilvie's syndrome: a rare cause of the acute abdomen].

Ogilvie's syndrome (acute colonic pseudo-obstruction) is a rare clinical disease characterized by segmental distension of the proximal colon caused by a paralysis without mechanic obstruction. It may be a sequel of underlying neurological, medical or surgical disease. Risk factors are respiratory decompensation, electrolyte disturbances and different drugs. A special kind is the primary idiopathic pseudoobstruction with a high risk of perforation or necrosis. Especially elderly patients (> 70 years) with cardiovascular or neurologic diseases and accordant drugs are concerned. Clinical symptoms are progressive abdominal distension and abdominal pain like an acute abdomen. The differential diagnosis of a mechanic ileus is important for further treatment. This case report should draw attention to this rare disease.

Abdomen, Acute↗

PubMedDate not supplied

Polyarteritis nodosa. An unusual cause of acute abdomen.

Two cases of acute abdomen operated on twice and biopsy specimens confirmed are presented. The diagnosis of a systemic necrotizing vasculitis group of polyarteritis nodosa was established. The syndrome affects predominantly males between the second and forth decade of life. The gastrointestinal tract is involved in approximately 50% of the cases. While a negative laparotomy may be considered as a surgical pit-fall, nevertheless, it is the only way of establishing the diagnosis and treating the complications of the disease in some of the cases.

Abdomen, Acute↗

PubMed2003

Unusual causes of acute abdomen in a Nigerian hospital.

UNLABELLED: Acute abdomen is the most common abdominal emergency associated with high morbidity and mortality in General surgical practice. Over a 7-year period, a study of unusual causes of acute abdomen was undertaken, with the aim of identifying these causes and outcome of operative management. Eleven cases were identified accounting for 4% of cases of acute abdomen seen during the period of the study. Four cases of liver diseases (33.3%) comprising 2 patients (16.7%) with ruptured primary liver cell carcinoma, 1 (one) case each of haemoperitoneum due to ruptured liver haemangioma and haemorrhagic disorders from liver cirrhosis. One patient had acute leukaemia with massive haemoperitoneum and acute abdomen. Five (45.5%) had gastrointestinal perforations; 1 patient (9%) each had multiple jejunal perforations, perforation of stomal ulcer at gastrojejunostomy site, perforation of gastric cancer; perforated carcinoid tumour of sigmoid colon and idiopathic perforation of the caecum. There was also a case of caecal volvulus. Mortality was 7 patients (63.6%). All patients with liver pathology and acute leukaemia died. The cases of malignant tumour perforation were well and alive 4-6 years after the operation. CONCLUSION: Operation could have been avoided in 45.5% of these cases if the appropriate investigations, had been available and carried out.

Abdomen, Acute↗

PubMed1998

Efficacy of routine laparoscopy for the acute abdomen.

BACKGROUND: Laparoscopic surgery of selected acute abdominal conditions has been shown to be highly effective. Therefore, we investigated the diagnostic accuracy and therapeutic efficacy of routine laparoscopic surgery for the acute abdomen. METHODS: After appropriate investigations, patients with acute abdomen, with or without a specific diagnosis, were offered the options of either laparoscopic or open surgery. Postoperatively, we analyzed the outcome measures of diagnostic accuracy, complications, and operating time of laparoscopy. The hospital stays for our patients were compared to case-matched controls. RESULTS: The accuracy of laparoscopic diagnosis is the same as laparotomy. The 62% of our patients who were managed totally laparoscopically required shorter hospitalization than the case-matched controls treated by open operation. Morbidity was not increased by laparoscopy in patients who required conversion to open operation. The additional cost of laparoscopy appeared modest. CONCLUSIONS: Routine laparoscopy for the acute abdomen is safe and accurate. Patients eligible for laparoscopic treatment also require less hospitalization time.

Abdomen, Acute↗

PubMed1998

Acute abdomen in pregnancy.

OBJECTIVE: To calculate the frequency of acute abdomen in pregnancy due to non-obstetric causes in a Saudi population, to discuss the etiology of the high incidence, to discuss how pregnancy altered the symptomatology of acute abdomen and to evaluate the result of early surgical intervention and use of tocolytics on maternal and fetal health. DESIGN: Retrospective analytic study of all cases of acute abdomen in pregnancy admitted between 1/1/1991 and 31/12/1993 to evaluate the result of early surgical intervention and use of tocolytics. SETTING: The surgical wards of Asir Central Hospital, Abha, Saudi Arabia. SUBJECTS: Sixty pregnant Saudi females who were admitted because of acute abdomen due to non-obstetric causes. RESULTS: The frequency of acute abdomen in pregnancy due to non-obstetric causes in this population is 0.39% which is high in comparison to other studies and the etiology is multifactorial. Resemblance of early acute abdomen symptoms like nausea, vomiting to those of normal pregnancy and the anatomical displacement of abdominal organs by the pregnant uterus greatly masked the clinical picture and enhanced surgical delay awaiting definitive criteria for surgical intervention. This delay significantly increased maternal morbidity (P < 0.05) and resulted in a poor fetal outcome. Those who had early surgical intervention had a better perinatal outcome (P < 0.001) and decreased maternal morbidity (P < 0.05). Although tocolytics were used, they proved to be ineffective, altered the maternal clinical picture and had fetal side-effects. CONCLUSION: There is a higher incidence of acute abdomen in pregnancy and although pregnancy blunted the clinical picture, early surgical intervention resulted in a better perinatal outcome and decreased maternal morbidity. Tocolytics had their side effects and did not improve the fetal outcome.

Abdomen, Acute↗

PubMed1995

[Endometriosis of the bladder muscular layer as a cause of acute abdomen].

OBJECTIVES: A case of acute abdomen arising from endometriosis of the bladder is described. The rarity of this condition prompted us to report on the present case and the problems encountered in making the differential diagnosis. METHODS/RESULTS: A patient with endometriosis of the muscle layer of the bladder mimicking acute gynecological abdomen is described. CONCLUSIONS: Endometriosis of the bladder is extremely rare and usually presents as urinary problems and rarely as acute abdomen.

Abdomen, Acute↗

PubMed2000

The acute abdomen and the obstetrician.

An acute abdomen in pregnancy can be caused by pregnancy itself, be predisposed to by pregnancy or be the result of a purely incidental cause. These various conditions are discussed. The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. The clinical evaluation is generally confounded by the various anatomical and physiological changes occurring in pregnancy itself. Clinical examination is further hampered by the gravid uterus. The general reluctance to use conventional X-rays because of the pregnancy should be set aside when faced with the seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both mother and fetus. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems regardless of the pregnancy.

Abdomen, Acute↗

PubMed1956