The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transp...The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).展开更多
Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hosp...Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hospital from March 2023 to March 2024 were selected, all of whom were acute abdomen patients admitted to the Department of Obstetrics and Gynecology. In this study, the patients were divided into two groups. One group of 40 patients was given a simple abdominal B-ultrasound diagnosis (control group). The other group of 40 patients was given both abdominal and vaginal B-ultrasound examinations (experimental group). The diagnostic accuracy between the two groups was compared. Results: Patients in the experimental group had higher consistency rates with pathological diagnosis results in ectopic pregnancy rupture, embryonic arrest, acute pelvic inflammation, corpus luteum rupture, and intrauterine adhesions as compared to the control group. At the same time, the inspection accuracy rate of the experimental group (92.50%) was higher than that of the control group (70.00%) (P < 0.05). Conclusion: The combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen was of great significance in improving the accuracy of clinical diagnosis and guiding doctors to provide effective treatment.展开更多
Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures ...Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.展开更多
BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the mos...BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.展开更多
Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of ac...Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1<sup>st</sup> Jan 2017 to 31<sup>st</sup> Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.展开更多
Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal ...Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.展开更多
Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: ...Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.展开更多
The changes of Toll-like receptor （TLR） 2, 4 of peripheral blood mononuclear cells （PBMCs） in the acute abdomen patients associated with systemic inflammatory response syndrome （SIRS） and their potential signifi...The changes of Toll-like receptor （TLR） 2, 4 of peripheral blood mononuclear cells （PBMCs） in the acute abdomen patients associated with systemic inflammatory response syndrome （SIRS） and their potential significance were explored. A clinical study was performed on 103 acute abdomen patients in whom 65 were associated with SIRS. Forty healthy individuals served as normal controls. The mRNA expression of TLR2, 4 was detected by RT-PCR, and the expression of TNF-α and IL-6 by ELISA. The level of plasma endotoxin, hospital stay and mortality were measured. It was found that the endotoxin level was increased to varying degrees in all the acute abdomen patients, and the endotoxin level was and hospital stay longer in SIRS group than in non-SIRS group （P〈0.01）. TLR2 mRNA, TLR4 mRNA, IL-6 and TNF-ct could be detected with low value in normal controls, but they were up-regulated markedly on the 1 st day after admission. Then TLR4 mRNA, IL-6 and TNF-α were decreased gradually, but TLR2 mRNA maintained at a high level till the 5th day. These indexes above in SIRS group were higher than those in non-SIRS group （P〈0.01）. The results of correlation analysis revealed the expression of TLR2, 4 mRNA was positively correlated with the levels of TNF-α and IL-6, and the hospital stay, The results of Logistic regression demonstrated that overexpression of TLR2, 4 mRNA might result in higher risk of multiple organ dysfunction syndrome （MODS）. It was concluded that in the acute abdomen patients associated with SIRS, the expression of TLR2, 4 in PBMCs was increased markedly, suggesting that TLR might play an important role in the pathogenesis of acute abdomen associated with SIRS.展开更多
The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bo...The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.展开更多
A case of spontaneous rupture of giant gastrointestinal stromal tumor(GIST) of stomach causing acute abdomen is described below. A male patient with abdominal mass presented with symptoms and signs of acute abdomen af...A case of spontaneous rupture of giant gastrointestinal stromal tumor(GIST) of stomach causing acute abdomen is described below. A male patient with abdominal mass presented with symptoms and signs of acute abdomen after admitting for 1 day. After preoperative management and evaluation, an exploratory laparotomy was performed, where rupture of a huge tumor in the stomach was found. A subtotal gastrectomy including the mass was performed and the final immunohistochemical examination verified that the neoplasm was a high risk GIST. The postoperative period was uneventful and the patient received treatment with imatinib mesylate, and regular follow-up without recurrence.展开更多
Acute abdomen is an emergency diseasecommonly seen in clinic.It can be caused bymany diseases and is characterized by ab-rupt onset,acute abdominal pain and evenshock in severe cases.Since 1977,I haveused electro-acup...Acute abdomen is an emergency diseasecommonly seen in clinic.It can be caused bymany diseases and is characterized by ab-rupt onset,acute abdominal pain and evenshock in severe cases.Since 1977,I haveused electro-acupuncture to treat this dis-ease and made a summary of 164 cases展开更多
Spontaneous rectus sheath hematoma(SRSH) is a rare entity that mimics acute abdomen.Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without...Spontaneous rectus sheath hematoma(SRSH) is a rare entity that mimics acute abdomen.Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms presentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis.Stable SRSH can be managed conservatively with good outcome.展开更多
102 cases of the acute abdominal disease were treated with the blood-lettingpuncture and cupping. 56 cases were cured, 22 markedly effective, 17 improved and 7 ineffective.Total effective rate was 93.1%.
Rationale:As an uncommon manifestation of congestive heart failure,congestive hepatopathy requires an early diagnosis in order to render appropriate care.Misdiagnosis as intraabdominal sepsis may lead to erroneous ini...Rationale:As an uncommon manifestation of congestive heart failure,congestive hepatopathy requires an early diagnosis in order to render appropriate care.Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention,such as fluid boluses,that can potentially tip an already sick patient with poor reserves over into an extreme state.Patient’s Concern:A 65-year-old man was brought to the emergency department for excruciating abdominal pain,vomiting and jaundice.He also had lower limb pitting edema and was hypotensive en route.Diagnosis:Congestive hepatopathy.Interventions:Intravenous furosemide and fluid restriction.Outcomes:The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department.Lessons:It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies.In this case of acute decompensated congestive heart failure,early recognition of the cause makes a difference to the management.展开更多
Acute abdomen is a common presentation in emergency medicine. It represents 5% to 10% of all Emergency Department (ED) visits. Diagnosis by imaging includes digital X-ray unit, sonography (US) unit and computed tomogr...Acute abdomen is a common presentation in emergency medicine. It represents 5% to 10% of all Emergency Department (ED) visits. Diagnosis by imaging includes digital X-ray unit, sonography (US) unit and computed tomography (CT) equipment. During the last years, a trend towards increased use of computed tomography in patients with acute abdomen can be seen. Additionally, patient with severe claustrophobic often cannot tolerate MR scanner. The aim of the present study was to investigate the possibility of optimizing Helical CT parameters in the protocol and emphasize the CT features of selected cases of disorders related acute abdominal complain at the Emergency Department both in general and in a number of selected conditions (Urolithiasis, Aortic Aneurysm Rupture and acute cholecystitis). According to this work findings, non-contrast CT after ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Contrast-enhanced CT was highly sensitive for acute aortic syndrome and therefore the CT imaging protocols must be adjusted in order to minimize dose from radiation.展开更多
Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and ...Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of acute surgical abdomens operated in the surgical emergency department of the Centre Hospitalier Universitaire Souro Sanou (CHUSS). This was a retrospective descriptive study of 426 cases of surgical acute abdomens operated in the CHUSS surgical emergency department from 1 January to 31 December 2015. These 426 cases accounted for 24.14% of the emergency interventions carried out in the CHUSS surgical emergency department. These were 314 (73.7%) men and 112 (26.3%) women with an average age of 30 years. Among the causes, there were 187 (43.9%) cases of acute generalized peritonitis, 71 (16.7%) cases of acute intestinal occlusions, 49 (11.5%) cases of acute appendicitis, 38 (9.4%) cases of strangulated parietal hernias, 16 (3.8%) cases of abdominal contusions, and 15 (3.5%) cases of penetrating wounds of the abdomen. The appendectomy was the most performed gesture with 112 (26.3%) cases. The time to surgery was greater than 48 hours in 29 (6.8%) cases. Complications were observed in 68 (16%) cases with 35 (8.2%) cases of parietal infections, 18 (4.2%) cases of postoperative peritonitis. The death occurred in 37 (8.7%) patients. The average hospital stay was 8.7 days. Improving the prognosis of acute surgical abdomens requires early diagnosis and treatment, as well as better postoperative follow-up.展开更多
Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We ...Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.展开更多
Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly pro...Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly prominent.Objective:To explore the application effect of student standardized patient(SSP)in the clinical teaching of acute abdomen.Methods:Fifty-four fifth-year general medical students from class 1826 of the general department of The First Affiliated Hospital of Xi’an Medical University were selected as the research subjects and randomly divided into two groups,with 27 students in the experimental teaching group,and the remaining 27 students in the conventional teaching group.The experimental teaching group adopted the SSP teaching approach.The SSPs were generated from the training students of the hospital through the recruitment and training process of SSP.In this study,seven qualified SSPs were selected for the clinical teaching of acute abdomen.At the end of the course,a periodic assessment was held.The rank sum test was used to compare the excellent and good rates between the two groups,while t-test was used to compare the difference between the two groups.Results:The results showed that the excellent and good rate of the experimental teaching group was significantly higher than that of the conventional group,in which the difference between the two groups was statistically significant(p<0.05).In terms of the assessment results,the theoretical scores and skills scores of the experimental teaching group were better than those of the conventional teaching group,in which the differences between the two groups were statistically significant(p<0.05).Conclusion:Through the training of SSP for acute abdomen and its application in surgical teaching and examination,the superiority of SSP is emphasized.Although there are still some shortcomings in the application of SSP in clinical teaching,it is a relatively new and effective teaching method,and it will play an increasingly critical role in clinical skills training pertaining to the medical specialty.展开更多
Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset an...Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, HenochSchnlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.展开更多
The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim o...The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim of this study was to demonstrate optimum CT aspects and emphasize on the important features of CT for those patients presenting with an acute abdominal pain at the Emergency Department both in general and in a number of selected conditions (appendicitis, small-bowel obstruction, acute pancreatitis, and diverticulitis). The reported data by this study are based on the author working experience, which forms a continuous protocol adjustment process. The present study provides evidence that CT would result in definite diagnosis of patients with abdominal pain in terms of the detection of some urgent conditions.展开更多
文摘The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).
文摘Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hospital from March 2023 to March 2024 were selected, all of whom were acute abdomen patients admitted to the Department of Obstetrics and Gynecology. In this study, the patients were divided into two groups. One group of 40 patients was given a simple abdominal B-ultrasound diagnosis (control group). The other group of 40 patients was given both abdominal and vaginal B-ultrasound examinations (experimental group). The diagnostic accuracy between the two groups was compared. Results: Patients in the experimental group had higher consistency rates with pathological diagnosis results in ectopic pregnancy rupture, embryonic arrest, acute pelvic inflammation, corpus luteum rupture, and intrauterine adhesions as compared to the control group. At the same time, the inspection accuracy rate of the experimental group (92.50%) was higher than that of the control group (70.00%) (P < 0.05). Conclusion: The combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen was of great significance in improving the accuracy of clinical diagnosis and guiding doctors to provide effective treatment.
文摘Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.
文摘BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.
文摘Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1<sup>st</sup> Jan 2017 to 31<sup>st</sup> Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.
文摘Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.
文摘Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.
基金This project was supported by a grant from National Natural Sciences Foundation of China (No. 30200272).
文摘The changes of Toll-like receptor （TLR） 2, 4 of peripheral blood mononuclear cells （PBMCs） in the acute abdomen patients associated with systemic inflammatory response syndrome （SIRS） and their potential significance were explored. A clinical study was performed on 103 acute abdomen patients in whom 65 were associated with SIRS. Forty healthy individuals served as normal controls. The mRNA expression of TLR2, 4 was detected by RT-PCR, and the expression of TNF-α and IL-6 by ELISA. The level of plasma endotoxin, hospital stay and mortality were measured. It was found that the endotoxin level was increased to varying degrees in all the acute abdomen patients, and the endotoxin level was and hospital stay longer in SIRS group than in non-SIRS group （P〈0.01）. TLR2 mRNA, TLR4 mRNA, IL-6 and TNF-ct could be detected with low value in normal controls, but they were up-regulated markedly on the 1 st day after admission. Then TLR4 mRNA, IL-6 and TNF-α were decreased gradually, but TLR2 mRNA maintained at a high level till the 5th day. These indexes above in SIRS group were higher than those in non-SIRS group （P〈0.01）. The results of correlation analysis revealed the expression of TLR2, 4 mRNA was positively correlated with the levels of TNF-α and IL-6, and the hospital stay, The results of Logistic regression demonstrated that overexpression of TLR2, 4 mRNA might result in higher risk of multiple organ dysfunction syndrome （MODS）. It was concluded that in the acute abdomen patients associated with SIRS, the expression of TLR2, 4 in PBMCs was increased markedly, suggesting that TLR might play an important role in the pathogenesis of acute abdomen associated with SIRS.
文摘The differential diagnosis of acute abdomen is typically extremely broad in range, with vasculitis posing a rare but potentially life-threatening cause of acute abdomen. Here, we report a case of acute abdomen with bowel wall thickening limited to jejunum, accompanied by unexplained renal dysfunction. Later, the patient was diagnosed as having polyarteritis nodosa based on surgically resected jejunal necrosis. Despite aggressive treatment, including the use of steroid pulse therapy and continuous hemodiafiltration, the patient died. Although polyarteritis nodosa is extremely rare in patients with acute abdomen, acute abdomen is relatively common manifestation of that. And it is reported that involvement of small intestine suggests poorer prognosis. Our case highlights the importance of vasculitis as a differential diagnosis of patients with atypical acute abdomen. In this report, we not only review possible clues that might have led to an earlier diagnosis in this case, but also attempt to draw some lessons for treating similar cases in the future.
文摘A case of spontaneous rupture of giant gastrointestinal stromal tumor(GIST) of stomach causing acute abdomen is described below. A male patient with abdominal mass presented with symptoms and signs of acute abdomen after admitting for 1 day. After preoperative management and evaluation, an exploratory laparotomy was performed, where rupture of a huge tumor in the stomach was found. A subtotal gastrectomy including the mass was performed and the final immunohistochemical examination verified that the neoplasm was a high risk GIST. The postoperative period was uneventful and the patient received treatment with imatinib mesylate, and regular follow-up without recurrence.
文摘Acute abdomen is an emergency diseasecommonly seen in clinic.It can be caused bymany diseases and is characterized by ab-rupt onset,acute abdominal pain and evenshock in severe cases.Since 1977,I haveused electro-acupuncture to treat this dis-ease and made a summary of 164 cases
文摘Spontaneous rectus sheath hematoma(SRSH) is a rare entity that mimics acute abdomen.Rectus sheath hematoma is the accumulation of blood in rectus sheath due to muscle or epigastric vessel injury. However, SRSH without a trauma or anticoagulation is rare. It frequently mimics acute abdomen and it may lead to misdiagnosis and unnecessary laparotomy. In this article, we described two cases of SRSH with their diagnostic and therapeutic strategy. Both of our patients in report were neither consumed antiplatelet nor coagulopathy. They both had abdominal muscle straining before their symptoms presentation. We hypothesized that the SRSH may be induced by rectus muscle injury secondary to inappropriate straining or posture. To diagnose SRSH, clinical findings are important but radiologic imaging such as computed tomography, can be diagnostic. In expanding SRSH, percutaneous arterial embolization of epigastric artery is useful to secure the bleeding. If embolization is not feasible, surgical exploration hemostasis is curative. In non-expanding SRSH, it can be managed nonoperatively. SRSH is an important initial differential for acute abdomen. Radiologic imaging helps in diagnosis.Stable SRSH can be managed conservatively with good outcome.
文摘102 cases of the acute abdominal disease were treated with the blood-lettingpuncture and cupping. 56 cases were cured, 22 markedly effective, 17 improved and 7 ineffective.Total effective rate was 93.1%.
文摘Rationale:As an uncommon manifestation of congestive heart failure,congestive hepatopathy requires an early diagnosis in order to render appropriate care.Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention,such as fluid boluses,that can potentially tip an already sick patient with poor reserves over into an extreme state.Patient’s Concern:A 65-year-old man was brought to the emergency department for excruciating abdominal pain,vomiting and jaundice.He also had lower limb pitting edema and was hypotensive en route.Diagnosis:Congestive hepatopathy.Interventions:Intravenous furosemide and fluid restriction.Outcomes:The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department.Lessons:It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies.In this case of acute decompensated congestive heart failure,early recognition of the cause makes a difference to the management.
文摘Acute abdomen is a common presentation in emergency medicine. It represents 5% to 10% of all Emergency Department (ED) visits. Diagnosis by imaging includes digital X-ray unit, sonography (US) unit and computed tomography (CT) equipment. During the last years, a trend towards increased use of computed tomography in patients with acute abdomen can be seen. Additionally, patient with severe claustrophobic often cannot tolerate MR scanner. The aim of the present study was to investigate the possibility of optimizing Helical CT parameters in the protocol and emphasize the CT features of selected cases of disorders related acute abdominal complain at the Emergency Department both in general and in a number of selected conditions (Urolithiasis, Aortic Aneurysm Rupture and acute cholecystitis). According to this work findings, non-contrast CT after ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Contrast-enhanced CT was highly sensitive for acute aortic syndrome and therefore the CT imaging protocols must be adjusted in order to minimize dose from radiation.
文摘Surgical acute abdomens represent a significant proportion of surgical emergencies in terms of frequency, morbidity and mortality. The aim of our study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of acute surgical abdomens operated in the surgical emergency department of the Centre Hospitalier Universitaire Souro Sanou (CHUSS). This was a retrospective descriptive study of 426 cases of surgical acute abdomens operated in the CHUSS surgical emergency department from 1 January to 31 December 2015. These 426 cases accounted for 24.14% of the emergency interventions carried out in the CHUSS surgical emergency department. These were 314 (73.7%) men and 112 (26.3%) women with an average age of 30 years. Among the causes, there were 187 (43.9%) cases of acute generalized peritonitis, 71 (16.7%) cases of acute intestinal occlusions, 49 (11.5%) cases of acute appendicitis, 38 (9.4%) cases of strangulated parietal hernias, 16 (3.8%) cases of abdominal contusions, and 15 (3.5%) cases of penetrating wounds of the abdomen. The appendectomy was the most performed gesture with 112 (26.3%) cases. The time to surgery was greater than 48 hours in 29 (6.8%) cases. Complications were observed in 68 (16%) cases with 35 (8.2%) cases of parietal infections, 18 (4.2%) cases of postoperative peritonitis. The death occurred in 37 (8.7%) patients. The average hospital stay was 8.7 days. Improving the prognosis of acute surgical abdomens requires early diagnosis and treatment, as well as better postoperative follow-up.
文摘Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.
基金Shaanxi Undergraduate and Higher Continuing Education Teaching Reform Research Project in 2021 by Shaanxi Education Department,“Construction and Practice of Faculty Construction and Quality Assurance System Based on Online Learning Platform for Clinical Faculty of Western Medical College”(Project Number:21BZ066)Education and Teaching Reform Research Project in 2020 by Xi’an Medical University,“Construction and Practice of‘Double-Qualified’Teaching Staff Construction and Quality Assurance System in Affiliated Hospitals Based on‘Clinical Teachers Online Learning Platform’”(Project Number:2020JG-02)。
文摘Background:In recent years,with the gradual expansion of the scale of medical education,the shortage of medical teaching resources and the reluctance of patients to cooperate with teaching have become increasingly prominent.Objective:To explore the application effect of student standardized patient(SSP)in the clinical teaching of acute abdomen.Methods:Fifty-four fifth-year general medical students from class 1826 of the general department of The First Affiliated Hospital of Xi’an Medical University were selected as the research subjects and randomly divided into two groups,with 27 students in the experimental teaching group,and the remaining 27 students in the conventional teaching group.The experimental teaching group adopted the SSP teaching approach.The SSPs were generated from the training students of the hospital through the recruitment and training process of SSP.In this study,seven qualified SSPs were selected for the clinical teaching of acute abdomen.At the end of the course,a periodic assessment was held.The rank sum test was used to compare the excellent and good rates between the two groups,while t-test was used to compare the difference between the two groups.Results:The results showed that the excellent and good rate of the experimental teaching group was significantly higher than that of the conventional group,in which the difference between the two groups was statistically significant(p<0.05).In terms of the assessment results,the theoretical scores and skills scores of the experimental teaching group were better than those of the conventional teaching group,in which the differences between the two groups were statistically significant(p<0.05).Conclusion:Through the training of SSP for acute abdomen and its application in surgical teaching and examination,the superiority of SSP is emphasized.Although there are still some shortcomings in the application of SSP in clinical teaching,it is a relatively new and effective teaching method,and it will play an increasingly critical role in clinical skills training pertaining to the medical specialty.
文摘Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, HenochSchnlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.
文摘The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim of this study was to demonstrate optimum CT aspects and emphasize on the important features of CT for those patients presenting with an acute abdominal pain at the Emergency Department both in general and in a number of selected conditions (appendicitis, small-bowel obstruction, acute pancreatitis, and diverticulitis). The reported data by this study are based on the author working experience, which forms a continuous protocol adjustment process. The present study provides evidence that CT would result in definite diagnosis of patients with abdominal pain in terms of the detection of some urgent conditions.
