Articles de revues : « Upper Abdominal Disease »

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Ridha, Ali, Njideka Oguejiofor, Sarah Al-Abayechi et Emmanuel Njoku. « Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease ». Case Reports in Infectious Diseases 2017 (2017) : 1–3. http://dx.doi.org/10.1155/2017/1972023.

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Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms.

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Hsu, Hung-Lin, et Wei-Jing Lee. « Man with sudden upper abdominal pain ». Hong Kong Journal of Emergency Medicine 26, n^o 2 (9 juillet 2018) : 130–31. http://dx.doi.org/10.1177/1024907918788221.

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A 52-year-old man without systemic disease presented to the emergency department with sudden-onset epigastric pain for 2 h. He had vomiting for several times without fever, diarrhea, or recent abdominal trauma. Point-of-care ultrasound revealed flap in the superior mesenteric artery. Percutaneous endovascular stent placement was arranged due to refractory upper abdominal pain and poor response to medical treatment.

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Roma, E., J. Panayiotou, Y. Kafritsa, C. Van-Vliet, A. Gianoulia et A. Constantopoulos. « Upper gastrointestinal disease, Helicobacter pylori and recurrent abdominal pain ». Acta Paediatrica 88, n^o 6 (2 janvier 2007) : 598–601. http://dx.doi.org/10.1111/j.1651-2227.1999.tb00006.x.

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Kurth, T., G. Holtmann, J. Neufang-Hüber, G. Gerken et H.-C. Diener. « Prevalence of Unexplained Upper Abdominal Symptoms in Patients with Migraine ». Cephalalgia 26, n^o 5 (mai 2006) : 506–10. http://dx.doi.org/10.1111/j.1468-2982.2005.01076.x.

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Patients with functional gastrointestinal disorders frequently report migraine. We aimed to determine the prevalence of idiopathic upper abdominal symptoms in patients with migraine and compare it with a control population of healthy blood donors. We assessed abdominal symptoms using the Bowel Disease Questionnaire in a series of 488 consecutive blood donors without migraine and 99 patients with migraine. Upper abdominal symptoms were reported by 38% [95% confidence interval (CI) 32, 44] of blood donors compared with 81% (67, 91, P < 0.001) of migraine patients. Of the blood donors, 23% (18, 28) reported frequent dyspepsia compared with 60% (44, 74, P < 0.001) of the migraine patients. Migraine was associated with frequent upper abdominal symptoms (odds ratio 2.7, 95% CI 1.2, 6.1) after adjusting for age, gender, smoking and consumption of analgesics and alcohol. Upper abdominal symptoms are significantly more frequent in patients with migraine compared with healthy controls. The association between migraine and idiopathic upper abdominal symptoms may suggest common pathophysio-logical mechanisms.

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Aiyegbeni, Bibiana, Saleem Jonnalagadda, Lee Creedon et Aija Teibe. « Rare Cause of Left Upper Abdominal Pain ». Prague Medical Report 122, n^o 2 (2021) : 106–11. http://dx.doi.org/10.14712/23362936.2021.11.

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Inflamed diverticular disease of the small bowel is an uncommon cause of acute abdominal pain. Despite its low prevalence rate (0.3–2%), it is associated with a high mortality rate between 20–25% (Fisher and Fortin, 1977; Ferreira-Aparicio et al., 2012). This is due to complications including perforation, bleeding, and obstruction. This case report presents the diagnosis and management of Mr. X, a 70-year-old male with jejunal diverticulitis and a duodenal diverticulum. Mr. X has a background of type 2 diabetes mellitus and sigmoid diverticulosis, he presented with a three-day history of left upper quadrant pain radiating to the left iliac fossa. He was haemodynamically stable despite his elevated inflammatory markers (C-reactive protein 161 mg/l and neutrophils 13.3×109/l) and computerised tomography (CT) of the abdomen and pelvis showing jejunal diverticulitis and a duodenal diverticulum. Mr. X was successfully treated with intravenous antibiotics and analgesia and a follow up CT scan showed that the jejunal diverticulitis had resolved. Previous operative management of the discussed pathology has been reported, the current report is novel as the diagnosis was made early and the case managed conservatively.

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Benny, Bobithamol K., Stephen Daimei, Thouseef Mohammed, Prity Ering et Tatagata Dutta. « Subacute infective endocarditis presenting as upper abdominal pain ». International Journal of Advances in Medicine 7, n^o 10 (22 septembre 2020) : 1588. http://dx.doi.org/10.18203/2349-3933.ijam20204079.

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Splenic abscess develops in 3-5% of patients with infective endocarditis. In more protracted subacute cases of infective endocarditis, symptoms and signs such as anorexia, weight loss, weakness, arthralgia and abdominal pain may occur in 5-30% of patients and thereby misleading the clinician to pursue incorrect diagnosis such as malignancy, connective tissue disease, or other chronic infection or systemic inflammatory disorders. Left upper quadrant pain can be a presenting symptom in a patient with IE, if it is complicated by septic embolization to spleen. Here reported a case of subacute infective endocarditis complicated with splenic embolization in a 34-year-old male with diabetic nephropathy and ischemic dilated cardiomyopathy, presented as acute abdominal pain.

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Md. Hafiz Sardar, Md Hafiz, Mohammad Murad Hossain, Khan Abul Kalam Azad, Md Uzzwal Mallik et Moumita Chakraborty. « Peptic Ulcer Disease and Misuses of Ulcer Healing Drugs in a Tertiary Care Hospital in Dhaka City ». Journal of Medicine 16, n^o 1 (24 février 2015) : 27–34. http://dx.doi.org/10.3329/jom.v16i1.22386.

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This prospective cross sectional study was conducted in Dhaka Medical College Hospital, Dhaka during July, 2013 to December, 2013. Hundred patients were included in this study. Peptic ulcer disease, presented as upper abdominal pain is one of the common disease with a number of underlying causes. Prospective analyses of 100 patients with upper abdominal pain were studied at medicine units of Dhaka Medical College Hospital, Dhaka. Of these 36 patients belonged to peptic ulcer, 20 patients to irritable bowel syndrome and 22 patients to non-ulcer dyspepsia. Next in order were helminthiasis (5 patients), cholelithiasis (4 patients), gastric carcinoma (4 patients), liver abscess (5 patients) chronic pancreatitis (3 patients) and acute pancreatitis (1 patient). Mean age incidence in this series was 39.47 years. Male and female ratio was 1.54:1. Forty patients were smoker with male and female ratio of 3.44:1.All patients had presenting feature of upper abdominal pain. Commonest site of pain was in the epigastrium in 48.08% of cases.Pain was burning in 43.27% cases, periodic pain in 24.03%, and nocturnal hunger pain in 33.65% of cases.Relief of pain after taking food were observed in 38.46%. Epigastric tenderness was present in 56.73% patients.The diagnosis of peptic ulcer disease, irritable bowel syndrome and non-ulcer dyspepsia, the three leading causes of upper abdominal pain, were suspected by history and physical examination but it was difficult to interpret these on clinical ground alone .Some routine and some selected investigation were done for confirmatory diagnosis.In this series, significant disparity detected between clinically diagnosed peptic ulcer diseases 90.38% and endoscopically confirmed peptic ulcer disease, 34.62% cases. As a consequence of wrong diagnosis of PUD, there are huge misuses of ulcer healing drugs and a great economic burden on patients (300 taka per month) and on the nation.DOI: http://dx.doi.org/10.3329/jom.v16i1.22386 J MEDICINE 2015; 16 : 27-34

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Wong, Ching Hin Kevin, Ho Kai Patrick Tsang, Oi Fung Wong, Hing Man Ma et Chau Hung Albert Lit. « A case of rectus sheath haematoma related to severe coughing in a patient with acute exacerbation of chronic obstructive pulmonary disease ». Hong Kong Journal of Emergency Medicine 26, n^o 6 (4 juin 2018) : 371–74. http://dx.doi.org/10.1177/1024907918779525.

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Introduction: Rectus sheath haematoma is a rare condition which is often misdiagnosed. Apart from abdominal trauma and anticoagulation, severe coughing is an uncommon precipitating cause of this rare condition. Case presentation: An elderly gentleman with history of ischaemic heart disease on aspirin developed rectus sheath haematoma due to severe coughing during an episode of acute exacerbation of chronic obstructive pulmonary disease. He developed severe abdominal pain and was noted to have epigastric bruising extending to bilateral loins. Ultrasound abdomen and computed tomography of the abdomen with contrast revealed haematoma over bilateral upper rectus abdominis muscles, which subsided with conservative management. Discussion and conclusion: Rectus sheath haematoma can be related to severe coughing. In patients, especially those with predisposing factors, presenting with abdominal pain and palpable painful abdominal mass, clinicians should raise the suspicion of this uncommon cause so that timely and appropriate management can be provided.

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Freeman, Hugh J. « Nonceliac Diaphragm Disease of the Duodenum ». Canadian Journal of Gastroenterology 14, n^o 5 (2000) : 453–55. http://dx.doi.org/10.1155/2000/365170.

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A 58-year-old, Indo-Canadian man presented with upper abdominal pain and the clinical features of a partial, gastric outlet obstruction. Subsequent studies, including endoscopic examination, revealed diaphragm-like strictures in the descending duodenum. Other reported causes such as celiac disease and drug-induced small bowel diaphragms were excluded. Possibly, the changes seen in this patient were related to ethnic food-induced, mucosal injury to the upper gastrointestinal tract. Further studies are needed to evaluate potential toxicity or protective effects of different ethnic diets and their relationship with the development of different intestinal diseases.

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Gomez, Anthony J., et Robert J. Bailey. « An Unusual Case of Monolobar Caroli’s Disease ». Canadian Journal of Gastroenterology 8, n^o 3 (1994) : 185–88. http://dx.doi.org/10.1155/1994/768974.

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A 27-year-old male with recurrent upper abdominal pain was found to have a suspicious mass in the right hepatic lobe. Right hepatectomy was performed. Pathological examination and further radiological evaluation proved this to be a focal form of Caroli’s disease.

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Namazova-Baranova, Leyla S., Svetlana G. Gubanova, Elena A. Vishneva, Irina V. Zelenkova, Viktor A. Gankovskii, Marina V. Egorova, Julia G. Levina, Elena V. Kaytukova et Kamilla E. Efendieva. « Multidisciplinary Approach to Recurrent Upper Respiratory Tract Diseases in Children. Intermediate Study Results ». Pediatric pharmacology 19, n^o 6 (11 janvier 2023) : 437–47. http://dx.doi.org/10.15690/pf.v19i6.2472.

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The issue of recurrent upper respiratory tract diseases in children is common and relevant. Commonly this pathology is associated with other diseases that lead to the prolonged, complicated, or chronic course of the inflammatory process in the upper respiratory tract. Objective. The aim of the study is to improve management principles for children with recurrent upper respiratory tract diseases according to the developed multidisciplinary and personalized approach (modern methods of diagnosis and health monitoring) for achieving long-term remission. Methods. The study included 65 children aged from 3 to 17 years 11 months with recurrent upper respiratory tract diseases. Examination: nasal, nasopharynx and larynx endoscopy, abdominal ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (complete blood count, evaluation of total and specific IgE levels, antistreptolysin O, nasopharynx and oropharynx microbiological study, enzyme-linked immunosorbent fecal analysis for Helicobacter pylori). Results. 88% of examined children showed allergic pathology according to our study results. Clinical signs of gastroesophageal reflux disease (GERD) were revealed in 30% of children with chronic oropharynx inflammation. GERD signs were revealed both via abdominal ultrasound with aqueous-siphon test and via fiberoptic laryngoscopy and later confirmed by esophagogastroscopy in 8.7% of patients. Obtained data indicates high prevalence of allergic and gastroenterological pathology in children with recurrent upper respiratory tract diseases. Conclusion. Obtained results allow us to establish scientifically multidisciplinary and personalized approach for the management of children with recurrent upper respiratory tract disease. This approach shall include key diagnostic methods required for improvement of comorbid conditions revealing, and achieving and maintaining control over the disease symptoms. The study is currently ongoing.

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Mascarenhas Saraiva, M., T. Ribeiro, T. Costa Pereira, P. Andrade, H. Cardoso et G. Macedo. « Role of enteroscopy in the diagnosis of whipple’s disease ». Acta Gastro Enterologica Belgica 84, n^o 4 (novembre 2021) : 665–67. http://dx.doi.org/10.51821/84.4.020.

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Whipple’s disease is a rare chronic systemic infection caused by Tropheryma whipplei. The widespread infection by this rod is responsible for the protean clinical manifestations of the disease, although its classical form is notable for the prevalence of abdominal symptoms such as chronic diarrhea and abdominal pain. Whitish-yellow patches, suggestive of lymphangiectasia, are typically observed in the duodenum during upper endoscopy. The diagnosis of this condition is supported by the identification in duodenal biopsies of Periodic acid-Schiff staining within lamina propria macrophages. Nevertheless, a significant portion of patients do not have lesions within the range of conventional upper endoscopy. Therefore, other endoscopic procedures such as video capsule endoscopy and enteroscopy may be useful to detect more distal lesions. The authors describe a case where the combined used of both techniques allowed the unmasking of this disease.

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Pinilla Roa, Análida Elizabeth, Myriam Consuelo López Páez et Martha Isabel Murcia. « Association between periodontal disease and septicemia due to pyogenic hepatic abscess ». Revista de la Facultad de Medicina 62, n^o 4 (7 mai 2015) : 631–35. http://dx.doi.org/10.15446/revfacmed.v62n4.43147.

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Case of a 65 year-old man with type-2 diabetes mellitus for 15 years who complained of abdominal pain in the right upper quadrant associated with unquantified fever and weight loss over a period of 25 days. In the emergency room, he presented tachycardia, tachypnea and fever of 37 º C, diffuse abdominal pain from light palpation without peritoneal irritation or right upper quadrant tenderness upon fist percussion test. Within a few hours the patient evolved to septic shock and required transfer to the intermediate care unit. The abdominal computerized axial tomography showed multiloculated hepatic abscess. Percutaneous drainage was performed with the culture positive for Escherichia coli and Fusobacterium spp. Then, the differential diagnosis was made between pyogenic or amebic liver abscess. Subsequently, oral cavity examination revealed severe periodontal disease with coronal destruction; therefore, extraction was scheduled.

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Kumar, Gagan, Dheeraj Dhotre, Amit Taneja, Jayshil Patel et Rahul Nanchal. « Outcomes of Open Upper Abdominal Surgery in Patients With Chronic Lung Disease ». Chest 140, n^o 4 (octobre 2011) : 847A. http://dx.doi.org/10.1378/chest.1119775.

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Bhandoria, Geetu, Aditi Bhatt, Sanket Mehta et Olivier Glehen. « Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction ». Surgical Techniques Development 12, n^o 1 (21 décembre 2022) : 1–33. http://dx.doi.org/10.3390/std12010001.

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Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson’s capsulectomy, clearance of the superior recess of the lesser sac, and Morrison’s pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies.

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R., Ramasubramanian, Jaipaul Y., Poppy Rejoice, Shafique A. et Heber Anandan. « Wilsons disease and autoimmune liver disease overlap syndrome : a clinical study ». International Journal of Research in Medical Sciences 7, n^o 2 (25 janvier 2019) : 477. http://dx.doi.org/10.18203/2320-6012.ijrms20190357.

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Background: The coexistence of Wilson’s disease and autoimmune liver disease in a same patient is a rare entity. Combined treatment with steroid and D-penicillamine may be effective. Aim of the study was analyse the clinical, histological, laboratory profile for patients with chronic liver disease with aim of finding the etiology of the disease.Methods: It is an observational study. Common clinical presentations were evaluated. Laboratory investigations done include complete blood count, renal and liver function tests, prothrombin time, viral markers for hepatitis A, B, C and E, USG abdomen and pelvis, portal Doppler studies and upper GI endoscopy. Specific tests include ANA, AMA, ASMA, Anti LKM-1Ab, serum ceruloplasmin and 24hrs urinary copper were done. Liver biopsy was done in selected patients.Results: Commonest clinical presentation was abdominal distension (80%), abdominal pain (30%), pedal edema (60%), splenomegaly (40%) and upper GI bleed (40%). Laboratory investigation revealed anemia (50%), thrombocytopenia (70%), prothrombin time prolongation in (60%), normal liver function in 60%, abnormal liver function in (40%). Autoimmune markers revealed ANA strong positivity in (40%), mild positivity in (60%). AMA, ASMA, Anti-LKM-1 were negative in all cases (100%). Liver biopsy showed features of autoimmune liver disease and Periportal copper deposition in 80% of cases.Conclusions: Coexistence of Wilson’s disease and autoimmune liver disease is a rare entity and medical treatment with steroids and D-penicillamine simultaneously to be started in these patients.

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Siramolpiwat, Sith, et Tanabute Limprukkasem. « A young man with progressive jaundice and abdominal distension ». Thai Journal of Hepatology 2, n^o 1 (4 janvier 2019) : 6–8. http://dx.doi.org/10.30856/th.jhep2019vol2iss1_02.

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Budd-Chiari syndrome (BCS) is a rare, life-threatening disease caused by obstruction of hepatic venous outflow. Common presentations are right upper quadrant pain, ascites, and hepatomegaly. A diagnosis of Budd-Chiari syndrome should be suspected when liver disease occurs in a patient with known risk factors for hypercoagulable state. We report a 22-years old transgender man presented with jaundice, marked ascites and hepatomegaly. Imaging studies showed complete thrombosis of all hepatic veins. Finally, he was diagnosed with Budd-Chiari syndrome with antiphospholipid syndrome. Figure 1 ภาพ CT upper abdomen แสดงให้เห็น marked ascites with heterogeneous liver enhancement, complete obliteration of all hepatic, caudate lobe hypertrophy, small intrahepatic venous collateral และ small arterial enhancing nodules

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Aguiar Ferreira, Ana, Paula Gomes, Luís Curvo-Semedo et Paulo Donato. « Whipple’s disease : imaging contribution for a challenging case ». BMJ Case Reports 13, n^o 2 (février 2020) : e233071. http://dx.doi.org/10.1136/bcr-2019-233071.

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Whipple’s disease is a rare and difficult-to-diagnose infectious disease, related to infection by gram-positive bacillum Tropheryma whipplei. Clinical manifestations are very variable, but the classic form usually begins with recurring arthritis, followed several years later by non-specific abdominal symptoms, leading to late diagnosis. We present the case of a 52-year-old man who was admitted in the emergency department with an insidious clinical picture characterised by weight loss, abdominal pain, diarrhoea and arthralgias. An abdominal ultrasound was performed, showing findings suggestive of Whipple’s disease, which, in conjunction with the clinical and laboratory findings, allowed the diagnosis to be correctly addressed. Upper endoscopy with duodenal biopsy revealed findings compatible with Whipple’s disease, and the diagnosis was also confirmed through PCR techniques of blood. The patient was given antibiotic therapy, with rapid and substantial clinical improvement.

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Buzatu, Casandra, Sanziana Daia et Ruxandra Ionescu. « NEURO-BEHÇET’S DISEASE ONSET – A DIAGNOSTIC CHALLENGE ». Romanian Journal of Rheumatology 25, n^o 1 (31 mars 2016) : 46–50. http://dx.doi.org/10.37897/rjr.2016.1.7.

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We are presenting the case of a 51 years old female diagnosed with Neuro-Behçet’s disease, undergoing immunosuppression and corticoid therapy in the present. The onset was with recurrent oral ulcerations. Neurological manifestations progressed rapidly from paresthesia in the upper and lower limbs to corset-like hypoesthesia of the abdominal wall and sphincterian incontinence. MRI of the spinal cord showed Transverse Myelitis.

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Chi, D. S., E. L. Eisenhauer, Y. Sonoda, N. R. Abu-Rustum, M. L. Gemignani, D. A. Levine, M. L. Hensley, P. Sabbatini, C. L. Brown et R. R. Barakat. « Improved overall survival for patients with advanced ovarian, tubal, and primary peritoneal carcinoma as a result of a change in surgical approach : A follow-up study ». Journal of Clinical Oncology 25, n^o 18_suppl (20 juin 2007) : 5530. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.5530.

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5530 Background: In January 2001, we initiated a programatic change in our primary surgical approach to advanced ovarian carcinoma utilizing extensive upper abdominal procedures as needed to achieve maximal cytoreduction. The objective of this study was to determine the impact of incorporating these procedures on overall survival in advanced ovarian, fallopian tube, and primary peritoneal carcinomas. Methods: Two groups of patients (pts) with stage IIIC and IV ovarian, tubal, and primary peritoneal carcinoma were identified for comparison. Group 1, the control group, consisted of all 168 pts who underwent primary cytoreduction between 1/96 and 12/99. Group 2, the study group, was composed of all 209 pts who underwent primary surgery between 1/01 and 12/04, during which time a more comprehensive debulking of upper abdominal disease was used, including diaphragm peritonectomy/resection, splenectomy, distal pancreatectomy, liver resection, resection of porta hepatis tumor, and cholecystectomy. Results: Comparison between the 2 groups revealed no significant difference in age, BMI, performance status, stage, tumor grade, proportion with primary ovarian cancer, preoperative CA-125 levels, preoperative platelet counts, percentage with ascites, or type of postoperative primary chemotherapy. The only 2 variables that differed significantly between the 2 groups were percentage of pts who had extensive upper abdominal surgery and percentage of pts cytoreduced to ≤1 cm residual disease (RD). Patients in Group 2 were more likely to have undergone extensive upper abdominal procedure(s) (37% vs. 1%; P <0.001). Cytoreduction to RD ≤1 cm was achieved in 50% of Group 1 pts compared to 80% of Group 2 pts (P <0.01). Overall median survival was significantly improved in Group 2 versus Group 1 pts (58 vs. 43 mos, [P=0.042], respectively). Conclusions: The recent incorporation of extensive upper abdominal surgical procedures to increase the rate of primary cytoreduction to residual disease ≤1 cm resulted in significantly improved overall survival. A paradigm shift toward more complete primary cytoreduction can improve survival for pts with advanced ovarian, fallopian tube, and primary peritoneal carcinomas. No significant financial relationships to disclose.

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Zivanovic, O., D. S. Chi, E. L. Eisenhauer, Y. Sonoda, D. A. Levine, C. L. Brown et R. R. Barakat. « A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal, and peritoneal carcinoma ». Journal of Clinical Oncology 25, n^o 18_suppl (20 juin 2007) : 5572. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.5572.

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5572 Background: We previously reported that preoperative CA-125 may predict primary cytoreductive outcome in patients (pts) with stage III ovarian carcinoma. We performed a contemporary analysis of the ability of preop CA-125 to predict cytoreductive outcome in advanced ovarian, tubal and peritoneal carcinoma. Methods: In 1/01, we initiated a programmatic change in our primary surgical approach to advanced gynecologic malignancies using extensive upper abdominal procedures to achieve maximal cytoreduction. We reviewed the records of all pts with advanced ovarian, tubal or peritoneal carcinoma who underwent primary cytoreduction at our institution between 1/01 and 4/05. Results: The study cohort included 277 pts. Primary disease site was: ovary; 232 (84%); tubal, 9 (3%); and peritoneum, 36 (13%). Stage was: IIIA, 6 (2%); IIIB, 12 (4%); IIIC, 215 (78%); and IV, 44 (16%). Tumor grade was: I, 6 (2%); II, 30 (11%), III, 235 (85%), and unknown, 6 (2%). Cytoreductive outcome was: no gross residual disease (RD), 68 (25%); ≤ 1 cm RD, 153 (55%); and > 1 cm RD, 56 (20%). There was no threshold CA-125 level that accurately predicted cytoreductive outcome. With CA-125 values > 500 U/mL, 50% (57/113) of pts required extensive upper abdominal surgery to achieve RD ≤ 1 cm, compared to 27% (25/93) for those with CA-125 < 500 U/mL (P = 0.03). The table demonstrates the number of pts cytoreduced to = 1 cm RD in relation to preoperative serum CA-125 and the proportion of pts who needed extensive upper abdominal surgery to achieve this degree of cytoreduction. Conclusions: After the incorporation of extensive upper abdominal procedures, preop CA-125 did not predict the primary cytoreductive outcome of pts with advanced ovarian, tubal or peritoneal carcinoma. With preoperative CA-125 > 500 U/mL, extensive upper abdominal procedures were necessary in 50% of pts to achieve residual disease ≤ 1 cm. These data may be useful as part of preoperative surgical counseling and planning. [Table: see text] No significant financial relationships to disclose.

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Colgan, Stephen, Francis Creed et Howard Klass. « Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain ». Psychological Medicine 18, n^o 4 (novembre 1988) : 887–92. http://dx.doi.org/10.1017/s003329170000982x.

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SynopsisSeventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of ‘psychoneurosis’ and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.

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Tomuş, Claudiu, Florin Zaharie, Lucian Mocan, Dana Bartoş, Roxana Zaharie, Cornel Iancu et Al Hajjar Nadim. « Minimal Invasive Treatment of Abdominal Multiorgan Echinococcosis ». International Surgery 98, n^o 1 (1 février 2013) : 61–64. http://dx.doi.org/10.9738/cc111.1.

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Abstract Hydatid disease is a severe zoonosis, exerting a high economic and social impact through its numerous complications, leading to disabilities, even death. Because of technical developments, especially the increasing experience of surgeons, laparoscopic surgery has been extended so that it can be successfully applied to abdominal hydatid cysts. We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. The abdominal ultrasonography and computed tomography (CT) showed 2 cyst-like tumors, with hydatid features: one affecting the eighth liver segment and the other located at the upper pole of the spleen. We performed the surgical intervention using a laparoscopic approach, with an uneventful postoperative follow-up and the patient was discharged home on postoperative day 4. The postoperative images at 6 and 12 months showed a decrease in size of the remnant cystic cavities.

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Takis, Panteleimon, Antonio Taddei, Riccardo Pini, Stefano Grifoni, Francesca Tarantini, Paolo Bechi et Claudio Luchinat. « Fingerprinting Acute Digestive Diseases by Untargeted NMR Based Metabolomics ». International Journal of Molecular Sciences 19, n^o 11 (23 octobre 2018) : 3288. http://dx.doi.org/10.3390/ijms19113288.

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Precision medicine may significantly contribute to rapid disease diagnosis and targeted therapy, but relies on the availability of detailed, subject specific, clinical information. Proton nuclear magnetic resonance (1H–NMR) spectroscopy of body fluids can extract individual metabolic fingerprints. Herein, we studied 64 patients admitted to the Florence main hospital emergency room with severe abdominal pain. A blood sample was drawn from each patient at admission, and the corresponding sera underwent 1H–NMR metabolomics fingerprinting. Unsupervised Principal Component Analysis (PCA) analysis showed a significant discrimination between a group of patients with symptoms of upper abdominal pain and a second group consisting of patients with diffuse abdominal/intestinal pain. Prompted by this observation, supervised statistical analysis (Orthogonal Partial Least Squares–Discriminant Analysis (OPLS-DA)) showed a very good discrimination (>90%) between the two groups of symptoms. This is a surprising finding, given that neither of the two symptoms points directly to a specific disease among those studied here. Actually herein, upper abdominal pain may result from either symptomatic gallstones, cholecystitis, or pancreatitis, while diffuse abdominal/intestinal pain may result from either intestinal ischemia, strangulated obstruction, or mechanical obstruction. Although limited by the small number of samples from each of these six conditions, discrimination of these diseases was attempted. In the first symptom group, >70% discrimination accuracy was obtained among symptomatic gallstones, pancreatitis, and cholecystitis, while for the second symptom group >85% classification accuracy was obtained for intestinal ischemia, strangulated obstruction, and mechanical obstruction. No single metabolite stands up as a possible biomarker for any of these diseases, while the contribution of the whole 1H–NMR serum fingerprint seems to be a promising candidate, to be confirmed on larger cohorts, as a first-line discriminator for these diseases.

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Sakaguchi, Yoshihisa, Osamu Ikeda, Kippei Ohgaki, Eiji Oki, Yoshiki Chinen, Yasuo Sakamoto, Kazuhito Minami, Yasushi Toh et Takeshi Okamura. « Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease ». Diagnostic and Therapeutic Endoscopy 2010 (23 juin 2010) : 1–4. http://dx.doi.org/10.1155/2010/682401.

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This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer.

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Shulpekova, Yu O., V. M. Nechaev et V. T. Ivashkin. « Biliary pain in the structure of episodes of right upper abdominal pain ». Voprosy detskoj dietologii 18, n^o 6 (2020) : 42–52. http://dx.doi.org/10.20953/1727-5784-2020-6-42-52.

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Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis

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Hassan, Nazmul, Mahmudul Hasan, Kaniz Fathema, Khondaker Mobasher, Fahmida Begum et Wahiduzzaman Mazumder. « A 14-year-old boy presenting with gradual abdominal distension and occasional abdominal pain for 2 years ». Bangabandhu Sheikh Mujib Medical University Journal 12, n^o 4 (25 décembre 2019) : 204–10. http://dx.doi.org/10.3329/bsmmuj.v12i4.44550.

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This article has no abstract. The first 100 words appear below: A 14-year-old boy, 4th issue of his non-consanguineous parents got admitted in the Department with the complaints of gradual abdominal distension and occasional abdominal pain since two years of his age. There was no history of jaundice, upper gastrointestinal bleeding, fever, contact with a known case of tuberculosis patient or family history of such type of illness. On examination, he was alert, anicteric, no facial dysmorphism, vitally stable, no stigmata of chronic liver disease and anthropometrically well thrived.

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Lisičar, Iva, Josip Begovac et Šime Zekan. « A rare case of Fitz-Hugh–Curtis syndrome caused by Chlamydia trachomatis in an HIV-positive male patient ». SAGE Open Medical Case Reports 7 (janvier 2019) : 2050313X1882359. http://dx.doi.org/10.1177/2050313x18823592.

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Fitz-Hugh–Curtis syndrome, a rare complication of pelvic inflammatory disease, is an inflammation of the liver capsule (thus called perihepatitis) and the surrounding peritoneum. It occurs extremely rarely in men and is typically characterized by a sudden onset of severe pain in the right upper abdominal quadrant. Ultrasound examination of the liver does not reveal any morphologic changes, and liver function tests are usually normal. Computerized tomography shows the thickening of the perihepatic fat, but definitive diagnosis is only possible by direct visualization by laparoscopy or laparotomy. We present a 33-year-old HIV-positive man with Chlamydia trachomatis proctitis who developed severe right upper abdominal quadrant pain. Abdominal ultrasound did not show any liver pathology, while computerized tomography revealed hepatic capsular thickening. After 21 days of doxycycline therapy, the patient’s symptoms subsided. Based on the clinical presentation and liver computerized tomography examination, the diagnosis of proctitis and the resulting Fitz-Hugh–Curtis syndrome was made. Although it is rarely seen in male patients, it should be a part of differential diagnosis in patients who present with right upper abdominal quadrant pain, especially in men who have sex with other men.

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Pereira, Eanes Delgado Barros, Ana Luisa Godoy Fernandes, Meide da Silva Anção, Clóvis de Araújo Peres, Álvaro Nagib Atallah et Sonia Maria Faresin. « Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery ». Sao Paulo Medical Journal 117, n^o 4 (juillet 1999) : 151–60. http://dx.doi.org/10.1590/s1516-31801999000400003.

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OBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009). CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient’s pulmonary status.

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Lee, M. G., C. H. Thirumalai, S. I. Terry et G. R. Serjeant. « Endoscopic and gastric acid studies in homozygous sickle cell disease and upper abdominal pain. » Gut 30, n^o 5 (1 mai 1989) : 569–72. http://dx.doi.org/10.1136/gut.30.5.569.

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Sivakumar, Aran, et Benjamin Stubbs. « Peptic ulcer disease ». InnovAiT : Education and inspiration for general practice 14, n^o 6 (14 avril 2021) : 372–78. http://dx.doi.org/10.1177/17557380211005791.

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Peptic ulcer disease (PUD) is defined as a disruption in the innermost lining of the gastrointestinal tract, due to the secretion of gastric acid or pepsin. The disruption is in the gastric epithelial layer, specifically the muscularis mucosae. PUD normally affects the stomach along with the first and second parts of the duodenum, although it is not limited to these areas. Typically, gastric ulcers induce upper abdominal pain within 30 minutes of eating, whereas duodenal ulcers cause discomfort much later. Endoscopic and histological investigations are the key to early identification and treatment of patients with PUD, with testing for Helicobacter pylori necessary in those patients suspected of having PUD. In this article we will be looking at the aetiology, pathophysiology and management of PUD.

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Boonzaaier-Botha, H., et C. Cock. « Polycystic liver disease - a disease entity presenting as part of autosomal-dominant polycystic kidney disease ». South African Journal of Radiology 8, n^o 2 (9 juin 2004) : 34. http://dx.doi.org/10.4102/sajr.v8i2.132.

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A 65-year-old man was referred to the Gastroenterology Department with complaints of longstanding upper abdominal discomfort and hepatomegaly. Ultrasound of the liver revealed a massively enlarged liver with multiple cystic areas. Aspiration of the largest cyst revealed 15 ml of yellow fluid without any organisms or malignant cells.A diagnosis of autosomal- dominant polycystic kidney disease was suspected, but could not initially be confirmed on ultrasound/ computed tomography imaging. Magnetic resonance imaging confirmed the multiple hepatic cysts and revealed multiple smaller cysts in both kidneys. Symptomatology subsided after aspiration of the largest cyst and the patient was discharged. The patient has subsequently been followed up and is currently symptom free. The case illustrates the importance of screening for associated kidney disease in patients with polycystic liver disease.

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Farraj, Kristen, Atul Sinha, Aboud Kaliounji, Deepthi Kagolanu, Kaleem Rizvon et Krishnaiyer Subramani. « Abdominal Pain : A Silent and Unlikely Cause ». Journal of Investigative Medicine High Impact Case Reports 9 (janvier 2021) : 232470962110452. http://dx.doi.org/10.1177/23247096211045254.

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While diverticulosis is a common phenomenon in the large intestine, it is a rare disease found in the small intestine accounting for only 0.06% to 1.3% of cases. Although most cases are asymptomatic, roughly 30% to 40%, it is crucial that it is on the differential of acute abdominal pain as it can be life-threatening and potentially require surgical management. Here, we describe a case of a 61-year-old Hispanic man who was found to have a perforated jejunal diverticula after initially presenting with left upper quadrant abdominal pain.

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Tung, Cheng-Cheng, Feng-Chi Chen et Chong-Jeh Lo. « Splenic Abscess : An Easily Overlooked Disease ? » American Surgeon 72, n^o 4 (avril 2006) : 322–25. http://dx.doi.org/10.1177/000313480607200409.

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Splenic abscess is an uncommon but potentially life-threatening disease. Recent advances in radiology have affected the diagnosis and management of this disease entity. The purpose of this study was to review our experience in managing these patients. We retrospectively reviewed the medical records of 51 patients with splenic abscess as seen in a tertiary medical center between 1998 and 2003. We analyzed the demographics, clinical manifestations, etiology, predisposing factors, diagnostic modalities, bacteriologic profile, treatment, and outcome of these patients. The mean age was 59.9 ± 14.2 years (ranging from 21–89 years). The male:female ratio was 29:22. Common symptoms included fever (82%), abdominal pain (71%), and nausea and vomiting (46%). The majority of these patients (83%) had leukocytosis. Thirty-six patients had associated parenchymal liver diseases and 26 patients had diabetes mellitus. Abdominal sonogram or computed tomography was performed to establish the diagnosis. Most cultures from the abscess cavities grew gram-negative enteric bacilli. Patients were treated with antimicrobial therapy only (n = 33), additional percutaneous drainage with a pigtail catheter (n = 11), or splenectomy (n = 7), and the survival rates were 48 per cent, 45 per cent, and 100 per cent, respectively. Splenic abscess should be considered in a patient with fever, left upper abdominal pain, and leukocytosis. Splenectomy appears to have better treatment outcome than percutaneous drainage or intravenous antibiotics alone.

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Bhardwaj, Sushma, Shourabh Sinha, Reetu Kundu et Ravinder Kaur. « Gastric adenomyoma : a case report ». International Surgery Journal 5, n^o 4 (23 mars 2018) : 1587. http://dx.doi.org/10.18203/2349-2902.isj20181154.

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Upper gastrointestinal (GI) bleeding is usually seen secondary to esophageal varices or peptic ulcer disease, but at times, unusual causes can be encountered. We present one such case of a young 30-year-old gentleman who presented with recurrent episodes of upper GI bleeding secondary to gastric adenomyoma (GA), a rare, benign gastric tumor that usually remains asymptomatic or presents with vague abdominal symptoms.

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Zhang, J., Z. Guan et P. Zhang. « Oesophagogastric invagination ». Annals of The Royal College of Surgeons of England 99, n^o 7 (septembre 2017) : e202-e203. http://dx.doi.org/10.1308/rcsann.2017.0006.

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Oesophagogastric invagination is a relatively rare disease that is primarily caused by a sliding hiatal hernia. We report a successfully treated case of oesophagogastric invagination caused by achalasia. Oesophagogastric invagination should be considered in patients complaining of upper abdominal discomfort.

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Kebkalo, A. B., A. O. Reyti, V. V. Gryanila et I. M. Yatsyk. « Modification of laparoscopic catheter setting for peritoneal dialysis in patients with chronic kidney disease ». Reports of Vinnytsia National Medical University 23, n^o 1 (1 mars 2019) : 159–62. http://dx.doi.org/10.31393/reports-vnmedical-2019-23(1)-28.

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Reducing the complications of the peritoneal dialysis (PD) procedure prolongs its use. The purpose of the work was to justify prolongation of peritoneal dialysis by modifying its setting. The study included 54 patients with chronic renal insufficiency, they carried out laparoscopic setting of PD; 14 patients were with omentopexy and 40 – with a classical statement. The operation was performed under general anesthesia. Surgical tactics were as follows: omentum folds were fixed to the parietal peritoneum; the control catheter was inserted through the window into the mesentery of the colon, and the dialysis portion at the bottom of the pelvis; sutured the window of the mesentery of the colon. Before insertion of the camera port, pneumoperitoneum was induced with a Veress needle, 10 mm below the navel. The pressure of abdominal gas was 12 mm Hg. Art. The point of entry into the abdominal cavity was established by the Hassan method: 5 cm lateral and 7 cm below the navel along the outer edge of the rectus abdominis muscle. A control catheter was inserted into the window under the transverse colon and inflated the balloon, the omentum was fixed to the parietal peritoneum 3 cm above the navel and the window in the colon mesentery was sutured. All early and late postoperative complications of the patients were recorded for 12 months (wound infections, including “tunnel infection”, dialysate leakage past the catheter, obturation of the catheter lumen, loss of tightness of omentoperitoneopexy). The study included 8 men and 6 women, aged from 43 to 76 years, of whom 2 patients had previously been operated on the abdominal organs. The operative intervention time averaged 54,6±15,4 min. No obstruction, catheter migration, or “tunnel infection” was established during the study. We have developed a laparoscopic technique of peritoneopexy of the upper half of the abdominal cavity, which will be used when the resource of the lower half of the abdominal cavity is exhausted and the effectiveness of preventing mechanical complications of the catheter PD has been proven.

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Memon, Farzana, Kanwal Baloch et Ameer Afzal Memon. « UPPER GASTROINTESTINAL ENDOSCOPIC BIOPSY ». Professional Medical Journal 22, n^o 12 (10 décembre 2015) : 1574–79. http://dx.doi.org/10.29309/tpmj/2015.22.12.840.

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Background: Upper GI endoscopy is an established procedure for investigatinga wide range of upper GI conditions especially inflammatory and malignant diseases ofstomach and esophagus. A good correlation in diagnosis can be achieved by complementingendoscopic findings with histology of biopsy specimens. Aims and objectives: 1) To evaluatemorphological patterns of upper GI conditions. 2) To correlate endoscopic characterization ofupper GI lesions with histopathological assessment of biopsy specimens. Study design: Aretrospective descriptive study. Period: Four year period from January 2010 to December 2013.Setting: Department of Pathology, LUMHS and were histologically assessed. Material andmethods: A total of 433 upper GI endoscopic biopsies were received. Patient’s age, gender andpresenting complaints were noted. Results: Stomach was the most frequent site of endoscopicbiopsy (51.3%) followed by esophagus (39%) and duodenum (9.7%). Majority of patients (51%)presented with dysphagia and abdominal pain. Mean age of presentation was 40 years; agerange, 9-90 years and male: female ratio is 1:1.6. Esophageal malignancy was the commonestneoplastic lesion with squamous cell carcinoma being the dominant histological type.Interestingly, inflammatory conditions were more common in the stomach. In the duodenum,celiac disease was clinically suspected and histopathological grading confirmed the diagnosiswith majority of the cases showing grade-II pathology. Conclusion: This large retrospectiveinstitutional based study showed a good correlation between endoscopic and histologicaldiagnosis. It further shows that esophagus is the predominant site of upper GI malignancy withstrong female predominance. Further studies are needed to identify the underlying risk factors.

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Stasyshyn, A. R., I. S. Stadnyk, A. I. Doroshak, I. M. Polianytsia, R. L. Bokhonko, T. M. Demianovych et O. B. Matviychuk. « Mesenteric thrombosis in patients with coronavirus disease : comprehensive assessment and treatment ». Medicni perspektivi 27, n^o 1 (30 mars 2022) : 86–91. http://dx.doi.org/10.26641/2307-0404.2022.1.254332.

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Acute mesenteric circulatory disorder belongs to the most serious diseases of the abdominal cavity. Being an emergency condition, it is associated with high mortality. Coronavirus infection is an anthroponotic disease in the group of acute respiratory infections, is characterized by damage to the upper respiratory tract, severe intoxication, coagulopathy and in severe cases - multiple organ failure. The aim of the work was to analyze the results of the surgical treatment of mesenteric vascular thrombosis in patients with COVID-19. We have studied the results of diagnostics and treatment of 13 patients (9 males and 4 females) with acute mesenteric thrombosis and COVID-19. We have analyzed patients’ complaints and the clinical picture of the disease, as well as performed general medical examination (routine blood and urine tests, biochemical parameters, coagulogram), X-ray examination of abdominal and thoracic cavities, computed tomography / angiography of abdominal organs, diagnostic laparoscopy, diagnostic mini-laparotomy and laparotomy. The symptoms of the disease include nausea, vomiting, abdominal pain, diarrhea, fever, cough, shortness of breath and belching. The disease was diagnosed by contrast computed tomography. Four patients developed simultaneous thrombosis – stroke, thrombosis of the portal and mesenteric veins, splenic and renal infarction, thrombosis of the superior mesenteric and portal veins. Six patients have been suffering from underlying health conditions, 7 patients – had none. Ten patients underwent surgery (laparotomy with resection of the nonviable intestine), 3 – received conservative treatment (heparin therapy). Six patients died (4 out of 10 – during surgery and 2 out of 3 – during conservative treatment). Postoperative mortality was 40%.

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CRUZ, Josilda Ferreira, Yasmim Anayr Costa FERRARI, Carla Perez MACHADO, Nathalia Nascimento SANTANA, Allan Victor Hora MOTA et Sonia Oliveira LIMA. « SARCOPENIA AND SEVERITY OF NON-ALCOHOLIC FATTY LIVER DISEASE ». Arquivos de Gastroenterologia 56, n^o 4 (octobre 2019) : 357–60. http://dx.doi.org/10.1590/s0004-2803.201900000-66.

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ABSTRACT BACKGROUND: Non-alcoholic fatty liver disease is characterized by deposition of lipids in the hepatic parenchyma exceeding 5% of liver weight in the absence of other conditions, such as viral or alcoholic hepatitis and metabolic disease. Non-alcoholic fatty liver disease is the most common form of chronic liver disease in several countries. In addition to liver complications, recent studies have shown a relation between liver fat and sarcopenia. OBJECTIVE: Determine the association between sarcopenia and the severity of non-alcoholic hepatic steatosis diagnosed by abdominal ultrasonography. METHODS: A clinical, cross-sectional study was conducted with a sample of male and female adults (18 to 70 years of age) submitted to ultrasonography for the investigation of non-alcoholic hepatic steatosis. Evaluations were also performed for the determination of upper and lower limb muscle strength. Data analysis was performed with the aid of the SPSS 22.0 program and involved ANCOVA and the Bonferroni post hoc test, with P-value <0.05 considered indicative of statistical significance. RESULTS: One hundred two patients were submitted to abdominal ultrasonography, 57.8% of whom presented some degree of non-alcoholic hepatic steatosis. The presence and degree of fatty liver infiltration were significantly associated with the sarcopenic index, determined by the ratio between upper and lower limb strength and BMI (P=0.009 and post-test P=0.028 for upper limbs; P=0.006 and post-test P=0.013 for lower limbs). CONCLUSION: In the present study, an association was found between the sarcopenic index and non-alcoholic hepatic steatosis, with an inversely proportional relation between this index and the severity of fatty infiltration. This finding offers further evidence of the metabolic interaction of the liver, adipose tissue and muscle.

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Anantha, Tejashree, Vidyavathii B. Chittaragi, M. Krishna Karthik, Jagadeesh Kumar, B. Suresh Kumar et Badveti Satya Sai. « A fatal, rare case of bilateral, upper, lower limbs and abdominal gangrene associated with brucellosis ». Journal of Laboratory Physicians 11, n^o 04 (octobre 2019) : 388–90. http://dx.doi.org/10.4103/jlp.jlp_46_19.

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AbstractBrucellosis distributed worldwide is a classical zoonotic disease. Complications associated with gangrene are quite uncommon and may or might not occur during the course of the disease. Here, we report a pediatric age group patient who presented with fever and gangrene over the upper and lower limbs and abdomen associated with brucellosis.

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Wegge, C., et J. Kjærgaard. « Evaluation of Symptoms and Signs of Gallstone Disease in Patients Admitted with Upper Abdominal Pain ». Scandinavian Journal of Gastroenterology 20, n^o 8 (janvier 1985) : 933–36. http://dx.doi.org/10.3109/00365528509088850.

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Anyaeze, Chineme Michael. « Reducing Burden of Hookworm Disease in the Management of Upper Abdominal Pain in the Tropics ». Tropical Doctor 33, n^o 3 (juillet 2003) : 174–75. http://dx.doi.org/10.1177/004947550303300321.

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A prospective study of the stool samples of 129 rural patients with symptoms of upper abdominal pain, tenderness and indigestion was carried out from 2 February 1998 to 31 December 1998 and followed up to June 1999. The age range was 11–85 years, female: male ratio 2.4:1: 102 specimens were positive for helminths — Ancylostoma duodenale (hookworm) 80 (62%); Trichuris trichuria (threadworm) 12 (9.3%); Ascaris lumbricoides (large roundworm) 10 (7.76%); Strongyloides stercoralis three (2.3%); Taenia saginata (tapeworm) three (2.3%). The female: male ratio for hookworm was 3:1. Treatment with appropriate anthelminthic agents were given serially at each visit according to the result of faecal examination. At 6 months follow up 88 patients were free of symptoms, 60 of which were caused by helminths the hookworm group. Stool ‘test and treat’ strategy appears to be a cost-effective approach in the management of these patients.

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Chedid, Aljamir D., Cleber R. P. Kruel, Marcio F. Chedid, Ronaldo J. S. Torresini et Geraldo R. Geyer. « Development of clinical celiac disease after pancreatoduodenectomy : a potential complication of major upper abdominal surgery ». Langenbeck's Archives of Surgery 390, n^o 1 (24 septembre 2004) : 39–41. http://dx.doi.org/10.1007/s00423-004-0516-5.

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Kang, Seok-Young, So-Yeon Lee, Jin-Seo Park, Jin-Cheol Kim, Bo-Young Chung, Chun-Wook Park et Hye-One Kim. « Darier Disease with Psoriasis ». Medicina 58, n^o 7 (6 juillet 2022) : 902. http://dx.doi.org/10.3390/medicina58070902.

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Darier disease is an autosomal dominant disorder with dark crusty patches and is classified as hereditary acantholytic dermatosis. Keratotic papules and crust are often present on the scalp, forehead, chest, back, upper arms, elbows, groin, and behind the ears, predominantly in seborrheic areas. A 48-year-old male patient presented skin lesions with pruritus on the trunk and both upper and lower extremities. He first noticed the lesion 15 years before. On physical examination, there were multiple erythematous papules with crust on the trunk and red-brown colored keratotic plaque on both extremities. The suspected histopathological diagnosis was psoriasis vulgaris. The patient’s skin lesions and pruritus were significantly improved after the psoriasis treatment. While continuing psoriasis treatment, the patient showed sudden worsening of the skin lesions on the scalp, abdomen, and fingernails (V-shaped nicks) with pruritus. Punch biopsy was performed on the abdominal lesion again and the final diagnosis was Darier disease. The patient was then treated using alitretinoin while maintaining the use of guselkumab for psoriasis. There are only a few cases that we found in which patients with Darier disease also had psoriasis. We report this rare case of Darier disease with psoriasis and propose that an additional biopsy might be necessary for accurate diagnosis and proper treatment.

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Soeprijanto, Bambang, Wajoe Djatisoesanto et Etty Hary Kusumastuti. « Emphysematous Pyelonephritis in Patient with Diabetes and Renal Cell Carcinoma ». Jurnal Radiologi Indonesia 1, n^o 1 (1 mai 2015) : 52–57. http://dx.doi.org/10.33748/jradidn.v1i1.6.

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Emphysematous pyelonephritis (EPN) usually happens in diabetes. It is reported a correlation between the Renal Cell Carcinoma (RCC) with diabetes. This is a rare case of PEN and RCC in diabetes which occur simultaneously. We present a case of 51 year old male referred with right ?ank mass and medical history of diabetic disease. Renal ultrasound revealed a solid tumor at the upper pole of the right kidney. Plain abdominal X-ray showed a lot of gas, fecal material, and patches of alcifcation in the right upper abdomen. On abdominal computed tomography found a collection of gas located in the upper right abdomen. An irregular solid tumor detected at the upper pole of the right kidney. The tumors was obtained at surgery and emphysematous pyelonephritis was found and then nephrectomy performed. Histopathological examination revealed a Renal Cell Carcinoma besides emphysematous pyelonephritis. The patient had no postoperative serious complications during his hospital stay and his symptoms resolved completely. We report the rare case with an occurrence of EPN and RCC simultaneously in diabetes.

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Weinberg, Yves, Arie Feldman, Daniel J. Jakobson et Joseph Mishal. « Spontaneous Pathologic Splenic Rupture in a Patient with Plasmodium falciparum Infection, First Case Reported in Israel ». Infectious Disease Reports 12, n^o 3 (8 décembre 2020) : 121–26. http://dx.doi.org/10.3390/idr12030022.

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Travelers exposed to malaria may develop severe disease and complications. A less well-known complication is spontaneous pathologic splenic rupture, which is still under-reported and has never been reported in Israel. In this paper, we report a 23 years old healthy young man presenting in the emergency department, two weeks after coming back from Sierra Leone, with intermittent fever, mild tachycardia and mild left upper quadrant abdominal pain. The patient was diagnosed with Plasmodium falciparum infection and developed rapidly after hospital admission spleen rupture. He was managed conservatively at first but ultimately underwent splenectomy after being hemodynamically unstable. In the recovery period, the patient developed acute respiratory distress syndrome and was reintubated. A high level of suspicion is recommended in every malaria patient presenting with left upper quadrant abdominal pain, even if minimal. Ultrasonography availability in the internal medicine department may be a critical diagnostic tool, especially in non-endemic areas.

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Pavlovic, Milorad, Zorica Dakic, Branko Milosevic, Milos Korac, Branko Brmbolic et Aleksandar Dzamic. « Human case of fasciolosis in Serbia treated with triclabendazole ». Vojnosanitetski pregled 71, n^o 2 (2014) : 202–6. http://dx.doi.org/10.2298/vsp1402202p.

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Introduction. The number of humans infected by Fasciola hepatica is increasing worldwide. Humans can become accidental hosts by ingesting drinking water or plants contaminated with metacercariae. Case report. We reported a case of a 68-year-old Serbian woman, in which the diagnosis of acute fasciolosis had been established after serious diagnostic concerns. Based on clinical picture (episodic right upper quadrant abdominal pain, febrility and generalized body pain) and biochemical analyses (high eosinophilia and high activity of alkaline phosphatase), she was appointed as suspected to the acute fasciolosis. Stool and duodenal aspirate exams were negative for Fasciola ova. In the absence of adequate serologic diagnostic for fasciolosis in Serbia, the diagnosis was confirmed using enzyme immunoassays and immunoblot at the Institute for Tropical Diseases in Hamburg, Germany. Soon after triclabendazole was administered, the symptoms disappeared and biochemical values returned to normal. Conclusion. The diagnosis of human fasciolosis may be problematic and delayed, especially in non endemic areas, because physicians rarely encounter this disease and a long list of other diseases must be considered in the differential diagnosis. The syndrome of eosinophilia, fever, and right upper quadrant abdominal pain suggest acute fasciolosis. Unclear source does not rule out fasciolosis.

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Li, Chunyan, Fei Huang, Yu Wang et Mei Tian. « Ureteritis associated with systemic lupus erythematosus : a case report ». Journal of International Medical Research 49, n^o 2 (février 2021) : 030006052098794. http://dx.doi.org/10.1177/0300060520987944.

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We report herein an unusual case of systemic lupus erythematosus in a 35-year-old woman who developed acute abdominal pain while hospitalized. Abdominal computed tomography (CT) scan with enhancement indicated long-segment inflammatory lesions in the right ureter. The patient received spasmolytic and analgesic drugs with poor effect and continued to have persistent severe abdominal pain and signs of peritonitis. We suspected that the patient had acute abdominal disease, but no abnormality was detected during laparoscopic surgery. Therefore, we considered the possibility of right upper urinary tract hydronephrosis; the patient’s abdominal pain was relieved after double-J tube implantation. The patient’s clinical symptoms improved after hormone and mycophenolate mofetil therapy for 1 year, and all laboratory indicators returned to normal. Reexamination by abdominal CT showed that the long-segment inflammatory lesions of the right ureter had resolved. Early identification and diagnosis are important for ureteritis associated with systemic lupus erythematosus.

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Fernandes, Vanessa Pacini Inaba, Elizete Aparecida Lomazi et Maria Angela Bellomo-Brandão. « A rare association of intussusception and celiac disease in a child ». Sao Paulo Medical Journal 134, n^o 5 (19 septembre 2016) : 457–60. http://dx.doi.org/10.1590/1516-3180.2016.0092220616.

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ABSTRACT: CONTEXT: Intussusception is a common cause of acute intestinal obstruction in the pediatric population and it is normally idiopathic. Rare cases of chronic intussusception require investigation with greater attention. CASE REPORT: We present a clinical case of a three-year-old boy with aqueous diarrhea, abdominal distension, vomiting and weight loss over a two-month period. During the investigation, abdominal ultrasound showed imaging of intussusception. The intraoperative findings showed the intussusception had resolved spontaneously. In further investigation, it was found that the diarrhea was malabsorptive and, after the patient underwent upper gastrointestinal endoscopy, a diagnosis of celiac disease was made. After a gluten-free diet was introduced, the patient showed complete remission of symptoms and regained weight, and normal growth was reestablished. CONCLUSION: If the clinical presentation of intussusception is unusual, etiological investigation should be undertaken. In this case report, celiac disease was the underlying cause.

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