Persistent lower abdominal pain induced by long peritoneal shunt catheter

Summary  Persistent abdominal pain directly induced by a peritoneal catheter of a ventriculoperitoneal shunt, which is associated with no other complications such as bowel perforation, pseudocyst or infection, has not been previously reported. A 65-year-old woman with hydrocephalus developed persistent lower abdominal pain radiating to the perineal area after shunt insertion. Radiography suggested that the distal end of a peritoneal catheter was located in a cul-de-sac of the pelvis. Otherwise, all studies were negative for shunt infection, fluid collection, or other abdominal and pelvic events. The patient’s pain resolved completely after surgery in which the peritoneal catheter was shortened. In the presence of unexplained, persistent lower abdominal pain after shunt placement, the need to shorten the peritoneal catheter should be considered. Correspondence: Robert F. Spetzler M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 W. Thomas Road, Phoenix, AZ 85013, Arizona.     

Risk factors of ceftriaxone-associated biliary pseudolithiasis in adults: influence of renal dysfunction

Background

Ceftriaxone (CTRX) is a known cause of biliary pseudolithiasis (BPL) mainly in children. Biliary elimination of CTRX increases in patients with renal dysfunction. However, the influence of renal dysfunction on the incidence of CTRX-associated BPL has not been well investigated. The aim of this study was to investigate the cumulative incidence of CTRX-associated BPL in adults and to assess if renal dysfunction is a risk factor.

Methods

We retrospectively analyzed the medical records of 478 patients treated with CTRX to assess the incidence and risk factors of CTRX-associated BPL. We examined age, sex, body weight, dosage, and duration of CTRX therapy, and the concentrations of serum creatinine, estimated glomerular filtration rate (eGFR), albumin, and serum calcium in all the patients. The cumulative incidence of BPL was calculated using a competing risk model. The multivariate analysis of each variable for the development of BPL was assessed by a Cox proportional hazards model.

Results

A total of 362 patients (75.7%) had renal dysfunction (eGFR: < 60 mL/min). The cumulative incidence of BPL in patients with renal dysfunction was significantly higher than that in patients with normal kidney function (4.1 vs. 0.6%, p = 0.017). Renal dysfunction (Hazard ratio (HR) 8.14, 95% CI 1.05–63.0, p = 0.045) and female sex (HR 5.35, 95% CI 1.17–24.5, p = 0.031) were independent risk factors of CTRX-associated BPL, which was confirmed using multivariate analysis (renal dysfunction: HR 7.93, 95% CI 1.04–60.5, p = 0.046) (female sex HR 4.65, 95% CI 1.03–21.1, p = 0.046).

Conclusions

Renal dysfunction is an independent risk factor of CTRX-associated BPL in adults.

     

Acute surgical admissions for abdominal pain in adults in Kumasi, Ghana

BACKGROUND: Abdominal pain of less than a weeks' duration is the presenting complaint in one of every five patients admitted to the surgical Accidents and Emergency Ward of the Komfo Anokye Teaching Hospital in Kumasi. This study is a prospective one, to determine the cause of abdominal pain in a large number of patients. METHODS: A monthly audit of discharge summaries for all patients admitted with acute abdominal pain was prepared and transferred to a special study pro forma to provide data over the 84-month period from January 1998 to December 2004. RESULTS: There were 3114 patients, 2070 men and 1044 women. The ages ranged from 15 to 95 years. The seven most common causes of the admissions were acute appendicitis 698 (22.4%), typhoid ileal perforation (506) 16.2%, acute intestinal obstruction 391 (12.6%), gastroduodenal perforations 342 (11.0%), non-specific abdominal pain 306 (9.8%), abdominal injures 260 (8.3%) and acute cholecystitis 102 (3.2%). There were 1976 (63.4%) emergency operations. Appendicectomy was a common operation that was carried out (638 cases or 32.3%). Two hundred and thirty patients (7.4%) died. Thirty-five patients died before and 195 after operation. Of these 230 deaths, 110 (47.8%) reported to the hospital after three or more days of illness. Twenty-six per cent and 23.7% of postoperative deaths occurred after emergency colonic resections and closure of gastroduodenal perforations, respectively. CONCLUSION: Acute appendicitis, typhoid ileal perforation, acute intestinal obstruction and gastroduodenal perforations were the leading causes of acute admissions for abdominal pain to our hospital. Late presentation was associated with increased mortality.     

Significance of routine digital rectal examination in adults presenting with abdominal pain

AIM: Routine digital rectal examination (DRE) in children with abdominal pain has slowly gone out of practice but is still performed routinely in adults. This study was undertaken to assess the significance of routine DRE in adults with acute abdominal pain. PATIENTS AND METHODS: A total of 100 consecutive adults admitted to the emergency surgical unit with acute abdominal pain were studied prospectively. Following DRE, patients who were willing to participate in the study were requested to complete an anonymous questionnaire. The house officer conducted the rectal examination at admission and also completed an evaluation sheet. RESULTS: A working diagnosis of acute appendicitis in 38 patients and gastroduodenal, pancreatobiliary pathology in 24 patients was made. DRE did not alter clinical diagnosis or initial management in any of the 100 patients. Routine DRE did not detect any unrelated pathology. Of the patients, 93 wanted to know why rectal examination was required. Overall, 78 patients rated the DRE as uncomfortable. Although 43 were willing for DRE as a routine, 54 patients preferred to have the DRE at the time of other bowel tests rather than at the time of the emergency admission. CONCLUSIONS: Various routine medical procedures have given way to evidence-based practice. This study has demonstrated the limited role of routine DRE in adults with no anorectal or GI symptoms during their initial evaluation for acute abdominal pain.     

Plain abdominal radiographs and acute abdominal pain

The records of all (5080) patients presenting to a district general hospital with acute abdominal pain over a 4-year period were examined. The contribution of abdominal radiographs to the assessment of patients with suspected appendicitis, urinary tract infection, and non-specific abdominal pain was evaluated, these conditions accounting for 48 per cent of patients with abdominal pain and 32 per cent of those with abdominal radiographs. Any positive information from these radiographs was less likely to be helpful than incidental or inconsistent (and hence potentially misleading). Because of this high 'false positive' rate it is suggested that if the initial diagnosis is suspected appendicitis, urinary tract infection, or non-specific abdominal pain, there is little value in the routine use of abdominal radiographs.     

Hypoglycemia and abdominal pain

A case of subastragaloid dislocation of the left ankle occurring during authorized military skiing is reported.     

Anuria in infants and children

The urologist may be involved in the initial evaluation of a child with anuria. In our experience the most common cause of anuria in neonates was perinatal hypoxia and in older children it was the hemolytic uremic syndrome. Obstructive uropathy as a cause of anuria in infants and children appears to be uncommon.     

Cystic abdominal lymphangioma in adults

Cystic abdominal lymphangioma is a rare tumor in adult age. It occurs usually in children and is localised mostly in the head and neck. Only 2-8 % of lymphangiomas are localised intraabdominally. We present a case of a 20-year-old man who complained about acute abdominal pain after physical activity. Diagnosis of intraabdominal multilocular cyst was done by ultrasound, computed tomography and coeliacography. The definitive diagnosis of lymphangioma of the hepatoduodenal ligament was established by laparotomy and histologic examination of the specimen. Cystic abdominal lymphangioma is a rare disease in adults with difficult preoperative diagnosis. The surgical extirpation often completed with resection of involved organ is the method of choice in the treatment of this rare disease.     

Appendicitis and non-specific abdominal pain in childhood

Abdominal pain is a common experience during childhood and frequently presents to secondary healthcare facilities. Although non-specific abdominal pain and appendicitis are the most common causes, the clinician should also be aware of the diagnosis and management of all causes of abdominal pain in children. This article provides an overview of abdominal pain in children, including history and examination, initial management, diagnostic categories, modes of investigation, and definitive treatment.     

Appendicitis and non-specific abdominal pain in childhood

Abdominal pain is a common experience during childhood and frequently presents to secondary healthcare facilities. Although non-specific abdominal pain and appendicitis are the most common causes, the clinician should also be aware of the diagnosis and management of all causes of abdominal pain in children. This article provides an overview of abdominal pain in children, including history and examination, initial management, diagnostic categories, modes of investigation, and definitive treatment.     

Lymphangioma of the mesentery. A rare cause of acute abdominal pain syndrome in adults]

We report about one case of cystic lymphangioma of the jejunum in a 27-year-old woman admitted to hospital for abdominal pain. The study of this case and the review of the literature enabled us to bring out the main characteristics of the lesion: rarity in adults, benignancy, mode of occurrence--most often painful--, radiological--and particularly CT--features, diagnosis based on histological findings only, and lastly, treatment with surgical exeresis that must be complete to prevent recurrence.     

地震灾害所致腹部损伤的救治

2008年5月12日14时28分汶川大地震,给灾区人民群众生命财产造成巨大损失.我院作为距地震灾区最近的大型军队医院,短时间内接受了大量从现场直接后送以及经前线医疗队初步处理而转来的伤员,震后1周时间内,医院共接诊地震伤员2320例,收治入院1760例[1],其中腹部损伤收治46例,行手术探查25例,分别为胃穿孔行修补术1例,小肠穿孔行穿孔修补或部分小肠切除7例,肝破裂行修补术4例,脾破裂行切除术5例,肠系膜血管损伤行部分肠切除1例,小肠离断伤行部分肠切除2例,肝脾联合损伤行肝修补脾切除2例,延迟性小肠溃疡伴出血行部分肠切除3例.