Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males

Objective:To evaluate the features of testicular torsion presenting with acute abdominal pain and to raise awareness of testicular torsion with specific symptoms.Methods:From October 2005 to June 2016,nine patients with testicular torsion who presented with isolated acute abdominal pain rather than scrotal pain as their primary symptom were retrospectively reviewed.Data,including the age of patients,season at admission,initial medical history,external genital examination,emergency ultrasound findings,operative findings,duration of abdominal pain,complications,and follow-up results,were collected.Results:The average age of patients was 14 years(range 10-17 years).Seven patients whose genitals were not initially examined externally were misdiagnosed as having ordinary abdominal diseases.Surgical exploration revealed that all the involved testes necrotized,and orchidectomy was performed.In the other two patients,scrotal and testicular abnormalities were detected immediately on admission,and emergency surgical exploration determined that the involved testis remained vital,so orchiopexy was performed.The mean duration from symptom onset to diagnosis was 4 h(3-5 h)in the orchiopexy group and 37 h(18-72 h)in the orchidectomy group.Six patients were psychologically affected during postoperative follow-up.Neither recurrence of testicular torsion nor testicular atrophy was recorded.Conclusion:Acute abdominal pain can be the initial and sole symptom of testicular torsion in young males.Physicians should pay close attention to the specific clinical presentation of testicular torsion.

Analysis on the Clinical Effects of Emergency Surgical Treatment on Patients with Acute Abdominal Pain

Objective:To study the clinical effects of emergency surgery in treating patients with acute abdominal pain.Methods:60 patients admitted to our hospital between January 2019 and December 2019 were randomly selected as subjects,and the incidence of complications and mortality of the patients were observed.Results:Among the 60 patients,definitive diagnosis was obtained during the operation and there was no mortality.After the operation,they were transferred to other relevant departments for continued treatment.Among the 60 patients,4 cases had complications,accounted for incidence of 6.67%.Conclusion:The diagnosis of emergency surgical treatment based on acute abdominal pain avoided misdiagnosis and realized non-invasive diagnosis,and provided a valid reference for avoiding overtreatment.

Establishment and Application of Early Risk Stratification Method for Acute Abdominal Pain in Adults

Background： Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians＇ clinical experience. The aim of this study was to establish an early risk stratification method （ERSM） for addressing adults with acute abdominal pain, which would gnide physicians to take appropriate and timely measures following the established health-care policies. Methods： In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study. Measurement data and numeration data were compared with analysis of variance and Chi-square test, respectively. Multiple regression analysis calculated odd ratio （OR） value. P and OR values showed the impacts of factors. ERSM was established by clinical experts and statistical experts according to Youden index. In Cohort 2, data from 305 patients with acute abdominal pain were enrolled to validate the accuracy of the ERSM. Then, ERSM was prospectively used in clinical practice. Results： The ERSM was established based on the scores of the patient＇s clinical characteristics： right lower abdominal pain ＋ 3 × diffuse abdominal pain ＋ 3 ×cutting abdominal pain ＋ 3 × pain frequency ＋ 3 × pain duration ＋ fever ＋ 2 × vomiting ＋ 5 × stop defecation ＋ 3 - history of abdominal surgery ＋ hypertension history ＋ diabetes history ＋ hyperlipidemia history ＋ pulse ＋ 2 - skin yellowing ＋ 2 × sclera yellowing ＋ 2 × double lung rale ＋ 10 × unconsciousness ＋ 2 ×right lower abdominal tenderness ＋ 5 x diffuse abdominal tenderness ＋ 4 x peritoneal irritation ＋ 4 × bowel sounds abnormal ＋ 10 × suspicious diagnosis ＋ white blood cell count ＋ hematocrit ＋ glucose ＋ 2 × blood urea nitrogen ＋ 3 × creatine ＋ 4× serum albumin ＋ alanine aminotransferase ＋ total bilirubin ＋ 3 × conjugated bilirubin ＋ amylase. When the score was 〈18, the patient did not need hospitalization. A score of≥18 and 〈38 indicated that the patient should be under observation or hospitalized. A score of≥38 and 〈50 indicated the need for an emergent operation. A score of≥50 indicated the need for admission to the Intensive Care Unit. The area under the receiver operating characteristic curve of the ERSM in Cohorts 1 and 2 were 0.979 and 0.988, respectively. Conclusions： This ERSM was an accurate and reliable method for making an early determination of the severity of acute abdominal pain. There was the strong correlation between scores of ERSM and health-care decision-making.

Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

AIM:To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion(CRAI) via a drug delivery system(DDS) in severe acute pancreatitis(SAP) patients with abdominal compartment syndrome(ACS).METHODS:We presented our recent experience in 8 patients with SAP.The patients developed clinical ACS,which required abdominal decompression.During the operation,a DDS was inserted into the peripancreatic artery(the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery).Through this DDS,a protease inhibitor,antibiotics and octreotide were infused continuously.The duration of the regional artery infusion ranged from 8 to 41 d.The outcomes and the changes in the APACHE Ⅱ score,computed tomography(CT) severity index and intraabdominal pressure(IAP) of the patients were retrospectively evaluated.RESULTS:Eight patients with an initial APACHE Ⅱ score of 18.9(range,13-27) and a Balthazar CT severity index of 9.1(range,7-10) developed severe local and systemic complications.These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension(IAH).After a mean interval of 131.9 ± 72.3 d hospitalization,7 patients recovered with decreased APACHE Ⅱ scores,CT severity indexes and IAP.The mean APACHE Ⅱ score was 5.4(range,4-8),the CT severity index was 2.3(range,1-3),and IAP decreased to 7.7 mmHg(range,6-11 mmHg) 60 d after operation.One patient died of multiple organ failure 1 wk after surgery.CONCLUSION:CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

EARLY SURGERY TO PATIENTS SUFFERING FULMINANT ACUTE PANCREATITIS WITH ABDOMINAL COMPARTMENT SYNDROME

Objective To retrospectively analyze and compare conservative versus surgical treatment of patients with fulminant acute pancreatitis (FAP) plus abdominal compartment syndrome (ACS). Methods From January 1998 to September 2005, 21 patients with FAP plus ACS were retrospectively analyzed. Ten patients were conservatively treated by means of intensive care medicine without surgery, and 11 patients received open surgical management and suction drainage. Results Seven of the 10 non-surgical patients died, comprising one with mild, four with moderate and two with severe ACS (70% mortality rate). Of the 11 patients receiving open surgical management in the early phase (within 3 days of disease initiation), three died, comprising one with moderate and two with severe ACS (27.3% mortality rate). The difference in mortality rates was found to be statistically significant. Conclusion Our data indicate patients suffering FAP with severe ACS should be treated with open management of the abdomen in the early phase (within 3 days), even in the absence of infection. This approach appears superior to that of conservative management. Surgical treatment resulted in abdominal decompression and subsequently significantly decreased the mortality rate and improved overall prognosis.

Clinical value of rapid urine trypsinogen-2 test strip, urinary trypsinogen activation peptide, and serum and urinary activation peptide of carboxypeptidase B in acute pancreatitis

AIM: To assess the usefulness of urinary trypsinogen-2 test strip, urinary trypsinogen activation peptide (TAP),and serum and urine concentrations of the activation peptide of carboxypeptidase B (CAPAP) in the diagnosisof acute pancreatitis.METHODS: Patients with acute abdominal pain and hospitalized within 24 h after the onset of symptoms were prospectively studied. Urinary trypsinogen-2 was considered positive when a clear blue line was observed (detection limit 50 μg/L). Urinary TAP was measured using a quantitative solid-phase ELISA, and serum and urinary CAPAP by a radioimmunoassay method.RESULTS: Acute abdominal pain was due to acute pancreatitis in 50 patients and turned out to be extrapancreatic in origin in 22 patients. Patients with acute pancreatitis showed significantly higher median levels of serum and urinary CAPAP levels, as well as amylase and lipase than extrapancreatic controls. Median TAP levels were similar in both groups. The urinary trypsinogen-2 test strip was positive in 68% of patients with acute pancreatitis and 13.6% in extrapancreatic controls (P<0.01). Urinary CAPAP was the most reliable test for the diagnosis of acute pancreatitis (sensitivity 66.7%, specificity 95.5%, positive and negative predictive values 96.6% and 56.7%, respectively), with a 14.6 positive likelihood ratio for a cut-off value of 2.32 nmol/L.CONCLUSION: In patients with acute abdominal pain,hospitalized within 24 h of symptom onset, CAPAP in serum and urine was a reliable diagnostic marker of acute pancreatitis. Urinary trypsinogen-2 test strip showed a clinical value similar to amylase and lipase.Urinary TAP was not a useful screening test for the diagnosis of acute pancreatitis.

Spontaneous chylous peritonitis mimicking acute appendicitis:A case report and review of literature

Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.

Acute appendicitis complicated by mesenteric vein thrombosis: A case report

BACKGROUND Acute appendicitis with mesenteric vein thrombosis(MVT)is an uncommon condition and usually lacks specific clinical manifestations,which leads to a high rate of misdiagnosis or delayed diagnosis,especially when it is accompanied by other abdominal diseases.Prompt and accurate recognition is vital for treatment and prognosis.CASE SUMMARY A 37-year-old woman had a history of acute metastatic right lower abdominal pain,nausea,and fever.A contrast-enhanced computed tomography(CT)scan showed a filling defect in the mesenteric vessels.The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics.The follow-up CT scan showed full resolution of the thrombosis and inflammation.CONCLUSION Clinical awareness is essential for recognizing MVT,especially when it is accompanied by other common acute abdominal diseases,such as acute appendicitis.Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.

Are all primary omental infarcts truly idiopathic?Five case reports

BACKGROUND Idiopathic omental infarction(IOI)is challenging to diagnose due to its low incidence and vague symptoms.Its differential diagnosis also poses difficulties because it can mimic many intra-abdominal organ pathologies.Although hypercoagulability and thrombosis are among the causes of omental infarction,venous thromboembolism scanning is rarely performed as an etiological investigation.CASE SUMMARY The medical records of the 5 cases,who had the diagnosis of IOI by computed tomography,were examined.The majority of the patients were male(n=4,80%)and the mean age was 31 years(range:21-38).The patients had no previous abdominal surgery or a history of any chronic disease.The main complaint of all patients was persistent abdominal pain.Omental infarction was detected in all patients with contrast-enhanced computed tomography.Conservative treatment was initially preferred in all patients,but it failed in 1 patient(20%).After discharge,all patients were referred to the hematology department for thrombophilia screening.Only 1 patient applied for thrombophilia screening and was homozygous for methylenetetrahydrofolate reductase(A1298C mutation)and heterozygous for a factor V Leiden mutation.CONCLUSION IOI should be considered in the differential diagnosis in patients presenting with progressive and/or persistent right side abdominal pain.Investigating risk factors such as hypercoagulability in patients with IOI is also important in preventing future conditions related to venous thromboembolism.

Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis:A case report and literature review

BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.

Ultrasound Diagnosis of Primary Epiploic Appendagitis: A Case Report

A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.

Relief of abdominal pain by morphine without altering physical signs in acute appendicitis

Background Abdominal pain is a common symptom among patients with acute appendicitis, yet these patients have long been denied relief from suffering because of widespread misconceptions associated with the use of opioids. We determined whether morphine hydrochloride masked the physical signs in adults with acute appendicitis and assessed the efficacy of morphine in relieving abdominal pain. Methods A prospective, double-blind, placebo controlled, clinical trial was conducted with 106 adult patients between 16 and 70 years old with acute appendicitis. Patients were randomly divided into a morphine group （n=-54） or a normal saline group （n=52）. All patients presented with acute abdominal pain with onset within 3 days. The morphine group received hypodermic injection of morphine （0.15 mg/kg; maximum 20 mg） and the control group members were given an equivalent volume of normal saline solution. The clinical symptoms, physical signs, and patients＇ cooperation during physical examination were assessed before and after 30 minutes of morphine or normal saline administration. Results Abdominal pain was significantly relieved and the patients＇ cooperation was improved in the morphine group after 30 minutes treatment compared with the control group and before morphine administration （P 〈0.05）. The physical signs were unaffected by either treatment （P 〉0.05）. Conclusions Morphine relieved abdominal pain and improved the patients＇ cooperation for treatment and care. Furthermore, the morphine did not mask the physical signs of acute appendicitis.