Delayed diagnosis of abdominal Henoch-Schonlein purpura in children:A case report

BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations,but without purpura appearance on the skin,the diagnosis and treatment are relatively difficult.This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis.CASE SUMMARY A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone.On day 7 after onset,gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash,and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa.On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy,but without complete resolution.On day 19,the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs,by which Henoch-Schonlein purpura was confirmed.After 5 d of sequential treatment with methylprednisolone and prednisone,abdominal pain disappeared and she was discharged.CONCLUSION Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain,and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash.For bacterial infection-induced Henoch-Schonlein purpura,glucocorticoid therapy alone without clearing the infection may not relieve symptoms.

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.

Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?

BACKGROUND The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome(IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort(seen in Rome III but not Rome IV) are different from those with abdominal pain(Rome IV).AIM To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain &discomfort.METHODS We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS patients.RESULTS Of the 367 Rome III IBS patients enrolled, 33.8%(124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group(n = 233) and the discomfort group(n = 83) for the following:(1) Frequency of defecatory abdominal pain or discomfort;(2) Bowel habits;(3) Coexisting extragastrointestinal pain;(4) Comorbid anxiety and depression;and(5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group(22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort(all P < 0.001).CONCLUSION IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting experience.

Intermittent abdominal pain accompanied by defecation difficulties caused by Chilaiditi syndrome: A case report

We report a case of intermittent lower abdominal pain and distension accompanied by defecation difficulties for 3 years due to Chilaiditi syndrome in a 59-yearold male. Before admission to our hospital, the patient had undergone gastroscopy, which showed gastritis and duodenitis, and colonoscopy, which showed cecum deformation and cicatricial changes of the mucous membrane in the colon hepatic flexure. A computed tomography(CT) scan of the abdomen at our hospital confirmed right hepatic atrophy and interposition of the colon. Moreover, CT simulation endoscopy identified cystic dilatation in the colon hepatic flexure with the widest diameter of 8.2 cm. The patient was diagnosed with Chilaiditi syndrome. As the patient was unable to endure his defecation difficulties, he underwent a laparoscope-assisted right hemicolectomy. The patient had a good recovery. During the follow-up period of 9 mo, the patient remained symptom-free.

A retrospective study of patients complaining of nontraumatic acute abdominal pain,admitted in the emergency department of an urban hospital in China

Background:Nontraumatic acute abdominal pain(AAP)accounts for a large proportion of emergency department(ED)admissions.This study aimed to explore the underlying correlations among basic information,imaging examinations,and diagnoses.Methods:A total of 7453 patients complaining of AAP,admitted to the ED of Zhongnan Hospital of Wuhan University,were enrolled in this retrospective study from January 1 to December 30,2019.We collected the following information from the patients:sex,age,date of visit,pain location,nature of pain,level of severity,imaging(computed tomography,x-ray,and ultrasound),diagnosis,and outcomes(re-lease from the hospital,transfer to another hospital,transfer to another department,observation room,hospitalization,or death).Results:According to this study,AAP was more common in female than male.A total of 82.11%patients of AAP were in level 3 of se-verity,while 0.19%patients were in level 1.A total of 77.20%of the patients had undergone imaging.Swelling pain and colic are the 2 most common types of AAP.Nonspecific abdominal pain(NSAP)is the most common diagnosis.In the diagnosis of NSAP and gastroenteritis,female patients were more prevalent than male patients,but for renal colic,male patients were 3 times as many as female patients.Non-specific abdominal pain,biliary colic,and cholecystitis are the 3 leading causes in patients 65 years or older.Nonspecific abdominal pain,renal colic,and gastroenteritis are the 3 leading causes of AAP in patients younger than 65 years.Conclusion:With the help of imaging,clinicians can specify a diagnosis and perform corresponding treatment in most cases.However,making a precise diagnosis of AAP within a short period is still challenging.Further research should be conducted to seek safer and more effective techniques to streamline clinicians’work.

2022年中国农业大学动物医院9167例犬腹部超声病例回顾性分析

为了总结超声检查技术在小动物临床中的实际应用,尤其是腹部超声在犬常见疾病中的超声诊断作用,以及不同疾病在超声诊断中异常的检出率,本研究对2022年1—12月中国农业大学动物医院9 167例犬腹部超声检查病例进行回顾性分析。结果显示,患犬年龄分布为1岁以下597例(6.5%),1~7岁2 887例(31.5%),7岁以上5 683例(62.0%);性别分布为雄性(包含雄性去势)4 262例(46.5%),雌性(包含雌性绝育)4 905例(53.5%)。扫查部位或系统的检查次数由高到低分别为肝胆系统(5 054例次,55.1%)、脾脏(4 818例次,52.6%)、泌尿系统(4 385例次,47.8%)、胰腺(4 061例次,44.3%、)、胃肠道(3 110例次,33.9%)、肾上腺(2 169例次,23.7%)和生殖系统(1 509例次,16.5%)。肝胆系统主要超声异常为胆泥淤积(2 918例次,57.7%),脾脏主要超声异常为脾脏结节(510例次,10.6%),泌尿系统主要超声异常为膀胱结晶(1 633例次,37.2%),胰腺主要超声异常为回声不均(1 162例次,28.6%),胃肠道主要超声异常为胃炎(238例次,7.7%),肾上腺主要超声异常为肾上腺增大(365例次,16.8%),生殖系统主要超声异常为子宫积液(226例次,15.0%)。此外,超声引导介入操作共1 312例次,占进行超声检查病例总数的14.3%。结果表明,腹部超声检查在诊断具有典型临床症状的病例,以及筛查病因不明但表现明显的病例方面,具有极高的临床应用价值。本研究数据为动物医学领域提供了宝贵的临床资料。

降钙素原对腹部手术后早期腹腔感染诊断价值的meta分析

目的采用荟萃分析的方法评价血清降钙素原在诊断腹部手术后早期腹腔感染的诊断价值。方法通过计算机检索中国知网、维普、万方、中国生物医学文献服务系统、PubMed、Springer等数据库,并通过追查参考文献、手工检索的方法搜索2001年1月至2023年1月发表的关于降钙素原和腹腔感染相关的文献,凭借纳入和排除标准筛选文献,提取数据和评价文献质量后,采用RevMan 5.3软件、Meta Disc 1.4软件进行数据分析。结果共纳入13篇文献,共计2021个病例,其中腹腔感染组487例,对照组1535例,meta分析显示降钙素原诊断手术后腹腔感染的敏感度为75%[95%CI(71%~79%)],特异度为66%[95%CI(64%~68%)],阳性似然比为3.20[95%CI(2.26~4.54)],阴性似然比为0.35[95%CI(0.26~0.46)],SROC的AUC为0.8348。结论降钙素原诊断术后腹腔感染的效能较高,能较好地早期发现腹腔感染,有望成为早期预测腹腔感染的独立指标。

Diagnosis of spontaneous isolated superior mesenteric artery dissection with ultrasound:A case report

BACKGROUND Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a rare disease that originates from the superior mesenteric artery,without the presence of aortic and other arterial dissections.Most cases are diagnosed using contrastenhanced computed tomography(CECT),whereas the application of ultrasound is less common.CASE SUMMARY Here,we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating.The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption.This case was initially diagnosed using ultrasound and the results were later confirmed by CECT.After admission,the patient fasted,followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance.Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments.After 1 wk,the symptoms improved,and the patient was discharged.During telephone follow-up,the patient did not develop similar symptoms.CONCLUSION Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.

产前超声诊断先天性心脏病的误漏诊情况及影响因素分析

目的探究产前超声诊断先天性心脏病(CHD)误漏诊的发生情况,并分析其影响因素。方法选取2019年5月至2023年2月行胎儿CHD筛查136例孕妇为研究对象,均进行产前超声检查,对比产前超声心动图检查异常结果与产后诊断或引产解剖结果,统计误诊及漏诊情况,利用单因素及多因素Logistic回归分析CHD产前超声误漏诊的影响因素。结果27例经引产或者产后确诊CHD患儿中,18例与产前超声检查完全符合,诊断符合率为66.67%。漏诊5例(室间隔缺损3例、右心室双出口2例),误诊4例(右心室双出口2例、法洛四联症2例),漏诊率为3.68%,误诊率为2.94%。年龄、吸烟史或被动吸烟、体质量增重过重、羊水不足、腹壁瘢痕、医生临床经验少是CHD产前超声误漏诊的独立危险因素(P<0.05,P<0.01)。结论产前超声对CHD具有良好的诊断价值,但存在一定的误漏诊情况。年龄、吸烟史或被动吸烟、体质量增重过重、羊水不足、腹壁瘢痕、医生临床经验少是产前超声误漏诊发生的危险因素,应针对以上因素采取相应措施以减少误漏诊。

基于数据挖掘探讨古代治疗腹痛的方药规律

目的:基于数据挖掘的方法,探索古代治疗腹痛的常用药物以及组方规律。方法:通过《中华医典》收集古代治疗腹痛的方剂,运用Excel 2019进行用药频次以及药物的四气、五味、归经频次分析,运用SPSS Modeler 18.0的Apriori算法对高频药物进行关联规则分析并作出关联网络图,运用SPSS Statistics 24.0对高频药物进行系统聚类分析。结果:筛选有效方剂共429首,涉及药物239味,共有甘草、肉桂、干姜、当归、木香等55味高频用药,排在前三位的四气、五味和归经分别是温、平、热,辛、苦、甘和脾、胃、肝,总结了18个药对药组关联结果以及10个核心药物聚类组合。结论:古人治疗腹痛以辛温、辛热之药温中散寒止痛为主;以苦温、辛温之药理气活血、疏调气机为常;兼以甘温、甘平之药温中补虚、缓急止痛;辨证选用苦寒之药泻火清热、泄下攻积。

磁控胶囊内镜在儿童再发性腹痛中的诊断价值

目的探讨磁控胶囊内镜在儿童再发性腹痛(RAP)中的应用价值。方法回顾性分析2021年1月-2021年6月上海交通大学医学院附属儿童医院内镜中心125例行磁控胶囊内镜检查的RAP患儿的临床资料,分析镜下病变检出情况和胶囊内镜在消化道各部位运行时间等。结果125例患者中,35例拟行全小肠检查(1例因吞服失败而未完成),90例在磁控条件下行食管及胃部检查。磁控胶囊内镜在食管内的中位运行时间为8.5 (5.3,12.5) s,在胃内的中位运行时间为49.0 (17.7,94.0) min,行全小肠检查的患儿,胶囊内镜在小肠内的中位运行时间为252.0 (192.5,340.0) min,全小肠检查完成率为97.1%(34/35),检查完成后所有胶囊内镜均顺利排出体外。上消化道病变检出率为71.8%(89/124),小肠病变检出率为68.6%(24/35)。磁控胶囊内镜对儿童RAP的总体病变检出率为73.4%(91/124)。结论磁控胶囊内镜在RAP患儿胃肠道病变检查中有较高的病变检出率,且安全无痛苦,具有一定的临床应用价值。

食管癌病人术后早期反流与相关症状的轨迹研究

目的:运用生态瞬时评估法进行症状轨迹评估,探究食管癌病人术后早期反流与相关症状的变化轨迹及关联度。方法:选取2020年10月—2021年5月在天津市某肿瘤专科医院食管肿瘤科接受食管癌根治术的142例病人为研究对象,调查病人开始进食后第1天~第4天的反流持续时间及反流、疲乏、疼痛、腹胀、失眠及咳嗽严重程度,运用潜变量增长曲线模型观察各症状发展轨迹,采用重复测量方差分析症状间的相关性。结果:食管癌术后早期症状轨迹变化趋势显示,反流严重程度、反流持续时间、疲乏、疼痛、失眠、咳嗽、腹胀的斜率依次为-1.156,-2.229,-0.263,-1.601,-2.141,-1.395,-1.157,代表相关症状初始水平的截距依次为3.938,3.375,2.968,4.488,4.650,3.994,3.952,相关症状初始水平严重程度由高到低依次为失眠、疼痛、咳嗽、腹胀、反流及疲乏。在时间效应下,疲乏、疼痛、失眠、咳嗽严重程度得分分别于开始进食后第1天~第4天的不同时间点差异有统计学意义(P≤0.05)。在时间与反流严重程度的交互效应下,开始进食后第1天~第4天反流严重程度均对腹胀严重程度影响不明显(P>0.05)。在时间与反流严重程度的交互效应下,开始进食后第1天、第2天反流严重程度对疲乏、疼痛、失眠影响不明显(P>0.05),但开始进食后第3天反流严重程度对疲乏、失眠有影响(P≤0.05),开始进食后第4天反流严重程度对疼痛有影响(P≤0.05)。结论:术后进食有利于术后症状的减轻,反流持续时间下降最为显著。开始进食后,失眠程度最重,疲乏、疼痛、失眠受反流症状影响较大。

子宫切除术后异位妊娠误诊原因分析

目的 探讨子宫切除术后异位妊娠误诊原因及防范措施。方法 通过数据库检索子宫切除术后异位妊娠误诊病例32例,对其临床资料进行系统回顾并进行相关文献复习。结果 本病好发年龄段为30~40岁。本组中31例以下腹痛为首发症状,10例存在休克症状。32例因首次就诊未行妊娠相关检查而误诊13例。32例中23例明确诊断为输卵管异位妊娠,6例明确诊断为腹腔异位妊娠,明确诊断为宫颈残端妊娠和卵巢妊娠各1例,1例由于输卵管卵巢粘连,无法区分具体妊娠位置。均行急诊手术治疗。主要病因为子宫切除术前即存在异位妊娠5例,输卵管与阴道或宫颈断端相通23例,阴道或宫颈断端与腹腔存在瘘管4例。出现首发症状距子宫切除术时间为术后10 d~12年,以开腹子宫次全切除术为主。结论 子宫切除术后仍有异位妊娠的可能,应引起临床医生的重视,诊疗过程中要及时准确诊断或排除此病,避免延误患者治疗。

《素圃医案》产后腹痛证治特色探析

以新安医家郑重光《素圃医案》中6则产后腹痛验案为主要研究内容,总结其主要辨治经验与用药特色。郑重光认为妇人产后腹痛的病因病机常责之“瘀”和“寒”,该病多由寒凝、血瘀或者瘀久化热引起;临证精审,重视脉诊,常常脉症合参以辨证论治;治疗上灵活运用活血、祛瘀、排脓、温阳、散寒之法;善用附子、干姜、肉桂温热之品以补气温阳、用阳化阴;并指出白术有闭气、助脓之弊,治疗妇人产后恶露未尽、腹痛未止时应当慎用白术。

以“腹痛、心悸”为表现的镉中毒1例并文献复习

镉中毒是一种罕见的重金属中毒,急性口服镉中毒有病情急、进展快、难以鉴别的特点。本文介绍了广州中医药大学第三附属医院1例以“腹痛、心悸”为首发表现的患者。该患者发病后迅速进展为呼吸衰竭、肝肾功能衰竭,通过血镉检查发现为急性镉中毒。镉中毒无特效解毒剂,予维护器官功能、生命支持为主要治疗手段。患者多脏器功能持续恶化,最终死亡。结合治疗中的问题,本文回顾复习相关文献,总结镉中毒特点,并提出临床上碰到诊断不明确的肝肾功能损伤,要及时考虑到中毒可能,及时行血、尿毒物检查,有助于诊断。

绝经后重度下腹痛发现子宫内膜癌一例及绝经后腹痛相关疾病文献复习

绝经后重度腹痛常见于子宫内膜癌、卵巢癌和宫颈癌晚期,少见于子宫腺肌病恶变、子宫内膜异位囊肿恶变、胃肠道间质瘤(gastrointestinal stromal tumor,GIST)和子宫内膜结核。几乎上述所有疾病的诊断金标准都是病理检查,影像学检查可作为参考辅助诊断,当患者无典型临床症状或B超和磁共振成像无典型影像学特征时,影像学结论会影响医生的诊断,从而延误治疗。通过分析1例子宫腺肌病患者出现绝经后腹痛,无明显内膜增厚、宫腔积液、阴道出血等典型临床表现,术后诊断为ⅢC期子宫内膜浆液性癌患者的临床资料,复习引起绝经后腹痛相关疾病的文献,探讨以绝经后反复腹痛为临床表现患者的诊断策略,防止误诊误治。

糖尿病急性腹痛合并酮症酸中毒的诊治策略探析

目的探究糖尿病急性腹痛合并酮症酸中毒的诊治策略,为临床糖尿病急性腹痛合并糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的早期诊断提供思路。方法选取2021年6月—2022年6月于大田县总医院治疗的80例急性腹痛为表现的糖尿病患者,根据是否合并出现DKA分为DKA组(46例)和非DKA组(34例),同时对两组患者进行补液、降糖、降酮、补钾等治疗,观察两组患者的腹膜炎阳性率和影像学检查阳性率以及治疗后1、2、3 d的症状缓解、死亡情况。结果DKA组患者的腹膜炎阳性率和影像学检查阳性率明显高于非DKA组,差异有统计学意义(P<0.05)。非DKA组患者在治疗后1、2、3 d的症状缓解情况明显优于DKA组,差异有统计学意义(P<0.05),而两组患者死亡情况比较,差异无统计学意义(P>0.05)。结论糖尿病急性腹痛合并酮症酸中毒的患者腹膜炎体征及影像学检查阳性率均较高,临床医师在诊治中应加强对该疾病的认识,警惕早期症状,及早检查相关指标鉴别DKA的发生。

Median arcuate ligamentum syndrome:Four case reports

BACKGROUND Median arcuate ligamentum syndrome(MALS)is a disease entity with unclear pathogenesis.If it is not considered in advance,the clinical diagnosis of the disease is very difficult because patients complain of digestive discomfort including pain.However,this characteristic is not specific to MALS.There have been no studies to assist in making a quick diagnosis.The aim of this case series was to recognize that MALS must be considered as a differential factor in the cause of abdominal pain.CASE SUMMARY We described cases in which four patients complained of abdominal pain over a long period but in whom a diagnosis of MALS could not be made.If the gastroenterologist does not take into account abdominal pain in advance,the patient is considered an asymptomatic gallstone patient and has their gallbladder removed despite imaging evaluation.The patient may also be considered a psychiatric patient and may be administered psychiatric drugs over a long period.In all four cases in this report,the patients experienced abdominal pain.In three cases,the diagnosis was possible by the clinician’s judgment considering both clinical symptoms and imaging techniques shortly after the onset of symptoms.However,in one case that lasted over 20 years,a clear diagnosis was not possible.Even after complaining of colicky pain and performing a cholecystectomy,the diagnosis was made only after the symptoms persisted.In all four cases,the symptoms were relieved by neuromodulators.CONCLUSION MALS is a rare disease and it is easy to miss because it is not malignant,but patients can suffer from pain over a long period.For the accurate diagnosis of a patient complaining of abdominal pain,the diagnosis must be differentiated.In addition,as there are asymptomatic patients,patients who need treatment should be carefully selected,and improvement with medical treatment can be expected.Large-scale studies are also needed.

现代腹腔镜在诊治慢性腹痛中的临床应用

目的 探讨应用现代胜利腹腔镜技术诊治慢性腹痛的临床经验。方法１９９３年以来，选择６０例腹痛部位相对固定、已除外妇科与消化科疾病的慢性腹痛患者，经腹腔镜探查腹痛原因并进行相应的手术治疗。结果 腹腔镜探查均获成功，未发生手术并发症。３５ 例接受了腹腔镜阑尾切除术与腹腔粘连松解；２０例接受了单纯的腹腔粘连松解；另５例腹腔镜探查仅发现盆腔有轻度炎症表现，只予单纯冲洗处理。４５例术后随访了半年至５年，２４例腹痛症状基本消失，１３ 例腹痛症状有所减轻，８例腹痛没有缓解。完全缓解率为５３％，部分缓解率为２９％，总有效率为８２％。结论 现代腹腔镜诊治慢性腹痛具有探查范围广、诊疗一体化、便于跨学科联合、以及微创高效的独特优势。

非创伤性急性腹痛2520例临床分析

目的:增加对非创伤性急性腹痛疾病的认识,提高其诊断率。方法:抽取兰州大学第一医院急诊科2006年2520例以非创伤性急性腹痛为首发症状的急诊病例进行病因、症状、体征、辅助检查的统计和分析。结果:以非创伤性急性腹痛为首发症状的急诊病例,外科疾病占54.3%;内科疾病占37.5%;妇科疾病占8.3%。其中最常见病因为内科疾病急性胃肠炎(占19.7%)。结论:以非创伤性急性腹痛为主要表现的疾病病因复杂,包括内、外、妇科,表现多样、特征不典型,而且外科疾病比例占一半以上,急诊医生应高度重视其鉴别诊断。