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.

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

AIM:To investigate whether seasonal changes had an effect on the incidence of acute appendicitis(AA)or nonspecific abdominal pain(NSAP).METHODS:We carried out a national register study of all patients with a hospital discharge diagnosis of AA and acute NSAP in Finland.Data were analyzed for the whole country and correlated to seasonal and weather parameters(temperature,humidity).Moreover,additional sub-analyses were performed for five geographically different area of Finland.RESULTS:The observation period spanned 21 years,with 186558 appendectomies,of which 137528(74%)cases were reported as AA.The incidence of AA declined for 32%over the study period.The average incidence of the NSAP was 34/10000 per year.The mean annual temperature,but not relative humidity,showed clear geographical variations.The incidence of AA decreased significantly during the cold months of the year.No correlation was detected between temperature and incidence of NSAP.Humidity had a statistically significant impact on NSAP.CONCLUSION:The incidence of acute appendicitis is declining in Finland.We detected a clear seasonality in the incidence of AA and NSAP.

Abdominal separation in an adult male patient with acute abdominal pain

We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine. The membrane also formed an orifice in the ileal pars caeca, from which a 30 cm herniated ileum formed a "C"-shaped loop which was strangulated by the orifice. An abdominal separation was diagnosed after surgery. We liberated the membranous peritoneum which incarcerated the intestinal canal from the root ofileocecal junction to Treitz ligament, and reduced the small intestinal malrotation. The patient had an uneventful recovery after opera-tion with his abdominal distention disappeared during the follow-up. Abdominal separation is a rare situation, which may be related with embryo development. Surgery is a choice of treatment for it.

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.

The Method of Soothing the Liver in the Treatment of Acute Abdominal Pain

Pancreatic pseudocyst, whose clinical feature is small simple cyst, is a common local complication of acute pancreatitis and will not need surgery in ordinary circumstances. However, some cases could appear secondary disorders related to the location of the cyst and the role of decomposition enzymes of content, such as cyst rupture moving into the abdomen, bleeding, cystic infection, compression and internal fistula formation with adjacent organs and so on^([1]). But the spleen-related complications resulting from it are rare. There was 1 patient with pancreatic pseudocyst admitted to Dongfang Hospital Affiliated to Beijing University of Chinese Medicine and the report is as follows.

Acute pancreatitis as initial presentation of acute myeloid leukemia-M2 subtype:A case report

BACKGROUND Direct infiltration of the pancreas by acute myeloid leukemia(AML)with acute pancreatitis(AP)as an initial symptom is extremely rare.Only once in the literature,the leukemia cells in AML have been implicated as the cause of AP.Pancreatitis caused by a rare predisposing factor is often misdiagnosed as idiopathic pancreatitis or pancreatitis of other common causes.Severe AP(SAP)progresses rapidly with a high fatality rate.Therefore,it is important to identify the predisposing factors in the early stage of SAP,evaluate the condition,determine prognosis,formulate treatment plans,and prevent a recurrence.Here,we describe a case of SAP due to AML.CASE SUMMARY A 61-year-old man presented to the hospital with fever and persistent abdominal pain.Blood analysis presented significantly elevated serum amylase and severe thrombocytopenia.Computed tomography examination of the abdomen revealed peripancreatic inflammatory effusion.The patient had no common etiologies and risk factors for AP,but the concurrent severe thrombocytopenia could not be explained by pancreatitis.Finally,the bone marrow aspirate and biopsy inspection revealed the underlying reason for pancreatitis,AML(M2 type based on the French-American-British classifications system).CONCLUSION Direct infiltration of the pancrease by acute leukemia,particularly AML cells,is an infrequent cause of AP.Therefore,although AP is a rare extramedullary infilt-ration characteristic for AML patients,it should be considered when determining the etiology of AP.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.

Etiology of non-traumatic acute abdomen in pediatric emergency departments

Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, HenochSchnlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

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.

Rare case of intussusception in an adult with acute myeloid leukemia

Intussusception is rarely reported in adult patients with acute leukemia. We report a case of intussusception in a 29-year-old woman with acute myeloid leukemia(AML). She developed right lower quadrant pain, fever, and vomiting on day 16 of induction chemotherapy.Physical examination showed tenderness and guarding at the right lower quadrant of the abdomen. Abdominal computed tomography(CT) showed distension of the cecum and ascending colon, which were filled with loops of small bowel, and herniation of the ileocecal valve into the cecum. We proceeded to laparotomy and revealed ileocecal intussusception with the ileocecal valve as the leading point. The terminal ileum was thickened and invaginated into the cecum, which showed gangrenous changes. Right hemicolectomy was performed and microscopic examination of the colonic tissue showed infiltration of leukemic cells. The patient recovered after the operation and was subsequently able to continue treatment for AML. This case demonstrates that the diagnosis of intussusception is difficult because the presenting symptoms can be non-specific, but abdominal CT can be informative for preoperative diagnosis. Resection of the involved bowel is recommended when malignancy is suspected or confirmed. Intussusception should be considered in any leukemia patients presenting with acute abdomen. A high index of clinical suspicion is important for early diagnosis.

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

有腹膜炎的症状的剧烈腹的疼痛由于进腹洞的乳糜的突然的溢出是经常被错将当成另外的疾病过程的一个稀罕条件。诊断很少外科手术前地被怀疑。我们报导与象在承认前放射到更低的恰好腹的象限的间歇热和腹上部的疼痛那样的急性阑尾炎的典型症状介绍了的自发的乳糜的腹膜炎的一个案例。

CT Optimization for Diagnosis of Some Acute Abdomen Cases

The acute abdomen is one of the most frequent causes for presentation to the emergency department. Imaging plays an important role for an accurate diagnosis, which in turn diminishes morbidity and mortality. The aim of this study was to demonstrate optimum CT aspects and emphasize on the important features of CT for those patients presenting with an acute abdominal pain at the Emergency Department both in general and in a number of selected conditions (appendicitis, small-bowel obstruction, acute pancreatitis, and diverticulitis). The reported data by this study are based on the author working experience, which forms a continuous protocol adjustment process. The present study provides evidence that CT would result in definite diagnosis of patients with abdominal pain in terms of the detection of some urgent conditions.

Electroacupuncture for abdominal pain relief in patients with acute pancreatitis:A three-arm randomized controlled trial

Background: Electroacupuncture(EA) may reduce the severity of acute pancreatitis(AP) and provide additional pain relief in patients with chronic pancreatitis. However, the ability of EA to relieve pain in patients with AP has not been well documented.Objective: This study was undertaken to compare the pain-relieving effects of EA and conventional treatment in patients with AP.Design, setting, participants and interventions: This study was conducted using a randomized, controlled,three-arm, parallel-group and multi-center design. Patients diagnosed with AP were randomly and equally assigned to EA1, EA2 or control groups. All participants received conventional standard-of-care therapy for AP. Local EA alone was administered in EA1, and local plus distal EA was given in EA2.Local EA included two abdominal acupoints, while distal EA included twelve peripheral acupoints. EA groups underwent one session of EA daily for 4 days(days 1–4), or until pain was resolved or discharged.Main outcome measures: The primary outcome measure was the change in the visual analogue scale(VAS;0–100) pain score between baseline and day 5.Results: Eighty-nine participants were randomized into EA1, EA2 and control groups, and 88(EA1, 30;EA2, 29;control, 29) were included in the full-analysis set. VAS score change(median [interquartile range]) on day 5 was(12.3 ± 22.5) in the EA1 group,(10.3 ± 21.5) in the EA2 group, and(8.9 ± 15.2) in the control group. There were not significant differences in the change in VAS score among treatments(P = 0.983). However, time to food intake was significantly shorter in the EA group(EA1 + EA2) than in the control group(median 2.0 days vs 3.0 days), with a hazard ratio of 0.581(P = 0.022;95% CI,0.366–0.924). No significant adverse events occurred.Conclusion: EA treatment did not significantly reduce pain after 4 days of treatment in patients with AP-associated abdominal pain but significantly reduced time to first food intake.

Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study

BACKGROUND Acute right colonic diverticulitis (ARCD) is an important differential diagnosis of acute appendicitis (AA) in Asian countries because of the unusually high prevalence of right colonic diverticula. Due to qualitative improvement and the high penetration rate of computed tomography (CT) scanning in Japan, differentiation of ARCD and AA mainly depends on this modality. But cost, limited availability, and concern for radiation exposure make CT scanning problematic. Differential findings of ARCD from AA are based on several small studies that used univariate comparisons from Korea and Taiwan. Previous studies on clinical and laboratory differences between AA and ARCD are limited. AIM To determine clinical differences between AA and ARCD for differentiation of these two diagnoses by creating a logistic regression model. METHODS We performed an exploratory single-center retrospective case-control study evaluating 369 Japanese patients (age ≥ 16 years), 236 (64.0%) with AA and 133 (36.0%) with ARCD, who were hospitalized between 2012 and 2016. Diagnoses were confirmed by CT images. We compared age, sex, onset-to-visit interval, epigastric/periumbilical pain, right lower quadrant (RLQ) pain, nausea/vomiting, diarrhea, anorexia, medical history, body temperature, blood pressure, heart rate, RLQ tenderness, peritoneal signs, leukocyte count, and levels of serum creatinine, serum C-reactive protein (CRP), and serum alanine aminotrans-ferase. We subsequently performed logistic regression analysis for differentiating AA from ARCD based on the results of the univariate analyses.RESULTS In the AA and ARCD groups, median ages were 35.5 and 41.0 years, respectively (p=0.011);median onset-to-visit intervals were 1 [interquartile range (IQR): 0-1] and 2 (IQR: 1-3) days, respectively (P < 0.001);median leukocyte counts were 12600 and 11500/mm3, respectively (P = 0.002);and median CRP levels were 1.1 (IQR: 0.2-4.1) and 4.9 (IQR: 2.9-8.5) mg/dL, respectively (P < 0.001). In the logistic regression model, odds ratios (ORs) were significantly high in nausea/vomiting (OR: 3.89, 95%CI: 2.04-7.42) and anorexia (OR: 2.13, 95%CI: 1.06-4.28). ORs were significantly lower with a longer onset-to-visit interval (OR: 0.84, 95%CI: 0.72- 0.97), RLQ pain (OR: 0.28, 95%CI: 0.11-0.71), history of diverticulitis (OR: 0.034, 95%CI: 0.005-0.20), and CRP level > 3.0 mg/dL (OR: 0.25, 95%CI: 0.14-0.43). The regression model showed good calibration, discrimination, and optimism. CONCLUSION Clinical findings can differentiate AA and ARCD before imaging studies;nausea/vomiting and anorexia suggest AA, and longer onset-to-visit interval, RLQ pain, previous diverticulitis, and CRP level > 3.0 mg/dL suggest ARCD.

Tomodensitometric Aspects of Acute Intestinal Ischemia: A Prospective Study of 20 Cases

Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis is known to be difficult at the early stage during which a well-conducted treatment may help reduce mortality. Multi-detector scanners were assessed to be far more sensitive and appropriate for the diagnosis of mesenteric ischemia than angiography. Objective: Study the tomodensitometric aspects of acute intestinal ischemia, and the traps of late diagnosis, in order to optimize the care and improve the prognosis of this disease. Patients and Methods: This is a prospective, longitudinal and descriptive study covering a period of nine (9) months. We have included all cases of acute intestinal ischemia. Results: Twenty (20) cases of acute intestinal ischemia were registered i.e. a frequency of 2.2 cases per month. The average age of the patients was 67.8 years with 0.7 as sex ratio. Abdominal pain was noted in all cases. History of cardiovascular disease was found in seven (7) cases. Abdominal angioscan was performed in fifteen (15) cases. There was a suspected diagnosis upon request in ten (10) cases. The main intestinal lesions were the lack of parietal enhancement (13 cases) and parietal thickening (12 cases). There were sixteen (16) cases of acute mesenteric ischemia and four (4) cases of ischemic colitis. The acute mesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases and mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction in eleven (11) cases. Ten (10) patients were operated and 10 others were treated medically. Thirteen (13) cases of death were registered. Conclusion: Acute intestinal ischemia is a rare but serious disease. Abdominal pain is the main ground for consultation. Diagnosis is often late and focuses on abdominal CT angiography. An early diagnosis could help improve its prognosis.

Osteomyelitis of the pubis in a young athlete revealed by severe abdominal pain

Acute osteomyelitis is a common condition in children. Only early diagnosis prevents complications. The location at the pubic bones is very rare, even exceptional at the pubis symphis. We report a case of osteomyelitis of the pubis in a young athlete of 14 years old whose symptoms were discussing an acute abdomen, to illustrate the unusual clinical presentation, so as not to miss the diagnosis and avoid unnecessary laparotomy.

Presentation of the Diverticulum of the Caecum, Cause of the Acute Abdomen

Solitary caecal diverticulum is an uncommon entity and therefore it is difficult to diagnose except during surgery exploration. It is extremely difficult to differentiate it preoperatively from acute appendicitis. We report a case of an enlarged colon segment, presenting macroscopically as tumor diverticulum in a 27-year-old female patient, presenting with a 2 day history of a severe abdominal right lower quadrant pain with accompanying anorexia, nausea, vomiting and high body temperature. After clinical assessment, laboratory examination, X-ray, and CT are performed, the indication for surgical treatment is set.

以消化道症状首发的系统性红斑狼疮误诊原因探析

目的分析以消化道症状为首发表现的系统性红斑狼疮(SLE)的误诊原因,并总结防范误诊措施。方法回顾性分析2013年12月—2023年9月曾误诊的3例SLE的临床资料。结果3例均以消化道症状为首发表现就诊。1例误诊为急性胃炎、肠梗阻,1例误诊为感染性腹泻、急性胃肠炎、胃肠道痉挛,1例误诊为急性肠炎。误诊时间7~30 d。3例入院后经追问病史、详细查体,完善血液免疫学指标、肾穿刺病理学检查后明确诊断为SLE,给予糖皮质激素治疗后症状缓解。3个月后随访症状消失。结论SLE临床表现多样,以消化道症状首发的早期SLE不易诊断,临床医师应提高警惕,减少或避免误诊误治。

社区居民对急性腹痛认知程度的现状及风险分析

目的 探索社区居民对急性腹痛的认知情况。方法 随机抽取2 714名社区居民,采用自制问卷的形式探讨不同年龄、文化程度和性别对社区居民急性腹痛认知程度的影响。结果 参与调查的社区居民中,急性腹痛院前就医时间<2 h的有946名,占比34.9%;院前就医时间2~24 h的有611名,占比22.5%;院前就医时间>24 h的有1 157名,占比42.6%。年龄、文化程度显著影响社区居民急性腹痛院前延迟就医情况(P=0.004、7.4969E-70);性别不影响社区居民急性腹痛院前延迟就医情况(P=0.951)。文化程度显著影响社区居民对急性腹痛部分相关急危重疾病的了解(P=5.47E-06)。结论 社区居民对急性腹痛的认知情况一般,需要加强对急性腹痛病因的宣传教育,缩短院前延迟时间,为急性腹痛危重患者争取更多的生命抢救时间。

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.