Recurrent Right Upper Quadrant Pain Masquerading an Underlying Colon Adenocarcinoma-Induced Intussusception

Case Reports in Gastroenterology ◽

10.1159/000516863 ◽

2021 ◽

pp. 501-506

Author(s):

Zeena Ayad Qiryaqoz ◽

Urvashi Katiyar ◽

Saad Shebrain

Keyword(s):

Abdominal Pain ◽

Surgical Intervention ◽

Colon Adenocarcinoma ◽

Unknown Origin ◽

Recurrent Abdominal Pain ◽

Quadrant Pain ◽

Rare Presentation ◽

Delay In Diagnosis ◽

Therapeutic Outcomes ◽

High Degree

Intussusception in adults is a challenging diagnosis that often requires a high degree of suspicion. In adults presenting with symptoms, almost 90% have underlying neoplasms. Most frequently, the presentation will include nonspecific abdominal pain, vomiting, and mucoid hematochezia. In this case, we present a 39-year-old female with a rare presentation of chronic, recurrent right upper quadrant abdominal pain over a 5-month interval. The misleading presentation with which the patient presented led to a delay in diagnosis and treatment of colon malignancy and serves to advocate for intussusception as a differential for adult patients presenting with obstructive symptoms of unknown origin and recurrent abdominal pain. Such cases should persuade physicians to plan prompt surgical intervention as to not delay optimal diagnostic and therapeutic outcomes.

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Subhepatic appendix: an ectopic topography not to be disregarded: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02883-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Abdoul Kadir Ibrahim Mamadou ◽

Souleymane Mounkaila ◽

Nouhou Hama Aghali ◽

Mahaman Laouali Harouna Amadou ◽

Ousseini Adakal

Keyword(s):

Elderly Patient ◽

Peptic Ulcer ◽

Abdominal Pain ◽

Case Report ◽

Surgical Intervention ◽

Quadrant Pain ◽

Case Presentation ◽

Perforated Appendix ◽

History Of ◽

The Right

Abstract Introduction Subhepatic appendix is most often due to an anomaly of rotation of the primary intestine occurring during embryogenesis. This ectopic topography associated with advanced age can be a serious diagnosis problem at the stage of appendicitis or appendicular peritonitis. Case presentation We report the case of a 60-year-old melanoderm man, with a history of urinary pathology and peptic ulcer, referred from a health district for abdominal pain of the right hypochondrium evolving for about 5 days, secondarily generalized, in whom we suspected peritonitis, the etiology of which remains to be determined. During the surgical intervention, after preoperative resuscitations measures, a phlegmonous perforated appendix was found under the liver. No postoperative complication was noted, and he was discharged home 8 days after his operation. Conclusion Subhepatic appendicular peritonitis occurring in an elderly patient poses enormous diagnostic problems. When faced with right upper quadrant pain, considering acute ectopic appendicitis would significantly reduce complications.

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Intestinal Obstruction in Pregnancy: A Case Report

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/564838 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Shakina Rauff ◽

Stephen Kin Yong Chang ◽

Eng Kien Tan

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Intestinal Obstruction ◽

Surgical Intervention ◽

Clinical Suspicion ◽

Fetal Mortality ◽

Delay In Diagnosis ◽

Appropriate Treatment ◽

Prompt Diagnosis ◽

In Pregnancy

Background. Intestinal obstruction in pregnancy is uncommon. The condition is associated with significant maternal and fetal mortality. The delay in diagnosis is due to nonspecific symptoms and a disinclination to carry out radiologic investigations in pregnancy.Case. A 39-year-old lady at 32 weeks of gestation presented with abdominal pain and nausea. Her symptoms worsened during admission. A computed tomography (CT) scan showed dilated small bowel loops suggestive of intestinal obstruction. She eventually underwent a laparotomy as conservative measures failed.Conclusion. A high index of clinical suspicion is required to diagnose intestinal obstruction in pregnancy. Prompt diagnosis should be made and the appropriate treatment instituted. Surgical intervention should be performed if necessary as further delay only results in increased morbidity and mortality.

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Pediatric Ovarian Torsion: A Diagnostic Challenge in COVID-19 Times

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33075 ◽

2020 ◽

Vol 18 (2) ◽

pp. 120-123

Author(s):

R. Chanchlani ◽

M. Jangid ◽

R. Ahmad ◽

P. Sharma

Keyword(s):

Abdominal Pain ◽

Surgical Intervention ◽

Lower Abdominal Pain ◽

Exploratory Laparotomy ◽

Ovarian Torsion ◽

Diagnosis And Treatment ◽

Diagnostic Challenge ◽

Delay In Diagnosis ◽

Functional Loss ◽

Early Surgical Intervention

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary.

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Pyrexia of unknown origin: a rare presentation of primary ovarian lymphoma

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201834 ◽

2020 ◽

Vol 9 (5) ◽

pp. 2191

Author(s):

Asha N. Gokhale ◽

Akriti Agarwal ◽

Bharat D. Purandare

Keyword(s):

Unknown Origin ◽

B Cell Lymphoma ◽

Exploratory Laparotomy ◽

Rare Presentation ◽

Initial Manifestation ◽

Delay In Diagnosis ◽

Pyrexia Of Unknown Origin ◽

Pet Ct ◽

Lymphomatous Involvement ◽

Late Manifestation

It is very rare to have a lymphomatous involvement of ovary. Malignant lymphoma of ovary is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma with ovarian mass as an initial manifestation is a rare entity and may have varied presentations which can cause confusion to the physician and cause delay in diagnosis. Study presents a case of non-Hodgkin’s lymphoma where the initial presentation was fever with weight loss, and was evaluated as pyrexia of unknown origin. When no other cause of fever was identified PET-CT was done showing metabolically active uterine mass with no lymphadenopathy. Exploratory laparotomy was planned followed by hysterectomy with bilateral salpingo ophorectomy with omentectomy. Ovarian malignancy was detected intraoperatively, which was diagnosed as diffuse large B cell lymphoma, NHL double expresser phenotype on histopathology and IHC. Patient was started on chemotherapy and is doing fine.

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DIAGNOSTIC LAPAROSCOPY IN CHRONIC AND RECURRENT ABDOMINAL PAIN MANAGEMENT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i12.1578 ◽

2020 ◽

Vol 4 (12) ◽

Author(s):

Abhishek Jina ◽

Abhinav Chaudhary ◽

U C Singh

Keyword(s):

Abdominal Pain ◽

Diagnostic Laparoscopy ◽

Unknown Origin ◽

Recurrent Abdominal Pain ◽

Chronic Abdominal Pain ◽

Chronic Appendicitis ◽

Fluid Analysis ◽

Invasive Method ◽

Safe Technique

Background: Chronic abdominal pain is a common condition encountered by many surgeons in their clinic every day. Despite of availability of different tests in maximum cases the reason behind the pain remains unknown. Diagnostic Laparoscopy is a safe technique that can identify the cause of the pain without using any invasive method. In the present study, the use of diagnostic laparoscopy in the diagnosis and management of chronic and recurrent abdominal pain of unknown origin was investigated. Material and Methods: All the patients who visited the outpatient department with chronic abdominal pain were included in this study. All the demographic parameters were included and after careful investigation diagnostic laparoscopy were conducted in all these patients. The postoperative outcomes were also recorded in all the patients. Result: Total of 51 patients was included in this study. Among these patients 23 patients were male and 28 patients were female. Maximum of the patients were in the 31-40 years of age group. The most common pathology for chronic abdominal pain was chronic appendicitis (n=9, 18%) followed by Koch's abdomen and adhesions (n=8, 16%). There were 4 cases of Carcinoma of the gall bladder and 3 cases of metastatic disease with dissemination in the peritoneal cavity and ascitis. 3 cases of liver cirrhosis and 3 cases of endometriosis were also detected. 2 cases of ovarian cysts which were missed by USG were detected correctly by laparoscopy. There were two unusual cases, one of chronic ectopic pregnancy and another of Crohn's disease. All the above findings were confirmed by direct visualizing (86%), or by biopsy (74%) or by fluid analysis. There were no long term complications in our study. Conclusion: The present study concluded that laparoscopy is a safe and effective method for diagnosis of chronic abdominal pain. Keywords: Chronic abdominal pain, diagnostic laparoscopy, recurrent abdominal pain

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Intermittent hydronephrosis in childhood

Orvosi Hetilap ◽

10.1556/oh.2013.29639 ◽

2013 ◽

Vol 154 (24) ◽

pp. 940-946 ◽

Cited By ~ 1

Author(s):

Miklós Merksz ◽

Bálint Sulya ◽

Mária Polovitzer ◽

Ildikó Héjj ◽

Diana Molnár ◽

...

Keyword(s):

Abdominal Pain ◽

Medical Records ◽

Abdominal Ultrasound ◽

Recurrent Abdominal Pain ◽

Final Diagnosis ◽

Occurrence Rate ◽

Unknown Etiology ◽

Delay In Diagnosis ◽

Pelviureteric Junction Obstruction ◽

Difficult Condition

Introduction: Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. Aim: The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pál Children Hospital, Budapest, Hungary. Patients and methods: Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. Results: 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Conclusions: Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys. Orv. Hetil., 2013, 154, 940–946.

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Pain Abdomen as a Presentation of Congenital Malrotation of Gut: A Case Series

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.8-4.262 ◽

2021 ◽

Vol 8 (4) ◽

pp. 65-68

Author(s):

Syed Sajid Hussain Shah ◽

Yousaf Aziz Khan ◽

Bibi Aalia

Keyword(s):

Abdominal Pain ◽

Case Series ◽

Failure To Thrive ◽

Recurrent Abdominal Pain ◽

Late Presentation ◽

Recurrent Pain ◽

Mortality And Morbidity ◽

Delay In Diagnosis ◽

History Of ◽

Work Up

Malrotation of the gut can present at any age but the majority of patients present in neonatal period or early infancy. Most children present with a history of recurrent colicky abdominal pain, vomiting which can be bilious and failure to thrive. Delay in diagnosis leads to increase in mortality and morbidity. Here we present a series of three patients, one girl aged 6 years, one 10 months old boy and one 10 years old boy, who got admitted at our Pediatric Department in a one month period. Patients had a history of recurrent abdominal pain and occasional vomiting, seen and managed by multiple paediatricians and GP doctors with extensive diagnostic workup but never the accurate diagnosis was made. Thorough history was taken and examination done, planned work up done for diagnosis. High index of suspicion is needed in children presenting with recurrent pain in the abdomen. Targeted work-up should be done and patients be kept on follow-up for diagnosis of late presentation of congenital malrotation of the gut.

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