PURPOSE: This study was performed to assess the clinical usefulness of transabdominal ultrasonography (TUS) in detecting peptic ulcer disease (PUD) in children. METHODS: Twenty-four patients (19 boys, 5 girls; mean age, 10.6±4.5 years [range, 3.0–17.9 years]) who were admitted to the hospital for acute abdomen or gastrointestinal bleeding and diagnosed with PUD by endoscopy and who underwent TUS were included. Clinical data were retrospectively collected by reviewing patient medical records. Gastric ulcer (GU) was suspected when the gastric wall exceeded 8 mm in thickness and had lost its five-layer structure on TUS. Duodenal ulcer (DU) was suspected if the duodenal wall thickness exceeded 5 mm. RESULTS: Sensitivity of TUS in diagnosing PUD was 66.7% for GU and 38.9% for DU. Mean age and body weight of the 11 patients suspected with PUD on TUS were 10.9±4.4 years and 38.1±17.2 kg, respectively. For 13 patients without suspected PUD, they were 12.1±4.1 years and 39.6±17.0 kg, respectively. There was a significant difference in height, weight, and body mass index between patients who were suspected to have PUD and those who were not suspected on TUS (p=0.014, 0.008, and 0.005, respectively). A significant difference in the sensitivity of TUS in diagnosing PUD was found between patients under 30 kg and those over 30 kg (88.9% and 20.0%, respectively; p=0.003). CONCLUSION: TUS investigation of the stomach and duodenum is an efficient method for PUD detection in children with low body weight. TUS can be used in preliminary diagnostic work-up before further invasive tests.
Abdomen, Acute ; Body Mass Index ; Body Weight ; Child* ; Diagnosis* ; Duodenal Ulcer ; Duodenum ; Endoscopy ; Female ; Hemorrhage ; Humans ; Medical Records ; Methods ; Peptic Ulcer* ; Retrospective Studies ; Stomach ; Stomach Ulcer ; Ultrasonography*

BACKGROUND: Improvements in perinatal intensive care have improved survival of extremely-low-birth-weight (ELBW) neonates, although the risk of acute abdomen has increased. The differential diagnosis resulting in abdominal surgery can be categorized into necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), meconium-related ileus (MRI), and meconium non-related ileus (MNRI). The purpose of this study was to review our experience with abdominal surgery for ELBW neonates, and to evaluate characteristics and prognosis according to the differential diagnosis. METHODS: Medical records of ELBW neonates treated between 2003 and 2015 were retrospectively reviewed. RESULTS: Of 805 ELBW neonates, 65 (8.1%) received abdominal surgery. The numbers of cases by disease category were 29 for NEC, 18 for SIP, 13 for MRI, and 5 for MNRI. Ostoma formation was performed in 61 (93.8%) patients; primary anastomosis without ostoma was performed in 4 (6.2%). All patients without ostoma formation experienced re-perforation of the anastomosis site. Seven patients had 30-day postoperative mortality (6 had NEC). Long-term survival of the surgical and non-surgical groups was not statistically different. NEC was a poor prognostic factor for survival outcome (P = 0.033). CONCLUSION: Abdominal surgery for ELBW neonates is feasible. Ostoma formation can lead to reduced complications compared to primary anastomosis.
Abdomen, Acute ; Critical Care ; Diagnosis, Differential ; Enterocolitis, Necrotizing ; Humans ; Ileus ; Infant, Newborn ; Intestinal Perforation ; Magnetic Resonance Imaging ; Meconium ; Medical Records ; Mortality ; Prognosis ; Retrospective Studies

OBJECTIVE: Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis. METHODS: The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed. RESULTS: The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR. CONCLUSION: Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.
Abdomen, Acute ; Alanine Transaminase ; Alkaline Phosphatase ; Appendicitis ; Appendix ; Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Demography ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; gamma-Glutamyltransferase ; Humans ; International Normalized Ratio ; Leukocyte Count ; Neutrophils ; Partial Thromboplastin Time ; Patient Admission ; Peritoneal Cavity ; Platelet Count ; Prothrombin Time

Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.
Abdomen ; Aged ; Aneurysm, False ; Angiography ; Arteries ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Consensus ; Cooperative Behavior ; Diagnosis ; Endoscopy ; Fistula ; Hemobilia ; Hemorrhage ; Humans ; Intestinal Fistula ; Ulcer

Spontaneous intramural hematoma is a rare complication of oral anticoagulants, and its incidence is expected to increase because of the increasing number of elderly patients undergoing anticoagulant therapy. Clinical manifestations of spontaneous intramural hematoma vary from mild abdominal pain to intestinal obstruction or acute abdomen. Early diagnosis is important because most patients can be treated successfully without surgery. The role of endoscopy in the diagnosis of intramural hematoma is not well established because almost all cases are diagnosed non-invasively with computed tomography scans. However, confirmation of the intramural hematoma through direct visualization of the involved bowel mucosa is helpful, if the imaging diagnosis is uncertain. We report a case of anticoagulant-induced spontaneous intramural hematoma, which was diagnosed using endoscopy, with relevant literature review.
Abdomen, Acute ; Abdominal Pain ; Aged ; Anticoagulants ; Diagnosis ; Early Diagnosis ; Endoscopy ; Hematoma ; Humans ; Incidence ; Intestinal Obstruction ; Intestine, Small ; Mucous Membrane

PURPOSE: Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population. METHODS: We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined. RESULTS: The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores. CONCLUSION: The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.
Abdomen, Acute ; Appendectomy ; Appendicitis* ; Asian Continental Ancestry Group ; Diagnosis ; Humans ; Pathology ; Prospective Studies ; Sensitivity and Specificity ; Skates (Fish)*

PURPOSE: Acute abdomen in women of childbearing age has a broad differential diagnosis, often presenting a diagnostic challenge to an emergency physician. Computed tomography (CT) has been used for an accurate diagnosis and prompt treatment of acute abdomen. On the other hand, the increasing use of CT has been a subject of concern for patients, particularly women of childbearing age, due to the potential risk of radiation exposure. This study analyzed the efficacy of various physical examinations for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain in the absence of laboratory abnormalities. METHODS: The charts and CT reports of women, aged 15-35 years old, who visited our ED for non-traumatic abdominal pain between May 2011 and April 2017 were reviewed retrospectively. Patients with chronic abdominal disease, pregnancy, recent abdominal surgery within one month, and abnormal laboratory tests were excluded. RESULTS: In total, 121 patients were identified, of which 34 patients fell into a group that required surgical intervention (surgical acute abdomen group). The remaining 87 patients were managed conservatively without surgical intervention (non-surgical acute abdomen group). The maximal tenderness point (p=0.006), rebound tenderness (p=0.001), shorter duration of abdominal pain (p < 0.001), and absence of diarrhea (p=0.001) were statistically significant for predicting the need for surgical intervention. CONCLUSION: In the absence of abnormal laboratory studies, the hypogastrium tenderness point, rebound tenderness, duration of abdominal pain, and diarrhea were found to be independently valid factors for detecting surgical acute abdomen in women of childbearing age who presented with non-traumatic abdominal pain.
Abdomen, Acute* ; Abdominal Pain* ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hand ; Humans ; Physical Examination ; Pregnancy ; Radiation Exposure ; Retrospective Studies

OBJECTIVE: To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans. METHODS: This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period. RESULTS: PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy. CONCLUSION: PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.
Abdomen, Acute ; Appendicitis* ; Checklist ; Diagnosis* ; Emergency Service, Hospital ; Learning Curve* ; Learning* ; Observational Study* ; Prospective Studies* ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Internal hernia is an uncommon cause of intestinal obstruction, accounting for 1%. The most common cause of internal hernia is left paraduodenal hernia (PDH), which causes acute or recurrent abdominal pain. Due to its nonspecific symptoms, diagnosis of PDH by physical examination is difficult. PDH in children is rarely reported. A 3-year-old-child presented with acute abdominal pain associated with multiple episodes of vomiting. He came to the emergency room three times with abdominal pain. Left PDH was identified by computed tomography. He was taken to the operating room. However cardiac arrest occurred during anesthesia, and he expired. Due to the rarity of PDH in children, it is difficult to consider it as a cause of recurrent abdominal pain. Therefore, considering the possibility of PDH in children with acute or recurrent abdominal pain is recommended.
Abdomen, Acute ; Abdominal Pain ; Anesthesia ; Child ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Hernia* ; Hernia, Abdominal ; Humans ; Intestinal Obstruction ; Operating Rooms ; Physical Examination ; Vomiting

Abdomen, Acute ; diagnosis ; Adult ; Female ; Humans ; Laparoscopy ; methods ; Omentum ; pathology ; surgery ; Torsion Abnormality ; diagnosis ; surgery