Plasma cholecystokinin levels were measured in children with recurrent abdominal pain to investigate the relationship of plasma cholecystokinin levels with colonic transit patterns and clinical symptoms. Subjects consisted of 120 children (mean age 9.6 +/- 2.6 years) for whom colonic transit study had also been done. Plasma cholecystokinin levels were 79.2 +/- 58.7 pg/mL in children with colonic inertia, 70.7 +/- 47.0 pg/mL in hindgut dysfunction, 57.4 +/- 53.1 pg/mL in pelvic outlet obstruction, and 67.6 +/- 47.9 pg/mL in normal colonic transit. These data showed that there was a tendency of increasing plasma cholecystokinin levels in children with proximal colon transit delay, although there was no significant difference among four groups. Plasma cholecystokinin levels in children of 10 years of age and under (54.5 +/- 40.4 pg/mL) were significantly lower (p = 0.01) than in children over 10 years (79.1 +/- 59.8 pg/mL). Plasma cholecystokinin levels based on colonic transit patterns, however, were not significantly different between the two age groups. There was no significant difference in plasma cholecystokinin levels between groups based on defecation frequency per week, presence of defecation pain, symptoms of milk intolerance, or the presence of emotional stress. These results suggested that there was a tendency of increasing plasma cholecystokinin levels in the younger age group and in children with delay in proximal colonic transit, but further study is required in relation to plasma cholecystokinin levels based on colonic transit patterns in a large number of patients.
Abdominal Pain/physiopathology* ; Abdominal Pain/blood* ; Child ; Cholecystokinin/blood* ; Colon/physiopathology* ; Female ; Gastrointestinal Transit* ; Human ; Male ; Recurrence

The adverse effects of pain in post-surgery or trauma patients are well documented. A reliable, safe approach to achieving unilateral analgesia in multiple contiguous thoracic dermatomes would be of great benefit to anesthesiologists in acute pain setting following thoracic or upper abdominal surgery. The aim of this study of post-cholecystectomy pain was to compare two methods of postoperative analgesia with interpleural block and paravertebral block with bupivacaine. Thirty otherwise healthy patients who had undergone elective cholecystectomy through a subcostal incision were randomly allocated to two groups of fifteen patients each and given either interpleural block(group 1) or paravertebral block(group 2) with 20 ml 0.5% bupivacaine mixed with 1:200,000 epinephrine through a single catheter. The degree of analgesia was assessed by a verbal rating scale, Prince Henry pain score and a visual analogue scale(VAS 1-10 cm ; O=no pain, 10=worst pain). These pain scores and vital signs were assessed just before and 10, 20, 30, 60 and 120 minutes after injection of bupivacaine. The onset time of analgesia was similar in both groups(6.6+/-3.74 minutes in group 1 and 5.5+/-2.88 minutes in group 2), but the duration of analgesia was significantly longer in group 1(6.5+/-1.92 hours) than group 2(4.5+/-2.17 hours)(p<0.05). In both groups Prince Henry pain scores significantly decreased 10 minutes after injection of bupivacaine and VAS also significantly decreased 10 and 20 minutes after injection(p<0.05), but there was no significant difference between two groups. The systolic blood pressure decreased 10 minutes after the injection of bupivacaine in both groups(Group 1-3.7%, Group 2-6.5%) and the diastolic blood pressure decreased 10 minutes after the injection of bupivacaine only in group 1(2.5%), (p<0.05), however, these changes in arterial blood pressure were of minimal clinical significance. There is no complication in group 1, but 2 out of 15 patients in group 2 showed bilateral blockade without any serious hemodynamic derangement clinically. In conclusion, both techniques showed similarity in the onset and the degree of analgesia except the duration of analgesia, and presented only a few minor complications. Therefore, we feel that paravertebral block can be used in case that coexisting pulmonary or pleural pathology limits the use of interpleural block for post-cholecystectomy pain management. Furthermore, either of the two techniques may be used alternatively in management of thoracic or upper abdominal pain according to technical skill and preference of anesthesiologists.
Abdominal Pain ; Acute Pain ; Analgesia ; Arterial Pressure ; Blood Pressure ; Bupivacaine* ; Catheters ; Cholecystectomy* ; Epinephrine ; Hemodynamics ; Humans ; Pain Management ; Pathology ; Vital Signs

Glycogenic hepatopathy (GH) is a rare complication of type 1 diabetes mellitus. We report the case of a 13-year-old diabetic female with poorly controlled blood sugar levels who presented with abdominal pain and distention 1 month in duration. She exhibited tender hepatomegaly, an elevated lipid profile, and elevated serum transaminase levels. Her liver histology was consistent with GH. The pathophysiology and/or underlying genetic background of GH remains unclear. The optimum treatment for GH is optimal glycemic control, and the prognosis is favorable. Clinicians should be aware of the possibility of GH and observe the clinical response to optimal glycemic control prior to invasive investigation.
Abdominal Pain ; Adolescent ; Blood Glucose ; Diabetes Mellitus, Type 1* ; Female ; Glycogen* ; Hepatomegaly ; Humans ; Liver ; Prognosis

Salmonella infected aneurysm of aorta is one of the local complications by systemic salmonellosis. We have experienced a case of the rupture of infected abdominal aortic aneurysm in 47-year old man. He was admitted because of 39degrees C fever, abdominal pain, back pain of 7 day's duration. Diabetes mellitus had been diagnosed previously, but not managed. Abdominal CT scans showed aneurysmal dilatation with periaortic air bubbles and severe atherosclerotic change of abdominal aorta from renal hilum to the iliac bifurcation level. Blood cluture yielded Salmonella group B strains. He was treated with intravenous ceftriaxone, metronidazole, ciprofloxacin. On the seventh hospital day, the patient showed sign of shock with blood pressure 80/60 mmHg and comatous conciousness. Abdominal CT scans revealed the rupture of infected aneurysm of abdominal aorta just superior to the iliac artery bifurcation. The patient had not underwent surgery, then he was expired.
Abdominal Pain ; Aneurysm ; Aneurysm, Infected* ; Aorta ; Aorta, Abdominal* ; Aortic Aneurysm, Abdominal ; Back Pain ; Blood Pressure ; Ceftriaxone ; Ciprofloxacin ; Diabetes Mellitus ; Dilatation ; Fever ; Humans ; Iliac Artery ; Metronidazole ; Middle Aged ; Rupture ; Salmonella ; Salmonella Infections* ; Shock ; Tomography, X-Ray Computed

Salmonella infected aneurysm of aorta is one of the local complications by systemic salmonellosis. We have experienced a case of the rupture of infected abdominal aortic aneurysm in 47-year old man. He was admitted because of 39degrees C fever, abdominal pain, back pain of 7 day's duration. Diabetes mellitus had been diagnosed previously, but not managed. Abdominal CT scans showed aneurysmal dilatation with periaortic air bubbles and severe atherosclerotic change of abdominal aorta from renal hilum to the iliac bifurcation level. Blood cluture yielded Salmonella group B strains. He was treated with intravenous ceftriaxone, metronidazole, ciprofloxacin. On the seventh hospital day, the patient showed sign of shock with blood pressure 80/60 mmHg and comatous conciousness. Abdominal CT scans revealed the rupture of infected aneurysm of abdominal aorta just superior to the iliac artery bifurcation. The patient had not underwent surgery, then he was expired.
Abdominal Pain ; Aneurysm ; Aneurysm, Infected* ; Aorta ; Aorta, Abdominal* ; Aortic Aneurysm, Abdominal ; Back Pain ; Blood Pressure ; Ceftriaxone ; Ciprofloxacin ; Diabetes Mellitus ; Dilatation ; Fever ; Humans ; Iliac Artery ; Metronidazole ; Middle Aged ; Rupture ; Salmonella ; Salmonella Infections* ; Shock ; Tomography, X-Ray Computed

Emphysematous cystitis is rare disease associated with gas in the bladder wall and lumen. Presentation is varied and sequelae may be minor, severe or fatal. Treatment consists of administration of appropriate antibiotics, control of blood glucose, and adequate bladder drainage. We present a case of emphysematous cystitis with diabetic woman, who did not present symptoms of cystitis but abdominal pain, nausea and vomiting. In our case, it was detected incidentally on simple radiography. After administration of susceptible parenteral antibiobcs and control of blood glucose level, her symptoms were improved.
Abdominal Pain ; Anti-Bacterial Agents ; Blood Glucose ; Cystitis* ; Drainage ; Female ; Humans ; Nausea ; Radiography ; Rare Diseases ; Urinary Bladder ; Vomiting

PURPOSE: Acute appendicitis has atypical clinical findings that make accurate preoperative diagnosis difficult. The aim of this study was to investigate the usefulness of laboratory analyses, especially total leukocyte count (WBC) and neutrophil count, C-reactive protein (CRP) in the diagnosis of acute appendicitis. METHODS: Sixty-nine patients who visited to the Department of Surgery, Sangju St. Mary's hospital with the diagnosis suspected acute appendicitis were studied. WBC, neutrophil count, CRP, and erythrocyte sedimentation rate (ESR) were analysed. Surgery for acute appendicitis was performed in fifty-four patients. According to histopathological findings of the appendix, the patients were divided into four groups: complicated (20 patients with perforated & gangrenous type), suppurative (9 patients), phlegmonous (25 patients), and normal (15 patients). The sensitivity and specificity of the laboratory tests in the diagnosis of acute appendicitis were calculated. RESULTS: The sensitivity of WBC>10, 000/mm3, neutrophil count>70% or >7, 000/mm3, and CRP>12 mg/L in acute appendicitis was 68.5%, 85.1%, and 74.0%, and the specificity was 86.0%, 73.3%, and 80.0% respectively. The combination of neutrophil count or CRP was 94.4% sensitivity. The severity of appendicitis had positive relationship with WBC, neutrophil count, and CRP (P=0.0001, P<0.0001, and P= 0.0014, respectively). The appendicitis and normal groups were significantly different in WBC, neutrophil count, and CRP (P<0.05). CONCLUSION: WBC, neutrophil count, and CRP have diagnostic value among the myriad causes of right lower quadrant abdominal pain and show a positive relationship with the severity of appendicitis.
Abdominal Pain ; Appendicitis* ; Appendix ; Blood Sedimentation ; C-Reactive Protein ; Cellulitis ; Diagnosis ; Gyeongsangbuk-do ; Humans ; Leukocyte Count ; Neutrophils ; Sensitivity and Specificity

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.
Abdominal Pain ; Aneurysm ; Aneurysm, Dissecting* ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Mesenteric Artery, Superior ; Natural History ; Spine*

Isolated dissecting aneurysm of the superior mesenteric artery (SMA) is a rare condition. Although aneurysms of the SMA are frequently classified with other splanchnic aneurysms, dissecting SMA aneurysms are quite different in terms of their etiology and natural history. Therefore, independent consideration is warranted during their treatment. In this case report, a dissecting aneurysm was accompanied by burst fractures of the first and third lumbar spines at the same height. We treated the patient, who was suffering from chronic post-prandial intermittent abdominal pain after falling down. The patient stopped displaying repeated episodes of abdominal pain did not recur after the false lumen entry was closed by a short exclusion stent graft, and there were no procedural complications. The stent graft remained patent, and the patient has remained free of symptoms during the 16 months follow-up period. We present here the case of a traumatic isolated SMA dissecting aneurysm that was successfully managed by endovascular treatment.
Abdominal Pain ; Aneurysm ; Aneurysm, Dissecting* ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Mesenteric Artery, Superior ; Natural History ; Spine*

A 33-year-old male presented with an acute onset of back pain and abdominal pain. He was 189.9 cm tall and had an arm span of 194 cm, and had mild pectus carinatum as well as arachnodactyly. Plain radiographs showed kyphoscoliosis of the lumbar spine, bamboo spine of the thoracic spine, and sacroiliitis of the pelvis. Abdominal computed tomography revealed debakey type 3 aortic dissection. We prescribed beta blockers to control his blood pressure. According to the modified New York criteria, we diagnosed him with HLA negative ankylosing spondylitis and initiated therapy with nabumetone and sulfasalazine. We later diagnosed Marfan syndrome based on the Ghent criteria and mutation screening at the fibrillin-1. After treatment, he has been followed up without symptoms or complications.
Abdominal Pain ; Arachnodactyly ; Arm ; Back Pain ; Blood Pressure ; Butanones ; Humans ; Male ; Marfan Syndrome ; Mass Screening ; Microfilament Proteins ; New York ; Pelvis ; Sacroiliitis ; Spine ; Spondylitis, Ankylosing ; Sulfasalazine