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*

PURPOSE: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. METHODS: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. RESULTS: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was 6.4±4.9 (range, 0.8–17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. CONCLUSION: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.
Abdomen, Acute* ; Bile Ducts, Intrahepatic ; Child ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Choledocholithiasis ; Common Bile Duct* ; Dilatation* ; Female ; Humans ; Recurrence ; Retrospective Studies ; Ultrasonography

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.
Abdomen, Acute* ; Abdominal Pain ; Estrogens, Conjugated (USP)* ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Ligaments* ; Myoma ; Ovary ; Parovarian Cyst* ; Ultrasonography

Abdomen, Acute ; diagnosis ; diagnostic imaging ; therapy ; Female ; Humans ; Infant ; Intussusception ; diagnosis ; diagnostic imaging ; therapy ; Ultrasonography

The initial radiologic evaluation of a patient with acute abdominal symptoms begins with plain abdominal radiographs. Plain abdominal radiographs are helpful for the diagnosis of intestinal obstruction and pneumoperitoneum. However, cross-sectional imaging modalities, such as ultrasonography or computed tomography, are necessary for specific diagnosis of acute abdomen. Ultrasonography is a non-invasive and comfortable tool for patients visiting emergency room. This article describes the ultrasonographic findings of most common diseases presenting with acute abdominal symptoms.
Abdomen, Acute* ; Diagnosis ; Emergency Service, Hospital ; Humans ; Intestinal Obstruction ; Pneumoperitoneum ; Ultrasonography*

Adnexal torsion in the third trimester is very rare. Because of changes in uterine size and anatomical position of abdominal organs, the diagnosis of adnexal torsion during pregnancy is difficult to establish on the basis of symptoms, physical findings, or radiologic technique. Delayed diagnosis and management can lead to serious complications, so a rapid, reliable, and accurate imaging is needed to evaluate pregnant women with acute abdomen. Ultrasonography has been the initial imaging modality of choice in evaluation of obstetric patient, but it is technically difficult in the third trimester. MR imaging can provide a broad evaluation of the pelvic organs and enables diagnosis of many causes of acute abdomen, especially in the third trimester. We have experienced a case of Parovarian cyst torsion at pregnancy 29+4 wks and reviewed it briefly.
Abdomen, Acute ; Delayed Diagnosis ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Parovarian Cyst* ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Ultrasonography

PURPOSE: To assess the incidence and diagnostic role of hyperechoic inflammatory fatty tissue (HIFT) in transabdominal ultrasonography (TAUS) for acute abdomen. MATERIALS AND METHODS: With TAUS, we examined 98 consecutive patients (68 women, 30 men; mean age, 32 years; age range, 4-84 years) having acute abdominal pain. We examined the abdomen and pelvis by TAUS to determine the cause of acute abdomen, to check for the presence of HIFT, and to investigate whether it was easier and earlier to find the main cause and HIFT presence. We also prospectively evaluated the shape, distribution, and diagnostic role of HIFT. Final diagnoses consisted of 47 cases of acute appendicitis, 14 of enterocolitis, 13 of PID, 7 of gynecological hemoperitoneum, 5 of colonic diverticulitis, 3 of ovarian torsion, 2 of colon perforation, 2 of only presence of non-specific HIFT, 1 of mesenteric lymphadenitis, and 4 of normal. RESULTS: HIFT were seen in 67 patients (68.4%), including 44/47(93.6%) of acute appendicitis, 2/14(14.3%) of enterocolitis, 11/13(84.6%) of PID, 0/7 of hemoperitoneum, 5/5 of colonic diverticulitis, 0/3 of ovarian torsion, 2/2 of colon perforation, and 1/1 mesenteric lymphadenitis. HIFT were detected earlier than the main cause in 17/44 of acute appendicitis, 6/11 of PID, and 4/5 of colonic diverticulitis. In acute appendicitis, the shape of HIFT appeared as fat thickening along the mesoappendix in 12/44, fat thickening along the mesoappendix and the opposite side in 13/44, fat encircled appendix in 6/44, fatty mass wrapping abscess in 10/44, and diffuse intraperitoneal fat thickening in 3/44. In PID, HIFT appeared as a single fatty mass in the pelvis and lower abdomen in 6/11, wrapping pelvic abscess in 2/11, and multiple fatty masses scattered in abdomen and pelvis in 3/11. In colonic diverticulitis, all 5 cases appeared as hyperechoic hemispheric mass covering the inflamed diverticulum. CONCLUSION: HIFT are a usual US finding in patients with acute abdomen, particularly on abdominal and pelvic inflammatory conditions, and they appear with characteristic shape and location in each disease. Therefore, earlier detection of HIFT using TAUS may be useful to make differential diagnosis and find complication in acute abdomen.
Abdomen ; Abdomen, Acute* ; Abdominal Pain ; Abscess ; Adipose Tissue* ; Appendicitis ; Appendix ; Colon ; Diagnosis ; Diagnosis, Differential ; Diverticulitis, Colonic ; Diverticulum ; Enterocolitis ; Female ; Hemoperitoneum ; Humans ; Incidence ; Male ; Mesenteric Lymphadenitis ; Pelvis ; Prospective Studies ; Ultrasonography*

An accessory spleen is often incidentally discovered in up to 20% of autopsies. However, it is exceedingly rare for this condition to result in an acute abdomen. In addition, torsion of an accessory spleen is extremely rare. In spite of this, the entity should be considered in the emergency department in the differential diagnosis of an acute abdomen associated with an intraperitoneal inflammatory mass. This report describes a case of acute torsion of an accessory spleen. A 26-year-old, previously health female was admitted to our hospital with severe abdominal pain and a palpable mass. Ultrasonography showed a well-defined ovoid, hypoechogenic, avascular mass. Computed tomography demonstrated a round, homogeneous hypodense mass with a whorling appearance and an engorged vascular structure in the left side of the mass. The presumptive diagnosis of a large exoenteric mass (small bowel or mesenteric origin) associated with mesenteric volvulus was made preoperatively. However, at laparotomy, the patient was found to have torsion and an infarction of an accessory spleen that had twisted on its long vascular pedicle.
Abdomen, Acute* ; Abdominal Pain ; Adult ; Autopsy ; Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Humans ; Infarction ; Intestinal Volvulus ; Laparotomy ; Spleen* ; Ultrasonography

Herein, a rare case of a spontaneous rupture of a liver abscess, resulting in pneumoperitoneum, is reported. A 71-year old female with uncontrolled diabetes mellitus, developed an acute abdomen. The chest x-ray and plain abdominal radiography findings revealed bilateral subphrenic free air, and the computed tomography suggested the rupture of a gas-containing pyogenic liver abscess in the left hepatic lobe, extending to the lesser omentum. An emergency laparotomy was performed, there was a ruptured pyogenic liver abscess in the left lobe, but no perforation of the hallow viscus organ. A left lobectomy of the liver, with surgical drainage, was performed. The occurrence of pneumoperitoneum secondary to the intraperitoneal rupture of a pyogenic liver abscess, is extremely rare. The condition is associated with high mortality as they are often misdiagnosis at a late stage as a hollow viscus perforation. Recently advances in computed tomography and ultrasound have resulted in liver abscesses being detect earlier. It must be borne in mind that a rupture of a gas-containing liver abscess can also mimic a perforation of the gastrointestinal tract.
Abdomen, Acute ; Aged ; Diabetes Mellitus ; Diagnostic Errors ; Drainage ; Emergencies ; Female ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic* ; Mortality ; Omentum ; Pneumoperitoneum* ; Radiography, Abdominal ; Rupture* ; Rupture, Spontaneous ; Thorax ; Ultrasonography

PURPOSE: This study was performed to evaluate the pediatric appendicitis score (PAS) and to propose diagnostic criteria for acute appendicitis in children. METHODS: The medical records of 194 patients who underwent appendectomies for clinically suspected acute appendicitis and the preoperative evaluations of those patients in our emergency room were, respectively, reviewed. Each of 8 clinical variables, hopping tendereness in the right lower quadrant (RLQ), anorexia, pyrexia, nausea/vomiting, RLQ tenderness, leukocytosis, neutrophilia, and migration of pain, was assigned a score of 1 or 2 to obtain a total of 10. The PAS, ultrasound (US), and combination of the PAS and US were evaluated for sensitivity, specificity, predictive value, and accuracy. RESULTS: Negative appendectomies were performed in 11.3% (22 of 194 patients) of the cases. A PAS > or = 6 was compatible with the diagnosis of appendicitis. However, in cases with a PAS< or =5, US was necessary for the diagnosis of appendicitis. Analysis of the data for the PAS and for combined PAS and US method revealed, respectively sensitivities of 73.8% and 94.6%, specificities of 86.4% and 70.6%, positive predictive values of 97.7% and 96.6%, negative predictive values of 29.7% and 60.0%, and accuracies of 75.3% and 92.1%. CONCLUSION: The PAS is a simple and good diagnostic test for assessing an acute abdomen and diagnosing acute appendicitis in children. However, a combination of the PAS and US is more accurate than the PAS alone in diagnosing acute appendicitis.
Abdomen, Acute ; Anorexia ; Appendectomy ; Appendicitis* ; Child ; Diagnosis ; Diagnostic Tests, Routine ; Emergency Service, Hospital ; Fever ; Humans ; Humulus ; Leukocytosis ; Medical Records ; Sensitivity and Specificity ; Ultrasonography