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A junior SHO's experience on the surgical admission unit
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Intestinal obstruction is a common cause of an acute abdomen. It can occur at any point of the intestine and can even occur in more than one place at once, particularly if some disease process sticks several loops of bowel together (e.g. Crohn’s disease). The higher the level of the obstruction, the less dilated bowel will be visible on X-ray, but vomiting will be an earlier feature. Vomiting is a relatively late feature of obstruction of the terminal ileum and colon. In contrast, the lower the level of the obstruction, the more likely that the patient will experience ‘total constipation’ (passing neither faeces or flatus), often accompanied by considerable distension of the abdomen by gas in the obstructed colon.
Abdomen
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
The sudden onset of severe abdominal pain represents a genuine emergency in general practice and is a common out-of-hours call. In the true acute abdomen, the patient is obviously ill, and as the clinical condition may deteriorate rapidly, ensure that you examine the patient as soon as possible.
Abdomen
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
The sudden onset of severe abdominal pain represents a genuine emergency in general practice and is a common out-of-hours call. In the true acute abdomen, the patient is obviously ill, and as the clinical condition may deteriorate rapidly, ensure that you examine the patient as soon as possible.
Acute appendicitis complicated by concomitant thyroid storm
Published in Baylor University Medical Center Proceedings, 2021
Michael M. Mohseni, Charles Graham
Thyrotoxicosis and thyroid storm (TS) can mimic an acute surgical abdomen.1 In some instances, patients undergo exploratory laparoscopy given concerns of an acute abdomen in the setting of TS and subsequently lack intraoperative findings.2 Differentiating medical from surgical causes of an acute abdomen is imperative to ensure initiation of appropriate therapies. In the setting of an emergent surgical condition, a patient with thyrotoxicosis needs premedication with beta-blockers, corticosteroids, and antithyroid agents to prevent TS in the perioperative or postoperative timeframes.3 Case reports of appendicitis with concomitant thyrotoxicosis are rare.3,4 However, clinicians must proceed cautiously to optimize patients’ thyroid status before any operative interventions, thereby minimizing risks of cardiovascular collapse or death. We present a case of acute appendicitis requiring surgical intervention in a patient simultaneously diagnosed with TS.
Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report
Published in Gynecological Endocrinology, 2021
Likun Wei, Yanfang Zhang, Xueru Song
The present case had severe OHSS related to multiple pregnancy after ovulation induction. We described the detrimental effect of an internal hernia, strangulated intestinal obstruction, and subsequent intestinal necrosis on the patient’s health. This case highlighted the need for vigilance of surgical acute abdomen in women with OHSS when insufferable abdominal pain cannot be alleviated after conservative treatment, or persistent severe gastrointestinal symptoms are not easily explained by the initial diagnosis. Clinicians should pay more attention to a previous history of abdominal surgery, physical examination results, and imaging results, and seek the consultation of surgeons, in order to make an early diagnosis in acute abdomen. It is necessary to relax the indications of exploratory laparotomy to avoid subsequent severe complications. Triplet pregnancy is a common iatrogenic complication in infertility treatment by ovarian induction. In the present case, pregnancy termination was requested to relieve the progress of OHSS, which was a life-threatening condition. As OHSS can lead to fatal harm in reproductive women, physicians must attach great importance to the risk factors of OHSS and make exact evaluation and intervention during the infertility treatment to decrease the incidence and severity of OHSS.
Beyond the commonest: right lower quadrant abdominal pain is not always appendicitis
Published in Alexandria Journal of Medicine, 2020
Mahmoud Agha, Maha Sallam, Mohamed Eid
Three patients (0.3%) had been presented with chronic right iliac fossa pain, with acute exacerbation. WBC was normal in two patients and elevated in only one patient. They had been diagnosed with CT scan as ileocecal tumors; which were proven pathologically to be adenocarcinoma. The one who had associated high WBC was presented with carcinoma associated with acute appendicitis (Figure 1). Acute abdomen may be the initial presentation of an ileocecal malignant tumor, commonly at this site adenocarcinoma or lymphoma, gastrointestinal stromal tumor, or metastasis, especially if complicated with perforation or abscess. The differentiation between an appendicular mass and a malignant ileocecal lump may be straightforward at the CT scan; if the appendix could be clearly identified and separated from the ileocecal mass lesion. However, this is not always a simple easy task. [10,11]