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Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Retroperitoneal abscess refers to infection in the lumbar and iliac regions. Lumbar abscess may present as fever, low back pain, tenderness, and lumbar muscle spasm. It results from infection in the spine or retroperitoneal structures, such as kidney, pancreas lymph nodes, and aortic aneurysm, or from a posterior perforation of the bowel or appendix. Pyogenic psoas abscess is difficult to diagnose because of its concealed location and nonspecific manifestations.82 A major cause in the past was tuberculosis, usually as a complication of Pott’s disease of the spine. Nowadays, pyogenic bacteria, Escherichia coli, Proteus, entero-cocci, and anaerobes are the etiologic agents. Most cases are secondary to periappendicular abscess, diverticulitis, inflammatory bowel disease, spinal osteomyelitis, perinephric abscess, and abdominal trauma. The main clinical features are fever, lower abdominal pain, and inguinal mass. Hip spasm (psoas sign) and an abnormal straight leg raising test are frequently present. Bacteremia is occasionally detected, especially in cases of Staphylococcus aureus infection. Conventional radiology such as plain abdomen film, barium enema, and intravenous pyelography may contribute to the diagnosis; however, ultrasonography, gallium scanning, and especially computerized tomography83 are more useful. Treatment involves surgical drainage as well as antibiotics.
Hip pain
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Clinical presentation can be mild and indolent with fever, lower abdominal/back/flank pain, or limp. There may be a flexion deformity of the hip and pain with extension of the leg or a positive psoas sign. This can also be seen with appendicitis. A mass may be palpable below the inguinal ligament if the abscess extends distally.
The Pediatric Gastrointestinal Physical Examination
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Abdominal examination of older children may yield findings such as abdominal tenderness that may be localized to the specific site of the pathology if there is peritoneal involvement (Table 1.4). Presence or absence of specific findings, such as rebound, abdominal guarding, or the psoas sign, may indicate inflammation involving specific regions of the peritoneum. Nerve fibers that are present may help directly to locate the site of abdominal disease; however, bowel inflammation can present differently. Mucosal damage may not be interpreted as well by the body as a pain presentation.
Abdominal pain – a common presentation with unusual diagnosis: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Yeshaswini. P.S. Reddy, Sriviji Senthil Kumaran, Varun Vanka, Asra Rab, Viren Patel
During this hospitalisation, she remained hemodynamically stable but endorsed significant distress due to the abdominal pain. Severe tenderness in the right lower quadrant to mild palpation with guarding, positive McBurney’s point tenderness, and positive rovsing’s sign were observed; psoas sign and obturator sign however were negative. Mildly decreased bowel sounds and absence of organomegaly were noted. Given the presentation, our differential diagnosis included acute appendicitis, acute ovarian torsion, Mckel’s diverticulum, acute ileitis, PID, ovarian cyst, renal calculus, endometritis, ectopic pregnancy, or tubo-ovarian abscess.