Computed tomography for diagnosis of acute appendicitis in adults.
CONCLUSIONS: The sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of different types of contrast enhancement or no enhancement does not appear to affect specificity. Differences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors. PMID: 31743429 [PubMed - in process]
We describe a patient who presented with abdominal pain at 13 weeks of gestation and was diagnosed with placenta percreta during laparoscopy for presumed appendicitis. Intraoperatively, placenta was seen perforating the uterine fundus and 1 l of hemoperitoneum was evacuated. However, the uterus was hemostatic and the patient was stable, so the procedure was terminated. The patient was then transferred to a tertiary care center, where she ultimately underwent an uncomplicated laparoscopic gravid hysterectomy. We conclude that placenta percreta can occur in the first trimester even in patients without traditional risk fa...
Abdominal pain is a common occurrence in pregnant women and may have a variety of causes, including those that are specific to pregnancy (eg, round ligament pain in the first trimester) and the wide range of causes of abdominal pain that affect men and women who are not pregnant (eg, appendicitis, acute cholecystitis). Noncontrast magnetic resonance (MR) imaging is increasingly performed to evaluate pregnant women with abdominal pain, either as the first-line test or as a second test following ultrasonography. The imaging appearance of causes of abdominal pain in pregnant women are reviewed with an emphasis on noncontrast MR imaging.
We present the case of unilateral nonhemorrhagic adrenal infarct in a 29-week pregnant 21-year-old woman. The patient presented with right upper quadrant pain, nausea, and vomiting. Ultrasonography of the right upper quadrant and appendix was negative for pathology. Magnetic resonance imaging of the abdomen demonstrated a right nonhemorrhagic adrenal infarct, subsequently confirmed with limited computed tomography of the upper abdomen. This case discusses the clinical presentation and pertinent imaging findings of adrenal infarction in pregnancy.
CONCLUSION: ACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management. PMID: 31544223 [PubMed]
ConclusionACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.
Rationale Abdominal pain in pregnancy represents a demanding diagnostic challenge in the emergency department (ED) due to the extensive list of differential diagnoses to be considered, coupled with the possibility of each disease having nonclassical, atypical signs and symptoms, resultant from the patient's pregnant state. Additionally, emergency physicians (EPs) face limitations on investigative imaging modalities because of the need to minimize fetal radiation exposure. EPs have to tackle this diagnostic challenge while performing a balancing act to maximize both maternal and fetal outcomes in a time-sensitive manner, ...
ConclusionsOur results demonstrate that urgent laparoscopic surgeries in the third trimester of pregnancy are feasible, and they can be safely performed with minimal risk for the patient and fetus. Larger prospective studies are required to validate these recommendations.
This JAMA Insights Clinical Update reviews approaches to imaging that are safe for the developing fetus in pregnant women with abdominal pain.
CONCLUSIONS: Uterine torsion may present with non-specific symptoms or be asymptomatic. Urgent laparotomy and rotation of the uterus into its normal anatomical position gives chance for normal course of pregnancy. Subsequent close outpatient care is obligatory to asses viability of the fetus and early detection of possible pregnancy complications. PMID: 30796791 [PubMed - as supplied by publisher]
Publication date: Available online 20 February 2019Source: The American Journal of SurgeryAuthor(s): Timothy Bax, Matthew Macha, John MayberryAbstractAbdCT for the evaluation of AAP in the ED in the US may be excessive and is potentially (although rarely) misleading and harmful. A selective policy of ‘AbdUS first’ combined with an observation unit and/or surgeon evaluation prior to AbdCT is preferred to a ‘routine AbdCT’ policy. Repeated AbdCTs for abdominal pain are not recommended because of cumulative radiation exposure. Standardized and complete history and physical examination, such as that ori...