abdominal pain

Appendicitis following a live laparoscopic donor nephrectomy (LLDN) is rare complication and can present a diagnostic challenge. LLDN patients represent a unique group of patients for which there is limited research. Preventing a second operation and preserving residual kidney function are important considerations. Herein we present a case of appendicitis 9 days post hand assisted laparoscopic donor nephrectomy which presented as right sided abdominal pain and was confirmed on computed tomography. It was successfully managed through a conservative approach of intravenous antibiotics and fluid. This case demonstrated successful conservative management of appendicitis post LLDN and is the first reported case of conservative management in LLDN patients and only the second reported case of appendicitis post LLDN.

 The diameter of the appendix is a key parameter in diagnosing appendicitis. The diagnostic threshold for this parameter is 6 mm, originally established through graded compression sonography of the right lower quadrant (RLQ) of the abdomen. However, without corroborative findings from computed tomography (CT), this threshold may not be a reliable indicator of appendicitis. To ensure accurate diagnosis, clinicians should perform a comprehensive, multiparameter imaging assessment of the appendix, rather than relying solely on appendix diameter.

 This study aimed to identify key factors for predicting appendicitis using contrast-enhanced coronal and sagittal CT images obtained through multiplanar reconstruction.
Patients and

 This single-center, retrospective, cross-sectional study included patients who presented to our emergency department (ED) with RLQ abdominal pain and subsequently underwent contrast-enhanced CT between July 2019 and September 2020. The primary study outcome was pathologically confirmed appendicitis. Two experienced radiologists assessed parameters such as appendix diameter, wall thickness, abnormal appendix enhancement, abnormal appendix content, appendix erection, and periappendiceal fat stranding. Multivariate logistic regression was performed to identify significant predictive factors for appendicitis.

 The study included 173 patients (median age: 37 years; women: 86). They were divided into appendicitis (n = 102) and alternative diagnosis (n = 71) groups. Significant differences were observed between the groups in terms of appendix diameter, wall thickness, wall enhancement, luminal content, appendix erection, and periappendiceal fat stranding (P < 0.001). The diagnostic sensitivity and specificity values for an appendix diameter threshold of 7.7 mm were 91% and 82%, respectively. An appendix diameter of > 7.7 mm (OR: 15.3; P < 0.001), abnormal appendix enhancement (OR: 12.5; P < 0.001), and appendix erection (OR: 6.1; P = 0.004) emerged as significant independent predictors of appendicitis.

 An appendix diameter of 7.7 mm appears to be the optimal threshold for diagnosing appendicitis. Additionally, the detection of abnormal appendix enhancement and appendix erection on contrast-enhanced CT images holds considerable diagnostic value.

This article discusses Fasciola hepatica infection, a zoonotic parasite that lives in the liver bile ducts. A 31-year-old female patient was diagnosed with symptoms such as nausea, increased liver enzymes, and right upper quadrant pain for about a year. The parasite was detected in the common bile duct by Endoscopic Ultrasound (EUS) and removed by Endoscopic Retrograde Cholangio Pancreatography (ERCP). Treatment was performed with 10 mg/kg triclabendazole. Eosinophilia, abdominal pain, and dietary history are important clues in the diagnosis of infection. Imaging methods, especially EUS, play a critical role in diagnosis. With this method, parasites can be seen as mobile hyperechogenic structures. If untreated, parasites can survive in their hosts for many years, therefore early diagnosis and treatment are important in preventing complications. It is recommended to monitor the eosinophil levels and serological test results of patients after treatment. As a result, EUS is a very valuable diagnostic tool in suspected cases.

Psychological and physical symptoms such as irritability, headache, abdominal pain, difficulty with bowel movements, and drowsiness that occur because of hormonal fluctuations during the menstrual cycle refer to premenstrual syndrome (PMS). The study examined whether the intake of fermented food containing Aspergillus oryza (Amazake and Raw-SHIOKOJI), a traditional Japanese food, improved the abdominal symptoms associated with PMS.

Eleven healthy Japanese collegiate women in their 20s participated in this interventional study. The study period was set to 28 days per phase, and the participants were examined over three separate phases: before, during, and after the intake of Amazake or Raw-SHIOKOJI. The participants were instructed to maintain a daily record of their food intake, bowel movements and menstruation throughout the study period.

The intake of fiber, fat, protein, and carbohydrate among 11 participants were similar, with no significant difference between the two groups. Menstrual abdominal discomfort in women in their 20s was noted during the luteal and menstrual phases. Eight participants (72.7%) experienced abdominal discomfort during the luteal phase and all participants experienced abdominal discomfort during the menstrual phase. Consuming fermented food containing Aspergillus oryzae may reduce PMS abdominal symptoms by 72.7%.

This study showed that consumption of food containing Aspergillus oryzae reduced abdominal discomfort associated with the luteal phase and may improve menstruating women's health and quality of life.

Lead toxicity is an environmental disease that has been encountered since ancient times and can present with symptoms such as abdominal pain, constipation, or neurological deficits. This issue accounts for the highest burden among environmental disorders.

The aim of this study was to assess the prevalence of lead toxicity in patients with abdominal pain in Southern Iran.

In this study, 50 pediatric patients with chronic abdominal pain and 50 healthy individuals were compared in terms of their blood lead levels and underlying demographic information that could contribute to lead toxicity.

A total of 100 participants were enrolled in this study, with a mean age of 8.50 ± 2.444 years, 53.0% of whom were male. The mean blood lead levels in the control and case groups were 1.54 ± 0.693 and 2.73 ± 2.547 µg/dL, respectively, with a statistically significant difference (P = 0.002). When cutoff values of 2 µg/dL and 3.5 µg/dL were considered for lead toxicity, the prevalence of lead toxicity was significantly higher in the case group. Environmental and demographic factors did not differ between patients with lead toxicity and those with normal lead levels (P > 0.05).

The prevalence of lead toxicity in children complaining of chronic abdominal pain was 12.0% (95% CI: 4.5% - 24.3%). However, more accurate testing of the environment is needed in future studies.

Cystic fibrosis (CF) represents a prevalent autosomal recessive condition that predominantly impacts the respiratory and gastrointestinal systems. Abdominal pain in patients with cystic fibrosis is commonly linked to conditions including distal intestinal obstruction syndrome, pancreatitis, or hepatic disease. This case report presents a rare etiology of abdominal pain, specifically mesenteric vein thrombosis (MVT) attributed to hereditary thrombophilia, observed in a pediatric patient diagnosed with cystic fibrosis (CF).

A 3-year-old female patient with a confirmed diagnosis of cystic fibrosis, established through a sweat chloride test, exhibited significant right lower quadrant (RLQ) abdominal pain. The initial diagnostic evaluation, comprising an abdominal series, laboratory assessments, and abdominal ultrasound, ruled out prevalent etiologies including DIOS, pancreatitis, and appendicitis. The presence of persistent pain necessitated additional diagnostic evaluation through a contrast-enhanced CT scan, which subsequently identified mesenteric vein thrombosis. The analysis of genetic testing revealed a homozygous mutation in the MTHFR C677T gene, which is suggestive of hereditary thrombophilia. These findings were corroborated through Sanger sequencing methodologies.

This case highlights the importance of evaluating uncommon conditions such as mesenteric vein thrombosis in pediatric patients with cystic fibrosis who exhibit atypical abdominal pain. An extensive diagnostic strategy, incorporating genetic analysis, is crucial for the prompt identification and focused intervention necessary to avert significant complications. Abdominal pain is a significant clinical symptom that may be associated with various underlying conditions, including cystic fibrosis, venous thrombosis, and mesenteric ischemia. Each of these conditions presents unique challenges in diagnosis and management, necessitating a comprehensive understanding of their pathophysiology and clinical implications.

The urachus is a duct that connects the allantois to the urinary bladder in the fetus. Partial or total obliteration failure of the urachus leads to various anomalies, which can be discovered in children and adults.

A 12-year-old boy presented with recurrent fever and abdominal pain two years ago. In the physical examination, he had tenderness in the lumbosacral area and Achilles tendons. Enthesitis-related arthritis (ERA), inflammatory bowel disease (IBD), and familial Mediterranean fever (FMF) were considered differential diagnoses. The patient was treated with a naproxen anti-inflammatory dose. After 15 months, his mother reported a bad odor discharge from his umbilical area. Investigations revealed patent urachus, and he underwent an operation that confirmed the diagnosis and resolved the patient's complaints.

Functional abdominal pain (FAP) is one of the most common gastrointestinal disorders affecting children. Evidence suggests the primary role of physiological factors in the development of FAP in children. Obsessive-compulsive disorder (OCD) creates excessive worrying, distress, mental preoccupation, and low self-esteem. The purpose of this study was to examine whether parental OCD is associated with the prevalence of FAP among children.

The purpose of this study was to examine whether parental OCD is associated with the prevalence of FAP among children.

This case-control study examined 200 parents of children and adolescents (4-16 years old) with and without FAP. The New Rome criteria (Rome IV) were used to diagnose FAPs. This study used the obsessive-compulsive inventory-revised (OCI-R) to assess different domains of OCD symptoms in parents. The other required information, such as age, demographic information, and socioeconomic status (SES), was collected through self-administered questionnaires.

The study included 88 parents of children with FAP as the case group and 100 parents of children without FAP as the control group. Comparing cases with controls, significant differences were observed in age, occupation and number of siblings. The mean case and control OCR-I scores were 28.81±10.57 and 20.83±13.16, respectively. Furthermore, the case group scored significantly higher in washing, obsessing, neutralizing, ordering, and checking subscale scores than controls.

The results of this study indicate that parental OCD is associated with the prevalence of FAP in children. Parents who suffer from OCD are more likely to have children with FAP. Parental OCD symptoms may influence the progression and development of FAP. However, more studies are warranted to confirm our results.

Splenic infarcts are uncommon and may not be readily considered in the emergency department, as the clinical presentation often mimics acute abdominal pain. While atherosclerotic damage commonly occurs at the abdominal aorta and its branching parts**, it can also affect the splenic artery, potentially leading to splenic infarction. Although it is widely acknowledged that the abdominal aorta and its branches are the most common sites for atherosclerotic damage, atherosclerosis of the splenic artery can also be an etiological factor for splenic infarction, leading to impaired blood flow in the spleen. Splenic infarction represents a clinical scenario that is not frequently encountered, and its presentation can resemble other causes of acute abdominal pain. This case report describes a patient who presented to the emergency department (ED) with abdominal pain and was subsequently diagnosed with splenic infarction secondary to atherosclerosis of the splenic artery.

  Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by changes in bowel movements and abdominal pain in the absence of structural disorders. Although effective treatment for irritable bowel syndrome is not yet available. One of the treatments is the low-dose antidepressants, depending on the type and severity of the disease. This study was performed to compare the effect of selective serotonin-norepinephrine reuptake inhibitors including duloxetine and imipramine from a tricyclic antidepressant.

forty-eight definitively diagnosed IBS patients (based on Rome III criteria) were examined in 2 groups of men and women. Patients in the control group were treated with Dicyclomine and Imipramine while the case group received dicyclomine and duloxetine. The outcomes were measured before and 3 months after treatment to determine and compare the improvement in responses (mainly diarrhea).

Duloxetine could significantly improve the symptoms such as abdominal pain in females (P-value: 0.01) and males (P-value: 0.001), bloating in females (P-value: 0.004) and incomplete defecation in females (P-value: 0.001) and in males (P-value: 0.007). The side effects of this drug were, however, higher than Imipramine. The introduction of more appropriate treatment requires further studies on a larger sample size to assess the symptoms and the side effects.

 Based on the effect of duloxetine on this clinical results, it is recommended as an effective treatment in controlling of abdominal pain, bloating, and incomplete defecation.

 Umbilicus visceral manipulation is an effective medical practice in the treatment of a wide range of diseases, including abdominal pain, as described in traditional Persian medicine (TPM) texts.

Case description: 

A 35-year-old married female (G2P2Ab0L2NVD2) from Gorgan, Iran, presented to the TPM health care center affiliated with Golestan University of Medical Sciences on February 21, 2022, due to abdominal pain, obesity, and increased appetite.

Tailoring the treatment to the individual characteristics of the client and incorporating TPM measures, such as manual procedures, in conjunction with modern medicine, can play a crucial role in the overall treatment process.

Studies have shown that Celiac Disease (CD) can present with patchy mucosal lesions. The aim of this study is to investigate the utility of duodenal bulb biopsy in the diagnosis of CD in some Iranian children. Moreover, we compare disease characteristics in children with CD consistent histology limited to the duodenal bulb (D1) with those of children with CD-related histology in the second part of duodenum (D2) with or without histology changes in D1.

This is a cross sectional study on anti-tissue transglutaminase antibody (anti TTG Ab) positive children in Mashhad between 2019 and 2021. Intestinal biopsies from D1 and D2 were done. Diagnosis of CD was defined by the Marsh classification above 1. Patients of 2 groups compared in terms of clinical and laboratory parameters.

from 81 serology positive patients, 70 patients were diagnosed with CD, based on Marsh classification. Among them, 6 patients (8.6%) had exclusive involvement of D1, and 64 cases (91%) had involvement of D2 with or without D1. The two groups did not have a statistically significant difference in terms of clinical presentation, serological and histopathological values.

Taking D1 biopsies can improve case finding of CD in the pediatric population.

Ectopic pregnancy (EP) is the leading cause of early pregnancy accounting for 10-15% of pregnancy-related deaths. It is lifethreatening condition where the majority of them present late. This study aims to evaluate the incidence, risk factors, clinical features, diagnosis, and management of EP in the tertiary care center.

This study conducted a retrospective analysis of electronic medical records from June 2015 to June 2020, focusing on participants in the age group of 18 to 45 years, to examine the occurrence of EP. The data were analysed with simple descriptive statistics and presented in frequency tables and charts of age group, parity, anemia grades, risk factors and presenting symptoms.

The incidence of EP in the current study was 0.38%. In the present study, 73.8% of women were of 20–30-year-old. In this study, 54.1% of women had a history of pelvic inflammatory disease (PID). Prior EP was seen in 19.7 % of cases. 16.4% of participants had a prior history of tubectomy and 19.7% had a previous history of infertility treatment, and 21.3% had a previous history of lower segment caesarean section (LSCS). In the present study, 65.5% of women presented with amenorrhea of 4-8 week, and 95% had abdominal pain. In the present study, common site was the right fallopian tube in 73.9% of cases. In this study, all cases need surgical management most common procedure carried out was salpingectomy. intensive care unit (ICU) admission was needed in 26.2% of cases, and no mortality was seen in our study.

EP is a serious and potentially life-threatening condition. Early diagnosis and prompt management are crucial in reducing maternal mortality and morbidity rates.

Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients’ information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.

The effectiveness of eradicating Helicobacter pylori infection in improving the symptoms of chronic gastritis has been examined; however, the results of the studies have been contradictory, especially in childhood. This study aimed to compare the clinical effectiveness of sequential Helicobacter pylori eradication treatment and proton pump inhibitor alone in children with chronic Helicobacter pylori-positive gastritis.

This randomized double-blinded clinical trial was conducted on 84 children aged 5 to 15 years suffering from Helicobacter pylori-associated active chronic gastritis. The patients in the experimental group received sequential therapy including omeprazole, amoxicillin, clarithromycin, and metronidazole; and those in the control group only received omeprazole. Before the intervention, and 2 and 4 months after it, the severity of clinical symptoms was assessed.

After therapeutic regimens, the intervention group was found to have a significantly higher decrease in the severity grades of some symptoms including heartburn, gastroesophageal reflux, and abdominal pain in the epigastric area as compared to the control group (P<0.05). The assessment of the frequency of clinical symptoms in the intervention and control groups also indicated a greater reduction in epigastric pain in the group treated with Helicobacter pylori eradication as compared to the control group (P<0.05).

Prescribing a sequential Helicobacter pylori eradication regimen can lead to reducing the severity of clinical symptoms in children suffering from chronic gastritis.

Acute pancreatitis, a potentially fatal disease, with symptoms including nausea and/or vomiting, indigestion, and abdominal pain, is known to range from a mild self-limiting state up to a more severe and lethal form. This review aims toprovide a clearer picture to improve understanding the role of viral agents in the development of acute pancreatitis.Common databases including PubMed, Google Scholar, and Scopus were used for the literature search. In this review search terms including virus, viral, infection, and specific descriptive terms for a virus were considered in different combinations. Various causative agents are recognized in the development of acute pancreatitis as one of the most frequent gastrointestinal diseases, such as gallstones, alcoholism, and hypertriglyceridemia. Microbial pathogens with about 10% of acute pancreatitis cases, mainly viruses, among other factors, are thought to play a role in this regard. Once the pancreatitis diagnosis has been made, depending on thecausative agent, the management approach and specific interventions affect the final outcome. Virus-induced acute pancreatitis in patients should be considered. Advanced diagnostic tests such as PCR, in situ hybridization, and biopsy can help for a betterunderstanding of the role of viruses in causing acute pancreatitis. Improvement in the tests will lead to timely diagnosis, treatment, and better management of pancreatitis.

This case report presents the clinical course of a 54-year-old male patient diagnosed with posterior NutcrackerSyndrome (NCS). The patient experienced recurrent episodes of macroscopic hematuria and severe left flankpain. He was diagnosed with retro-aortic left renal vein (RLRV ), an unusual congenital abnormality, which canresult in the compression of the left renal vein between the aorta and the vertebra. Initial attempts at con-servative management and endovascular interventions were unsuccessful. An open surgical intervention wasultimately performed. The surgery involved ligation of the left renal vein. Postoperatively, the patient experi-enced marked improvement in symptoms, with complete resolution of hematuria and pain. Furthermore, renalfunction remained stable, and no kidney-related complications were reported. This case suggests that, in certainsituations where endovascular intervention and transposition of LRV or re-implantation of the left gonadal veinare not feasible, ligation of the LRV may provide a safe and practical treatment option for patients with posteriorNCS. Future research is needed to validate these findings.

Heterotopic pregnancy, a rare form of pregnancy, can occur Simultaneously intrauterine and extrauterine. This can be a life-threatening condition and can be easily overlooked if undiagnosed. The patient was a 27-year-old woman, gravid3, para1, live1 and abortion1, at 10 weeks and 1 day by last menstrual period who went to the emergency room complaining of pain in the lower abdomen form 3 days ago. Pelvic ultrasound revealed both live intrauterine and extrauterine pregnancy by gestational age based on the Crown-rump length diameter, 9 weeks and 3 days with moderate to severe hemoperitoneum. The heterotopic pregnancy diagnosis is difficult and requires a high index of suspicion.

 Due to the multi-factoriality of chronic abdominal pain (CAP) in children, this study aimed to assess the main etiologies for CAP in children and its main determinants in a sample of the community of affected children living in Shahrekord, Iran.

 This cross-sectional study was conducted on 400 children aged 3-14 years who were referred to a referral clinic in Shahrekord, Iran in 2022. Abdominal pain at least 3 times in 3 months, which disrupted daily activities, was the criterion for entering the study. A checklist was prospectively fulfilled by interviewing to assess different aimed data.

 The majority of children complained of periumbilical pain as the main site of chronic pain, and other pain points were much less common. The main characteristics that provided grounds for suspecting this type of pain included right abdominal pain without clear justification, growth disorder, and severe vomiting. The most common definitive diagnosis was functional constipation, followed by chronic gastritis and fecal impaction.

 The occurrence of periumbilical pain, along with the occurrence of severe and frequent vomiting and growth failure can be considered diagnostic markers triad when suspecting the occurrence of CAP. The most common etiologies for such pains included functional constipation, chronic gastritis, and fecal impaction.