• Abdominal pain
• Delay
• Lawsuit
• Malpractice
• Misdiagnosis
• Risk

• Humans
• Abdominal Pain/etiology
• Abdominal Pain/diagnosis
• Emergency Service, Hospital
• Malpractice/legislation & jurisprudence

Peptic ulcer is a defect in the mucosal layer of the stomach or duodenum that extends into the deeper layers of their walls. Patients with peptic ulcer disease (PUD) may be asymptomatic or have mild abdominal discomfort. It is one of the common etiologies of perforated viscus resulting in secondary peritonitis, a life-threatening condition that carries high risk for morbidity and mortality especially in those who present late to the hospital or due to unrecognized and misdiagnosed perforation. Early detection of perforation of peptic ulcers should be based on clinical data and imaging techniques. We report a case of a 56-year-old female who presented to our ED with right upper quadrant (RUQ) pain radiating to the right shoulder, alleviated by food, and not aggravated by anything. On examination, the patient was vitally stable, tenderness in the RUQ was appreciated, and Murphy sign was positive. Thus, she was diagnosed with perforation of anterior first part of the duodenum. What makes our case peculiar is the presentation of biliary colic in the setting of perforated peptic ulcer.

• peptic ulcer disease
• perforated duodenal ulcer
• peritonitis

• Abdominal Pain/diagnostic imaging
• Abdominal Pain/etiology
• Child
• Diagnosis, Differential
• Diagnostic Imaging
• Humans
• Pediatrics

Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination in children. Although most children with acute abdominal pain have self-limited benign conditions, pain may be a manifestation of an urgent surgical or medical condition where the biggest challenge is making a timely diagnosis so that appropriate treatment can be initiated without any diagnostic delays that increase morbidity. This is weighed against the need to decrease radiation exposure and avoid unnecessary operations. Across all age groups, there are numerous conditions that present with abdominal pain ranging from a very simple viral illness to a life-threatening surgical condition. It is proposed that the history, physical examination, laboratory tests, and imaging studies should initially be directed at differentiating surgical versus nonsurgical conditions both categorized as urgent versus nonurgent. The features of the history including patient’s age, physical examination focused toward serious conditions, and appropriate tests are highlighted in the context of making these differentiations. Initial testing and management is also discussed with an emphasis on making use of surgeon and radiologist consultation and the need for adequate follow-up and reevaluation of the patient.

• acute abdominal pain
• surgical abdomen
• ultrasound

• acute appendicitis
• colonic diverticulitis
• ovarian torsion

• Appendicitis
• Children
• Cytokines
• Mesenteric lymphadenitis

Purpose: In this study we aimed to evaluate the radiological examinations of the pediatric patients who were operated with initial diagnosis of acute abdomen.

Methods: We retrospectively reviewed the clinical records and imaging findings of 252 children. All patients were evaluated by plain abdominal radiographs (PAX) and ultrasonography (US). Only 10 patients were examined using computed tomography (CT). The findings of the PAX, US and CT of each patient were determined from their detailed archive records according to their clinical diagnosis.

Results: The most frequent pathology was appendicitis in our study whereas the other pathologies were invagination, ovarian torsion, the complications of Meckel’s diverticulum, gastrointestinal obstruction and tuboovarian abscess in decreasing frequency. PAXs were valuable in diagnosis of the patients with ileus. It has been showed that US was the most useful for patients with appendicitis and invagination. CT was performed only in 4% of our cases as an advanced diagnostic method.

Conclusion: The pediatric patients with acute abdomen have been evaluated radiologically by PAX and US routinely and frequently. CT was performed as an advanced diagnostic method very rarely. CT would be utilized to a lower extent as a more advanced method of imaging in unsolved patient group, as US and PAX solve the pediatric acute abdominal pathologies in high percentages.

• computed tomography
• pediatric acute abdomen
• plain abdominal radiographs
• ultrasonography

• Future trends
• Pediatric imaging
• Update

• Appropriateness
• Diagnostic Imaging
• Pediatrics
• Radiation

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Crohn Disease/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Radiography, Abdominal/statistics & numerical data
• Retrospective Studies
• Sensitivity and Specificity
• Young Adult

The clinical presentation of community acquired pneumonia (CAP) in adults includes mainly symptoms from the respiratory system, whereas CAP is considered as a main cause of abdominal pain in pediatric patients.

We present the case of a patient, who was admitted to our hospital due to abdominal pain that deteriorated progressively and radiated to the lumbar region. The clinical examination revealed decreased breath sounds at the right lung base after 72 h, while the chest X-ray showed pneumonia of the right lung base. The blood culture isolated Streptococcus pneumoniae, and the patient received penicillin according to the results of the antibiogram. In addition, the patient developed symptoms of migratory arthritis, which resolved after 48 h.

CAP should be included in the differential diagnosis of abdominal pain in adult patients. Furthermore, the hematogenous spread of S. pneumoniae may be associated with the development of migratory arthritis.

• Abdominal pain
• Community acquired pneumonia
• Migratory arthritis

The aim of the present study was to investigate the efficacy and safety of standard outpatient re-evaluation for patients who are not admitted to the hospital after emergency department surgical consultation for acute abdominal pain.

All patients seen at the emergency department between June 2005 and July 2006 for acute abdominal pain were included in a prospective study using a structured diagnosis and management flowchart. Patients not admitted to the hospital were given appointments for re-evaluation at the outpatient clinic within 24 h. All clinical parameters, radiological results, diagnostic considerations, and management proposals were scored prospectively.

Five-hundred patients were included in this analysis. For 148 patients (30%), the final diagnosis was different from the diagnosis after initial evaluation. Eighty-five patients (17%) had a change in management after re-evaluation, and 20 of them (4%) were admitted to the hospital for an operation. Only 6 patients (1.2%) had a delay in diagnosis and treatment, which did not cause extra morbidity.

Standard outpatient re-evaluation is a safe and effective means of improving diagnostic accuracy and helps to adapt management for patients that are not admitted to the hospital after surgical consultation for acute abdominal pain at the emergency department.

• Adult
• Aged
• Aged, 80 and over
• Arteries
• Humans
• Intestine, Small/blood supply
• Male
• Mesenteric Vascular Occlusion/diagnostic imaging
• Middle Aged
• Radiography
• Vascular Diseases/diagnostic imaging
• Vascular Diseases/etiology
• Veins/physiopathology

AIM: Although the radiological features of acute appendicitis have been well documented, the value of plain radiography has not been fully appreciated. The aim of this study was to determine the frequency of the association of acute appendicitis with images of fecal loading in the cecum.

METHODS: Plain abdominal radiographs of 400 patients operated upon for acute appendicitis (n = 100), acute cholecystitis (n = 100), right acute pelvic inflammatory disease (n = 100) and right nephrolithiasis (n = 100) were assessed. The presence of fecal loading was recorded and the sensitivity and specificity of this sign for acute appendicitis were calculated.

RESULTS: The presence of fecal loading in the cecum occurred in 97 patients with acute appendicitis, 13 patients with acute cholecystitis, 12 patients with acute inflammatory pelvic disease and 19 patients with nephrolithiasis. The sensitivity of this sign for appendicitis was 97% and its specificity to this disease was 85.3%. Its positive predictive value for appendicitis was 68.7%; however, its negative predictive value for appendicitis was 98.8%.

CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign of acute appendicitis, and the absence of this sign probably excludes this disease. This is the first description of fecal loading as a radiological sign for acute appendicitis.

• Appendicitis
• Radiography
• Cecum
• Fecal loading
• Diagnosis

• Acute Disease
• Adolescent
• Adult
• Aged
• Appendicitis/diagnostic imaging
• Cecum/diagnostic imaging
• Feces
• Female
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Radiography