1/4. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria.OBJECTIVE: To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. patients AND methods: We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg. RESULTS: Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 /- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin d activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. CONCLUSION: We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/4. A pulmonary embolism case presenting with upper abdominal and flank pain.BACKGROUND: The clinical manifestations of pulmonary thromboembolism are non-specific, which makes this condition difficult to diagnose. A case of helical computerized tomography angiographically documented pulmonary thromboembolism, which initially presented as upper abdominal and flank pain, is described. CASE REPORT: A 46-year-old woman was referred to the emergency department for left flank and upper abdominal pain with diaphoresis and nausea. Her history included rheumatoid arthritis 3 years previously. During her examination the only abnormal finding was abdominal tenderness at the right upper quadrant and a positive Murphy sign without other systemic signs. A chest radiograph demonstrated an atelectatic line at the left lung base. The alveolar-arterial gradient was increased, and a ventilation-perfusion scan revealed a mismatch at the left upper and lower lobes, indicative of pulmonary thromboembolism. Helical computerized tomography angiography revealed filling defects on that side. The patient received anticoagulant therapy and gradually improved. CONCLUSION: The pathogenesis of the pain in the flank and upper abdomen is not known in this case. Unexplained upper abdomen and flank pain in a patient with risk factors for pulmonary thromboembolism, such as rheumatoid arthritis, should be investigated to rule out this treatable but potentially fatal condition.- - - - - - - - - - ranking = 0.33333333333333keywords = abdominal pain (Clic here for more details about this article) |
3/4. Papillary thyroid cancer with an initial presentation of abdominal and flank pain.PURPOSE: Well-differentiated thyroid cancer typically presents as a thyroid mass. Common sites of metastases upon presentation include cervical lymph nodes, lung, and bone. Well-differentiated thyroid cancer with clinically apparent kidney metastases is rare, with fewer than 20 cases reported in the literature. In the vast majority of these cases, the patients had known thyroid neoplasms at the time the renal metastases were identified. We report a case of papillary thyroid carcinoma that presented with abdominal pain in a 25-year-old woman with no previous history of thyroid disease. STUDY DESIGN: This study is a case report. RESULTS: The patient underwent radical nephrectomy for a right renal mass, which was diagnosed as papillary thyroid carcinoma follicular variant. During subsequent evaluation, metastatic disease was also identified in the patient's lungs. The patient was treated with total thyroidectomy and iodine 131. CONCLUSIONS: Papillary cancer, which ordinarily behaves in an indolent manner, can have unusual presentation, including disseminated metastasis on presentation. Renal metastases are extremely rare.- - - - - - - - - - ranking = 0.33333333333333keywords = abdominal pain (Clic here for more details about this article) |
4/4. Left flank pain as the sole manifestation of acute pancreatitis: a report of a case with an initial misdiagnosis.Acute pancreatitis is not an uncommon disease in an emergency department (ED). It manifests as upper abdominal pain, sometimes with radiation of pain to the back and flank region. Isolated left flank pain being the sole manifestation of acute pancreatitis is very rare and not previously identified in the literature. In this report, we present a case of acute pancreatitis presenting solely with left flank pain. Having negative findings on an ultrasound initially, she was misdiagnosed as having possible "acute pyelonephritis or other renal diseases". A second radiographic evaluation with computed tomography showed pancreatitis in the tail with abnormal fluid collected extending to the left peri-renal space. We performed a literature review and discussed this rare occurrence of acute pancreatitis. We also discussed the clinical pitfalls in this case.- - - - - - - - - - ranking = 0.33333333333333keywords = abdominal pain (Clic here for more details about this article) |