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11/18. Thoracoabdominal radiculopathy.

    Thoracic nerve root dysfunction (TNRD) manifested as abdominal pain is an infrequently reported condition. We present data on six patients who had chronic intermittent thoracoabdominal pain originating in the back. Diabetes and osteoarthritis of the spine were the chief causes of these symptoms. The electromyogram in all patients showed changes consistent with an acute radiculopathy. All patients responded to anti-inflammatory therapy in combination with phenytoin, carbamazepine, amitriptyline, or local nerve block. TNRD is a condition that may be diagnosed earlier if clinical suspicion is increased, thus sparing patients excessive testing and surgery, and affording quicker relief.
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keywords = nerve
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12/18. syndrome of the rectus abdominis muscle mimicking the acute abdomen.

    The syndrome of the rectus abdominis muscle is a disorder of unknown etiology that produces rupture or tear of the epigastric artery, and stretches the rectus cutaneous medialis nerve, producing excruciating pain. The disorder is misdiagnosed in 60% to 93% of cases. We report two cases that presented as acute abdomen. One helpful diagnostic test was the lidocaine test, accomplished by subcutaneous injection of lidocaine into the sheath of the rectus abdominis muscle near the rectus cutaneous medialis nerve; the procedure provided immediate pain relief and the patients remained asymptomatic. In addition to helping establish a diagnosis quickly the lidocaine test may spare the patient the unnecessary morbidity or mortality of more invasive procedures.
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keywords = nerve
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13/18. Gastric rupture from blunt abdominal trauma.

    Gastric rupture from blunt abdominal trauma is a rare occurrence. Six patients are presented and reviewed with the literature since 1930. Several features of the diagnosis and management of this injury are emphasized, including a strong association with thoracic trauma and a high incidence of intra-abdominal abscess formation which results from massive intraperitoneal contamination. mortality is not usually from gastric rupture per se, but rather from concomitant vascular or neurologic injury. The key to survival for these patients is early operative intervention and an aggressive approach to reoperation and drainage of abscesses.
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ranking = 0.21897224601319
keywords = injury
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14/18. Hemorrhagic pancreatitis associated with acetaminophen overdose.

    A 19-yr-old man ingested 25 g of acetaminophen in a suicide attempt. Twenty-one hours after the ingestion the plasma acetaminophen level was potentially hepatoxic at 62 micrograms/ml. The toxicology screen was negative for all other drugs. Thirty-six hours after admission the patient developed an acute abdomen with a serum amylase of 1500 IU. peritoneal lavage revealed a grossly hemorrhagic fluid. Exploratory laparotomy revealed necrotic pancreatitis. Hepatoxicity with the peak SGOT greater than 2000 IU and a mild renal toxicity with the creatinine of 1.9 mg/dl occurred despite late initiation of treatment with n-acetylcysteine. No other etiology for the pancreatitis was found. Peritoneal irrigation was continuously performed through a surgically placed dialysis catheter. pancreatitis associated with acetaminophen overdose has been reported twice in the past. Although the pathophysiology of the pancreatic injury is obscure, the lack of other etiological factors and temporal association of the pancreatitis with acetaminophen-induced hepatic and renal toxicity suggest a causal relationship.
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ranking = 0.10948612300659
keywords = injury
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15/18. bile duct disruption by blunt trauma.

    The rarity of bile duct injury secondary to blunt abdominal trauma leads to frequent delays in diagnosis and inappropriate management. An illustrative case is therefore described and 94 reported cases are reviewed. In 53% of patients, operation was delayed more than 24 hours. Early clinical findings of hypovolemia and acute abdomen are related to associated injuries. Late findings are abdominal distention and jaundice due to the biliary injury. early diagnosis is facilitated by diagnostic paracentesis. patients operated on during the first 24 hours after the injury had a statistically higher incidence of bile duct injury distal to the cystic duct (p less than 0.05) and of complete ductal severance (p less than 0.05). The association of location distal to the cystic duct and complete severance was highly significant (p less than 0.001). Management should include biliary exploration. cholangiography using concentrated water-soluble contrast agents may help to find the anatomy of obscure injuries. The choice of surgical repair must be individualized according to the location and the magnitude of the injury.
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ranking = 0.54743061503297
keywords = injury
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16/18. syndrome of the rectus abdominis muscle: A peripheral neurological condition causing abdominal diagnostic problems.

    Four cases of a painful abdominal syndrome are presented, the pain occurring in the distribution of the medial cutaneous branch of the 7th--12th intercostal nerves. The diagnosis presents difficulties because of severe abdominal pain. In 2 cases the clinical observations were corroborated by EMG findings. The symptoms, physical manifestations, mode of development and therapy are described. The term proposed for the condition is: syndrome of the rectus abdominis Muscle.
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keywords = nerve
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17/18. A case of tetanus mimicking acute abdomen.

    A 47-year-old man presented with backache and signs of acute abdomen. An exploratory laparotomy was performed. Post-operatively he developed hypoxaemia in the operating theatre and was brought to the Surgical intensive care Unit for ventilatory support and further investigations. history was then retaken and revealed a minor foot injury one month ago with subsequent development of muscle spasm and dysphagia. The diagnosis of tetanus was made. The patient was then treated with human antitetanus immune globulin and crystalline penicillin. Ventilatory support was continued, aided by infusion of morphine, diazepam and alcuronium. The recovery course was complicated by chest infection, urinary tract infection and sympathetic overactivity. He improved later and ventilatory support was discontinued three weeks after admission. He then made uneventful recovery and was discharged from the hospital forty days after admission.
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ranking = 0.10948612300659
keywords = injury
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18/18. Delayed splenic rupture: an unusual cause of the acute surgical abdomen.

    The diagnosis of delayed rupture of the spleen may be difficult to make because of the presumed triviality of the precipitating injury, an unpredictable time lag between the injury and the development of symptoms, and the possibility of atypical signs and symptoms remote from the bleeding spleen. The clinician may confuse the signs and symptoms with those of acute appendicitis or with some other cause. The authors present two case histories to illustrate the diagnostic difficulties caused by delayed rupture of the spleen. Whenever the acute surgical abdomen is present with concomitant anemia, the diagnosis of delayed rupture of the spleen should be considered.
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ranking = 0.21897224601319
keywords = injury
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