Background:

Abdominal pain of uncertain aetiology (non-specific abdominal pain; NSAP) is the commonest reason for emergency surgical admission. The aim of this study was to examine the role of early laparoscopy in the management of NSAP.



Methods:

Some 120 patients, admitted between November 1995 and October 1998 with acute abdominal pain of uncertain aetiology, were randomized into two groups: group 1 had laparoscopy during the first 18 h of admission and group 2 had close observation, conventional investigation and surgical intervention if signs of peritonism developed. Outcome measures were diagnosis, operative procedures, duration of hospital stay, readmission rate, morbidity and death, patient satisfaction and total number of investigations performed.



Results:

Median hospital stay was 2 (range 1–13) days in both groups (P = 0·87). A diagnosis was established in 48 (81 per cent) of 59 patients in group 1 compared with 22 (36 per cent) of 61 in group 2 (P < 0·0001). The morbidity rate was 14 (24 per cent) of 59 in group 1 and 19 (31 per cent) of 61 in group 2 (P = 0·3629). The readmission rate at a median follow-up of 21 (range 1–35) months was 17 (29 per cent) of 59 in group 1 compared with 20 (33 per cent) of 61 in group 2 (P = 0·6375). Well-being scores improved from 134 on admission to 149 of 177 6 weeks later in group 1 (P = 0·007) and from 132 to 143 of 177 in group 2 (P = 0·089).



Conclusion:

Early laparoscopy provided a higher diagnostic accuracy and improved quality of life in patients with NSAP. © 1999 British Journal of Surgery Society Ltd

Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain.

We studied whether short-term exposure to air pollution was associated with non-specific abdominal pain in epidemiologic and animal studies
Patients visiting the emergency department with non-specific abdominal pain were identified in Edmonton (1992 to 2002, n = 95,173) and Montreal (1997 to 2002, n = 25,852) We calculated the daily concentrations for ozone (O(3)), nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), carbon monoxide (CO), and particles <10 (PM(10)) or <25 (PM(25)) µm A case crossover study design was used to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with an increase in the interquartile range of the air pollutants We investigated differential effects by age and sex Mice were gavaged with urban particle extracts In animal models, colonic motility was tested, and visceral abdominal pain was measured using a writhing test, and behavioral response to oil of mustard and neostigmine Motility and pain was measured acutely (15 hours after gavage) and chronically (7-days and 21-days after gavage)
Emergency department visits for non-specific abdominal pain were primarily by women between the ages of 15-24 years Individuals aged 15 to 24 years were at increased risk of non-specific abdominal pain in Edmonton (same day CO: OR = 104, 95% CI = 102-106; and NO(2): OR = 106, 95% CI = 103-109) The risk of air pollution among 15-24 year olds in Montreal was significantly positive (same day CO: OR = 111, 95% CI = 105-117; NO(2): OR = 109, 95% CI = 101-116; SO(2): OR = 117, 95% CI = 110-125; PM(25): OR = 109, 95% CI = 104-115) Abdominal pain was increased by an acute gavage of pollution extract but not to chronic exposure to pollutants Colonic transit was delayed following chronic but not acute exposure with the pollutants
Epidemiological and animal data suggest that short-term exposure to air pollution may trigger non-specific abdominal pain in young individuals

/pdf/non-specific-abdominal-pain-and-air-pollution-a-novel-3f3v8kb9fo.pdf

Non-Specific Abdominal Pain and Air Pollution: A Novel Association

Helical computed tomography in differentiating appendicitis and acute gynecologic conditions.

Open appendectomy is the �gold standard' for the treatmentof acute appendicitis. Laparoscopic appendectomy though widelypracticed has not gained universal approval. Although it is a generallysafe operation, postoperative complications occur in few patients.Laparoscopic appendectomy was first described in 1983. Reports ofearly studies were equivocal with few studies evaluating analgesicrequirements and the length of hospital stay. This study was aimed tocompare laparoscopic with open appendectomy and ascertain thetherapeutic benefit, if any, in the overall management of acuteappendicitis.

/pdf/laparoscopic-versus-open-appendectomy-for-the-treatment-of-1dmcd1p72y.pdf

Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis

Laparoscopy is commonly used in the treatment of appendicular diseases and non-specific abdominal pain. Nevertheless, the role of day-case laparoscopic surgery in these cases is still debated. The aim of this study was to identify which cases of appendicitis or non-specific abdominal pain are most indicated for daycase laparoscopic surgery. From January 1 2000 to December 31 2005 at our institution 424 patients were treated laparoscopically for appendicitis or non-specific abdominal pain. 41 were operated on on a day-case basis. 81% of these (33 patients) were discharged from hospital within 24 hours of surgery. 2 patients could not be discharged because of persistent postoperative pain and 6 had a longer hospitalisation period for non-medical reasons. No major complications and no readmissions to hospital were observed in the 33 regularly discharged patients. Over the same period 61 patients were operated on by traditional "open" surgery for the same pathologies. Their postoperative hospitalisation was considerably longer. None of them were operated on on a day-case basis and none were discharged within 24 hours of surgery. 3 patients needed readmission to our institution within the first 30 postoperative days. Day-case laparoscopic. surgery is valid, safe and effective for the treatment of uncomplicated appendicitis and nonspecific abdominal pain. For successful laparoscopic day-case surgery it is of fundamental importance to ensure adequate preoperative patient selection and to pay proper attention to the treatment of postoperative pain.

Day-case laparoscopic surgery for appendicitis and non-specific abdominal pain.

Non-specific abdominal pain (NSAP) is a well-recognized clinical problem which places a significant burden on health resources. We studied 100 premenopausal women who were admitted consecutively through the Accident and Emergency Department of the Mater Misericordiae Hospital to assess final diagnosis, duration of hospital stay, extent of investigation, recurrence of symptoms and final diagnosis. The patients were placed in the following diagnostic categories: Gynaecological (30%), Renal (9%), Acute appendicitis (23%), Miscellaneous (9%) and Non-specific abdominal pain which accounted for 29% of the admissions. The mean duration of hospital stay for patients with NSAP was 67 days, one third underwent specialized investigations and one third underwent appendicectomies for normal appendices. On review, one year after admission, 66% of patients admitted with NSAP were asymptomatic.

Non-specific abdominal pain in pre-menopausal women.

Malignant insulinoma--a case report.

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Non-specific abdominal pain in pre-menopausal women.

Malignant insulinoma--a case report.