Abdominal pain, principles of diagnosis of urgent abdominal surgical pathology
https://doi.org/10.23946/2500-0764-2024-9-4-107-119
Abstract
Over 80 % of patients seeking treatment at the general surgical hospital on duty complain of abdominal pain. The paper presents current understanding of the dynamics of incidence of common acute abdominal surgical pathology in Kuzbass from 1993 to 2023. A comparative analysis was conducted between the first and last decades and revealed that acute cholecystitis was the leading cause by 2023 − 122 cases per hundred thousand population per year. This level was observed in both the first and third decades. The average annual number of patients treated for acute pancreatitis increased from 64.3 to 109.6 per hundred thousand residents, an increase of 70.4 %. On the contrary, the number of patients with acute appendicitis decreased from 190.8 to 93.5 per hundred thousand, a decrease of 51%. The fourth position is occupied by patients with intestinal obstruction; the incidence in the first and third decades was 41.7 and 45.2 per hundred thousand, respectively, an increase of 8.4%. In the dynamics of thirty-year observation, there was a decrease in the number of people operated on with perforated gastric and duodenal ulcers by 47.3 %, the incidence was 28.8 and 15.2 per 100,000, respectively. On the contrary, the average annual number of people treated with strangulated hernia increased by 35.1 %, the incidence increased from 29.9 to 39.8 per hundred thousand residents of the region. Severe, extremely intense abdominal pain at the onset of the disease is observed in 0.1−2 % of hospitalized patients with acute large-focal pancreatic necrosis, strangulation intestinal obstruction, perforated ulcer, and acute mesenteric ischemia. The lecture outlines the issues of diagnosing urgent abdominal surgical pathology, taking into account the nature, intensity and localization of pain. Issues of surgical tactics for diffuse, non-localized, extremely intense pain and differential diagnosis with peritonism syndrome and pseudoperitonitis are separately considered.
About the Author
V. I. Podoluzhny
Kemerovo State Medical University
Russian Federation
Russian Federation
Prof. Valery I. Podoluzhny, MD, DSc, Full Professor, Professor of the Department of Hospital Surgery
22a, Voroshilovа Street, Kemerovo, 650056
References
1. Wadhwa V, Jobanputra Y, Garg SK, Patwardhan S, Mehta D, Sanaka MR. Nationwide trends of hospital admissions for acute cholecystitis in the United States. Gastroenterol Rep (Oxf). 2017;5(1):36-42. https://doi.org/10.1093/gastro/gow015
2. Hamada S, Masamune A, Shimosegawa T. Management of acute pancreatitis in Japan: Analysis of nationwide epidemiological survey. World J Gastroenterol. 2016;22(28):6335-6344. https://doi.org/10.3748/wjg.v22.i28.6335
3. Razvodovsky YE. Alcohol consumption and pancreatitis mortality in Russia. JOP. 2014;15(4):365-370. https://doi.org/10.6092/1590-8577/2273
4. Podoluzhny VI, Shabalina OV, Oorzhak OV, Lesnikov SM. Characteristics of the dynamics of the volumes and structure in surgical treatment of patients with strangulated abdominal hernia. Siberian Medical Review. 2017;(3):38-42. (In Russian). https://doi.org/10.20333/2500136-2017-3-38-42
5. Lyust VI, Igissinov NS, Kozhakhmetov SK, Abduov MK, Zhumazhanov NM, Bikhanov NA, Toleubayev MT. Evaluation of changes in indicators of accident surgery in acute diseases of the abdominal cavity in the city of astana (compared to 1998 from 2018). Meditsina (Almaty) = Medicine(Almaty). 2019;12(210):24-28. (In Russian). https://doi.org/10.31082/1728-452X-2019-210-12-24-28
6. Masalov AE, Auyenov MU, Abdrakhmanov ST, Botakhanova ISh, Yestaeva ZhE. Options for surgical treatment of biliary pancreatitis. Global Science and Innovations: Central Asia. 2021; 2(12(12):54-59.
7. Khaladova LM, Zangionov GE, Karsanov AM. Morbidity and mortality indicators in acute pancreatitis as an indicator of the state of medical care at the regional level. Scientific Leader. 2023;25(123):26-28. (In Russian). https://doi.org/10.32687/0869-866X-2020-28-6-1298-1303
8. Gulikyan GN, Pakhomova RA, Vinnik YUS, Kochetova LV, Fedotov IA. Pancreatitis is a disease of the twenty-firtst century. Surgical practice. 2019;4(40):48-52. (In Russian). https://doi.org/10.17238/issn2223-2427.2019.4.48-52
9. Lee PJ, Papachristou GI, Speak K, Lacy-Hulbert A. Curr Opin. Immune markers of severe acute pancreatitis. Gastroenterol. 2024;40(5):389- 395. https://doi.org/0.1097/MOG.000000000000001053
10. O'Connell RM, Hardy N, Ward L, Hand F, Maguire D, Stafford A, Gallagher TK, Hotie E, O'Sulli-van AV, Ó Súillábháin SB, Gall T, McEntee J, Conneely J. Treatment and outcomes of patients with acute cholecystitis in Ireland: a national registry study. The Surgeon. 2024:S1479-666X(24)00085-4. https://doi.org/10.1016/j.surge.2024.08.004
11. Wilson SJ, Thavanathan R, Cheng W, Stuart J, Kim DJ, Glen P, Duigenan S, Shorr R, Woo MY, Perry JJ. Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis. Ann Emerg Med. 2024;83(3):235-246. https://doi.org/10.1016/j.annemergmed.2023.09.005
12. Ndong A, Togtoga L, Bach MS, Ndoye PD, Niang K. Prevalence and mortality of emergency ab-dominal surgical diseases in subSaharan Africa: a systematic review and meta-analysis. BMC Surg. 2024;24(1):35. https://doi.org/10.1186/s12893-024-02319-0
13. Lin KB, Lai KR, Yang NP, Chan CL, Liu YH, Pan RH, Huang CH, Epidemiology and socioeco-nomic features of appendicitis in Taiwan: a 12-year population-based study. World J Emerg Surg. 2015;10:42. https://doi.org/10.1186/s13017-015-0036-3
14. Kong VY, Sartorius B, Clarke DL. Acute appendicitis in the developing world is a morbid dis-ease. Ann R Coll Surg Engl. 2015;97(5):390-395. https://doi.org/10.1308/003588415X14181254790608
15. GBD Appendicitis Collaboration Group 2021. Trends and levels of the global, regional, and national burden of appendicitis from 1990 to 2021: results from the 2021 Global Burden of Disease Study. Lancet. Gastroenterol Hepatol. 2024;9(9):825-858. https://doi.org/10.1016/S2468-1253(24)00157-2
16. Babakhanov AT, Dzhumabekov AT, Zhao AV, Fakhradiev IR. The acute appendicitis modern vision. Vestnik kazahskogo nacional''nogo medicinskogo universiteta. 2020;3:248-251.
17. Dzhumabekov AT, Babakhanov AT, Zharmenov SM, Auelov NU, Serikbaev AD, Zhumabekova BA, Zhumabekova DA. Appendectomy at the contemporary stage (literature review). Vestnik kazahskogo nacional''nogo medicinskogo universiteta. 2021;3:198-205. https://doi.org/10.53065/kaznmu.2021.88.13.039
18. Kanibolotsky AA, Svishcheva PO, Makarova OV. Clinical and morphological analysis of various forms of acute appendicitis depending on age and gender. Clinical and experimental morphology. https://doi.org/10.31088/2226-5988-2018-27-3-14-17
19. Revishvili AS, Fedorov AV, Sazhin VP, Olovyanny VE. Emergency surgery in the Russian Federation. PIRogov Russian journal of surgery. 2019;(3):88-97. (In Russian). https://doi.org/10.17116/hirurgia201903188
20. Anbalakan K, Chua D, Pandya GJ, Shelat VG. Five year experience in management of perforated peptic ulcer and validation of common mortality risk prediction models are existing models sufficient? A retrospective cohort study. Int J Surg. 2015;14:38-44. https://doi.org/10.1016/j.ijsu.2014.12.022
21. Podoluzhny VI, Ivanov SV, Radionov IA. Analysis of the results of treatment of perforated duodenal ulcers. Polytrauma. 2016:1:33-37. (In Russian).
22. Lobankov VM, Kambarov MN, Blagonravov ML. The incidence of perforated ulcers: risk factors. Health is the basis of human potential: problems and solutions. 2015:10(2):718-719.
23. Markar SR, Vidal-Diez A, Holt PJ, Karthikesalingam A, Hanna GB. An International Comparison of the Management of Gastrointestinal Surgical Emergencies in Octogenarians-England Versus United States: A National Population-based Cohort Study. Ann Surg. 2021;273(5):924- 932. https://doi.org/10.1097/SLA.0000000000003396
24. Styazhkina SN, Maslova NA, Shutova EN. Sharp intestinal impassability in surgical practice. International research journal. 2015;11-5(42):54-55. https://doi.org/10.18454/IRJ.2015.42.163
25. Akhmetzyanov FSh, Egorov VI. Colorectal cancer complicated by obstruction: intestinal stoma or primary anastomosis? Problems in oncology. 2017;63(1):7-13. https://doi.org/10.37469/0507-3758-2017-63-1-7-13
26. Chan KS, Lim WW, Goh SSN, Lee J, Ong YJ, Ong MW, Goo JTT. Sustained improved emergency laparotomy outcomes over 3 years after a transdisciplinary perioperative care pathway-A 1:1 propensity score matched study. Surgery. 2024;176(3):849-856. https://doi.org/10.1016/j.surg.2024.04.016
27. Adejumo AA, Alegbego-Olarinoye MI, Akims SM, Akanbi OO. Acute small bowel obstruction: assessment of common etiology and management at the Federal Medical Centre, Keffi, north-central Nigeria Ann Afr Med. 2024;23(3):313-316. https://doi.org/10.4103/aam.aam_111_23
28. Sakowitz S, Bakhtiar SS, Mallick S, Porter G, Ali K, Chervu N, Benharash P. Association of socio-economic vulnerability with clinical and financial outcomes after emergency hernia repair. Am J Surg. 2024;235:115781. https://doi.org/0.1016/j.amjsurg.2024.115781
29. Karavokiros IG, Kirkilessis GI, Schizas D, Chelidonis G, Pikulis E, Griniatsos J. Emergency inguinal hernia repair in a tertiary public hospital in Athens, Greece during the economic crisis. BMC Surg. 2019;19(1):18. https://doi.org/10.1186/s12893-019-0477-9
30. Malik A, Zohdi M, Ahmad A, Seretis S. Single center experience of emergency hernia sur-gery during the COVID-19 pandemic: a comparative study of operative activity and out-comes before and after the outbreak. Med Glas (Zenica). 2021;18(2):463-467. https://doi.org/10.17392/1383-21
31. Moreno-Alfonso JC, Barbosa-Velásquez S, Molina Caballero A, Pérez Martínez A, Yárnoz Irazábal MC. Utility of the derived neutrophilto-lymphocyte ratio as a predictor of complicated appendicitis in pediatrics. Rev Esp Enferm Dig. 2024. https://doi.org/10.17235/reed.2024.10642/2024
32. Tayebi A, Olamaeian F, Mostafavi K, Khosravi K, Tizmaghz A, Bahardoust M, Zakaryaei A, Mehr DE. Assessment of Alvarado criteria, ultrasound, CRP, and their combination in patients with suspected acute appendicitis: a single centre study. BMC Gastroenterol. 2024 Jul 31;24(1):243. https://doi.org/10.1186/s12876-024-03333-5
33. Isohata N, Nagata K, Utano K, Nozaki R, Nozu S, Kato T, Kijima S, Matsumoto H, Majima K, Ryu Y, Hirayama M, Endo S. Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography. World J Gastroenterol. 2021;27(27):4441-4452. https://doi.org/10.3748/wjg.v27.i27.4441
34. Golder M, Ster IC, Babu P, Sharma A, Bayat M, Farah A. Demographic determinants of risk, colon distribution and density scores of diverticular disease. World J Gastroenterol. 2011;17(8):1009-17. https://doi.org/10.3748/wjg.v17.i8.1009
35. Aliev SAO, Aliev ES, Gakhramanova FA. Controversial issues of treatment tactics for diverticu-lar disease of the colon complicated by the first episode of acute diverticulitis. Coloproctology. 2020;19(2(72)53-59 https://doi.org/10.33878/2073-7556-2020-19-2-53-59
36. Eide TJ, Stalsberg H. Diverticular disease of the large intestine in Northern Norway. Gut. 1979;20(7):609-615. https://doi.org/10.1136/gut.20.7.609
37. Kayano H, Nomura E, Abe R, Ueda Y, Machida T, Fujita C, Uchiyama S, Endo K, Murakami K, Mukai M, Makuuchi H. Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perfo-ration: a single-center retrospective cohort study. BMC Surgery.2019;19(1):181 https://doi.org/10.1186/s12893-019-0629-y
38. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, BenIshay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP, Catena F. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12:38. https://doi.org/10.1186/s13017-017-0150-5
39. Abuov SM, Kosherbaeva LK, Zhappargaly NE, Karibayeva AE, Buzanov OM, Kenessov NM, Abzhamieva AA, Alchinbaev AA. Acute disorders of mesenteric circulation: questions of timely diagnostics and treatment (literature review). Vestnik KazNMU. 2020;4:355-362. (In Russian).
40. Petrov A, Zelenin V, Shcheglov D, Kotenkov K, Dudanov I. Experience in treating patients with acute mesenteric thrombosis in a multidisciplinary hospital. Medicine: Theory and Practice. 20248(4), 322-326. (In Russian). https://doi.org/10.56871/MTP.2023.92.26.055
41. Ponomaryova A.D., Leyderman I.N., Kasherininov I.Yu. Acute Mesenteric Ischemia in Critically Ill Patients. Possibilities of Laboratory Diagnostics. Systematic Literature Review and MetaAnalysis. Russian Sklifosovsky Journal "Emergency Medical Care". 2022;11(2):317-323. (In Russian). https://doi.org/10.23934/2223-9022-2022-11-2-317-323
42. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91(1):17-27. https://doi.org/10.1002/bjs.4459
43. Belyaev GYU, Koshelev EG, Egorov AA, Esin EV. Radiological diagnostics of acute mesenteric ischemia. Kremlevskaja medicina. Klinicheskij vestnik. 2023;4:84-90. (In Russian). https://doi.org/10.48612/cgma/bhbm-69gz-2zu2
44. Dubrova SE, Stashuk GA. Computed tomography in the diagnosis of acute mesenteric ischemia. Clinical gerontology. 2015;21(7-8):16-20. (In Russian).
45. Staroseltseva OA, Nudnov NV, Radutnaya ML, Kirchin AN, Bondar' EA, Bessonova LV, Altukhov EL, Yakovlev AA, Shaybak AF. Difficulties in the radiation diagnosis of acute mesenteric thrombosis in patients with chronic critical illness. Journal of radiology and nuclear medicine. 2021;102(4):217-226. https://doi.org/10.20862/0042-4676-2021-102-4-217-226
46. Stone JR, Wilkins LR. Acute mesenteric ischemia. Tech Vasc Interv Radiol. 2015 Mar;18(1):24-30. https://doi.org/10.1053/j.tvir.2014.12.004.
Review
For citations:
Podoluzhny V.I. Abdominal pain, principles of diagnosis of urgent abdominal surgical pathology. Fundamental and Clinical Medicine. 2024;9(4):107-119. (In Russ.) https://doi.org/10.23946/2500-0764-2024-9-4-107-119
Views:
242
Email this article 