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Metagenomic next-generation sequencing is a promising tool for detecting pathogens that are difficult to isolate by traditional modalities, particularly in the diagnosis of complex infections in immunocompromised children. We describe a child with X-linked agammaglobulinemia and chronic abdominal pain diagnosed with a multiorganism infection (Helicobacter cinaedi, Campylobacter coli and Parainfluenza) identified by various diagnostic tools, including plasma metagenomic next-generation sequencing.

Author(s): Freeman, Clifford L.; Lacy, Aaron J.; Miner, Aubrey; Rogers, Devin M.; Smith, Austin T.; Shah, Karan S. | Abstract: Introduction: Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD).Case Report: We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation.Conclusion: It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.

Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year-old man with a gastroduodenal artery pseudoaneurysm that manifested as recurrent hemorrhage. We highlight the possible etiologies, clinical presentations, diagnostic tools, and treatment options for this condition. In this instance, the patient was successfully treated by selective angioembolization. A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hemorrhage. At present, angioembolization is a first-line therapy.

Purpose Meckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools. Methods We conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis. Results The male to female ratio was 7.5: 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively. Conclusion To diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.

Although bleeding is a major complication of oral anticoagulant therapy, warfarin-induced spontaneous intramural hematoma of the small bowel is a very rare complication. The clinical features of spontaneous intramural hematoma vary from mild abdominal pain to panperitonitis due to bowel perforation. Because spontaneous intramural hematoma can proceed to a life threatening situation, early diagnosis is of vital importance. Although there are a number of radiologic diagnostic tools available including abdominal ultrasonography and computed tomography, confirmation of the diagnosis through direct visualization of the involved bowel mucosa is very helpful. Direct confirmation of warfarin-induced spontaneous intramural hematoma of the small bowel is possible using double-balloon enteroscopy. We report a case of warfarin-induced spontaneous intramural hematoma with a review of the relevant literature. (Intest Res 2011;9:162-165)

Functional abdominal pain (FAP) is associated with significant anxiety and impairment. Prior investigations of child anxiety in youth with FAP are generally limited by small sample sizes, based on child report, and use lengthy diagnostic tools. It is unknown whether a brief anxiety-screening tool is feasible, whether parent and child reports of anxiety are congruent, and whether parent and child agreement of child anxiety corresponds to increased impairment. The purpose of this investigation was to examine anxiety characteristics in youth with FAP using parent and child reports. Parent-child agreement of child anxiety symptoms was examined in relation to pain and disability.One hundred patients with FAP (8-18 years of age) recruited from pediatric gastroenterology clinics completed measures of pain intensity (Numeric Rating Scale) and disability (Functional Disability Inventory). Patients and caregivers both completed a measure of child anxiety characteristics (Screen for Child Anxiety and Related Disorders).Clinically significant anxiety symptoms were more commonly reported by youth (54%) than their parents (30%). Panic/somatic symptoms, generalized anxiety, and separation anxiety were most commonly endorsed by patients, whereas generalized anxiety, separation anxiety, and school avoidance were most commonly reported by parents. The majority (65%) of parents and children agreed on the presence (26%) or absence (39%) of clinically significant anxiety. Parent-child agreement of clinically significant anxiety was related to increased impairment.A brief screening instrument of parent and child reports of anxiety can provide clinically relevant information for comprehensive treatment planning in children with FAP.

Acute abdominal pain is still the domain of the surgeon. Among the many differential diagnosis that should be considered, acute appendicitis must be one of the main options for the clinician. Even though we have excellent diagnostic tools nowadays, accomplishing an accurate diagnosis is not that easy. We all know that is better to perform surgery on a normal appendix than not operating an appendix that will result in complications; we also know that the diagnostic challenge will be higher in a female patient. But, what if right lower quadrant pain is produced by a pathology that doesn’t involve that anatomical region? We present two cases that clearly explain this situation.

A 65-year-old female patient admitted to our clinic with complaints of abdominal pain and watery diarrhea. She was diagnosed with colovesical fistula based on virtual colonoscopy findings. Since endoscopic and other radiological diagnostic tools were not able to establish a definite diagnosis, we found this case suitable for presentation.

As a German pediatrician and pediatric gastroenterologist who lives in Norway, I read the article by Bufler et al. with great interest. Recurrent abdominal pain is an everyday phenomenon in pediatric consultations, in the individual practice as well as in the context of a second opinion in hospital. In Norway, fecal calprotectin measurement has been used as a routine biomarker for gastrointestinal (GI) inflammation since 2000. Calprotectin is particularly useful for distinguishing between organic and functional pathogenesis of recurrent GI symptoms, as functional GI symptoms do not elevate calprotectin levels above normal. As mentioned by Bufler and colleagues, fecal calprotectin is also among the primary diagnostic tools for chronic recurrent GI symptoms in Norway (1). One advantage is that the parents can be reassured if the measurement is negative (which is an important component in functional GI symptoms). Furthermore, if the calprotectin test result is negative, endoscopy has to be undertaken in a tiny minority of cases—namely, those patients in whom the suspected pathogenesis is other than inflammatory. In other words, using calprotectin helps reduce endoscopies in children with chronic GI symptoms to the lowest possible number.

From 1979 to 1987, 30 Patients with cacer of the gallbladder were operated. The average age was 66 with a range from 50 to 83 years. The ratio of men-to-women was 1:33. Chief complaints included abdominal pain and jaundice. CT and US were the most effective diagnostic tools for gallbladder cancer, and 19 cancers could be diagnosed preoperatively. Of the 19 patients, 17 were successfully operated, and only 6 of which revealed cures. The averaged survival period was 15.6 months with a range from one to 72 months in resectable cases, while 3.9 months with a range from 8 days to 14 months in unresectable cases. Four long survival patients of 3 years or over have curatively resected papillary adenocarcinomas.