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Common bile duct stones can be suspected in a patient presenting with biliary type colicky pain, elevated liver enzymes, jaundice, cholangitis or pancreatitis. Beside clinical features, laboratory evaluation and adequate abdominal imaging (primarily abdominal ultrasound) help to assess the likelihood for the presence of CBDS. Recent ESGE guidelines recommend direct ERCP in patients with visible stones or cholangitis only. In other cases (intermediate likelihood) EUS or MRCP before ERCP are recommended.

Background Same-admission cholecystectomy is advised after gallstone pancreatitis to prevent recurrent pancreatitis, colicky pain and other complications, but data on the incidence of symptoms and complications after cholecystectomy are lacking. Methods This was a prospective cohort study during the previously published randomized controlled PONCHO trial on timing of cholecystectomy after mild gallstone pancreatitis. Data on healthcare consumption and questionnaires focusing on colicky pain and biliary complications were obtained during 6 months after cholecystectomy. Main outcomes were (i) postoperative colicky pain as reported in questionnaires and (ii) medical treatment for postoperative symptoms and gallstone related complications. Results Among 262 patients who underwent cholecystectomy after mild gallstone pancreatitis, 28 of 191 patients (14.7%) reported postoperative colicky pain. The majority of these were reported within 2 months after surgery and were single events. Overall, 25 patients (9.5%) required medical treatment for symptoms or gallstone related complications. Acute readmission was required in seven patients (2.7%). No predictors for the development of postoperative colicky pain were identified. Discussion Some 15% of patients experienced colicky pain after cholecystectomy for mild gallstone pancreatitis, which were mostly single events and rarely required readmission. These data may be used to better inform patients undergoing cholecystectomy for mild gallstone pancreatitis.

Renal artery aneurysm is a rare condition. Most patients are asymptomatic. This case presented to the emergency with colicky pain and underwent left transurethral lithotripsy for left ureteral stone, due to simultaneous renal stone candidates for percutaneous nephrolithotomy. In the review of the imaging, we found a large renal artery aneurysm, so vascular surgery consult was done and the patient managed with coil embolization Misdiagnosis of this condition could be led to life-threatening bleeding if percutaneous nephrolithotomy was done. It is recommended that renal artery aneurysm should be considered in the differential diagnosis of renal rim-like opaque lesions.

The metabolism of lactate is important for infant gut health and may lead to acute lactate and/or H2 accumulation, pain, and crying as observed in colicky infants. Functional human studies often faced ethical challenges due to invasive medical procedures; thus, in this study, we implemented PolyFermS fermentation models to mimic the infant proximal colon, which were inoculated with immobilized fecal microbiota of two 2-month-old infants. We investigated the impact of pH, retention time, and accumulation of dl-lactate on microbiota composition and metabolic activity. We found that a drop in pH from 6.0 to 5.0 led to increased LPB and decreased LUB concomitantly with lactate accumulation. Increasing the RT resulted in complete lactate consumption associated with increased LUB. Our data highlight for the first time the impact of key abiotic factors on the metabolism of lactate, which is an important intermediate product for ecology and infant health., The metabolism of lactate impacts infant gut health and may lead to acute accumulation of lactate and/or H2 associated with pain and crying of colicky infants. Because gut microbiota studies are limited due to ethical and safety concerns, in vitro fermentation models were developed as powerful tools to assess effects of environmental conditions on the gut microbiota. In this study, we established a continuous colonic fermentation model (PolyFermS), inoculated with immobilized fecal microbiota and mimicking the proximal colon of 2-month-old infants. We investigated the effects of pH and retention time (RT) on lactate metabolism and of lactate-utilizing bacteria (LUB) exhibiting little or no H2 production. We observed that a drop in pH from 6.0 to 5.0 increased the number of lactate-producing bacteria (LPB) and decreased LUB concomitantly with lactate accumulation. Increasing RT from 5 to 10 h at pH 5.0 resulted in complete lactate consumption associated with increased LUB. Supplementation with dl-lactate (60 mM) to mimic lactate accumulation promoted propionate and butyrate production with no effect on acetate production. We further demonstrated that lactate-utilizing Propionibacterium avidum was able to colonize the reactors 4 days after spiking, suggesting its ability to compete with other lactate-utilizing bacteria producing H2. In conclusion, we showed that PolyFermS is a suitable model for mimicking young infant colonic microbiota. We report for the first time pH and RT as strong drivers for composition and metabolic activity of infant gut microbiota, especially for the metabolism of lactate, which is a key intermediate product for ecology and infant health. IMPORTANCE The metabolism of lactate is important for infant gut health and may lead to acute lactate and/or H2 accumulation, pain, and crying as observed in colicky infants. Functional human studies often faced ethical challenges due to invasive medical procedures; thus, in this study, we implemented PolyFermS fermentation models to mimic the infant proximal colon, which were inoculated with immobilized fecal microbiota of two 2-month-old infants. We investigated the impact of pH, retention time, and accumulation of dl-lactate on microbiota composition and metabolic activity. We found that a drop in pH from 6.0 to 5.0 led to increased LPB and decreased LUB concomitantly with lactate accumulation. Increasing the RT resulted in complete lactate consumption associated with increased LUB. Our data highlight for the first time the impact of key abiotic factors on the metabolism of lactate, which is an important intermediate product for ecology and infant health.

Hepatobiliary and pancreatic ascariasis occur due to migration of the round worm ascaris lumbricoides through the bile duct orifice finally reaching the common bile duct, main pancreatic duct, intrahepatic ducts or gallbladder. These resulted in acute epigastric and right hypochondriac region colicky pain. Ultrasound is the investigation of choice in hepatobiliary ascariasis. We present here sonographic images on four pediatric patients with acute biliary colic.

Introduction This study aimed to evaluate the clinical efficacy of intravenous metoclopramide for the relief of pain and nausea among the emergency department patients with renal colic. Methods Patients were randomised into three groups: tenoxicam (20 mg); tenoxicam (10 mg) plus metoclopramide (10 mg); and metoclopramide (10 mg). Changes in pain and nausea were examined at the 10th, 20th and 30th minute after treatment. The development of side effects would be recorded. After the 30th minute, the need for additional pain and nausea relief was evaluated. Results Totally 80 patients were enrolled in each group. There was significant mean pain score difference as measured by visual analog scale (VAS) from 0 minute to 10th, 20th and 30th minute post-treatment for all treatment groups (pConclusion Metoclopramide is as effective as tenoxicam to treat pain and nausea for patients with renal colic in the emergency department. (Hong Kong j.emerg.med.2015;22:93-99)

A case of Hymenolepis diminuta infection in a 43-year-old Malaysian male with persistent abdominal colicky pain is reported. Endoscopy revealed whitish worms in the lumen of the small intestine, which were identified as H. diminuta after microscopy. Patient was successfully treated with a single dose of praziquantel (25 mg/kg).

Infantile colic is affecting up to 20% of infants and is a frustrating problem for parents and the healthcare system. Although pathogenesis of infantile colic remains unknown one hypothesis is inflammation and visceral pain. There is increasing evidence suggestive of difference in intestinal microbiota among infants with colic and healthy controls. Probiotic consumption influences the microbiome as a dynamic stuff. Based on several studies, using probiotic and synbiotic can perform as a potentially useful strategy for prevention and treatment of pain and fussiness in colicky infants.

The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent on the spontaneous passage of proximal ureteral calculi ?10 mm. 92 patients having single radio-opaque proximal ureteral stone ?10 mm were randomized into two groups. Group 1 patients (n = 50) were followed with classical conservative approach and patients in Group 2 (n = 42) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, VAS score, change in colic episodes, and hospital re-admission rates for colicky pain were compared. The patients were furthermore stratified according to stone diameters

The clinical aspects and the diagnostic features of gallstone disease are described. The natural history of silent gallstones is overviewed, and the risk of developing symptoms and complications is also discussed. The importance of colicky pain as a specific gallstone symptom is highlighted, and the role of both laboratory tests and diagnostic investigations for differential diagnosis is discussed. Finally, we describe the diagnostic features of gallbladder stone disease, including indications, sensitivity, specificity, and limitations of different test investigations under special circumstances.

It seldome occurs that an isolated internal iliac artery aneurysm causes ureteral obstruction. This paper reports an operated case of isolated internal iliac artery aneurysm compressed and stretched the ureter causing hydronephrosis. A 67-year-old woman was uregently referred to the hospital because of colicky pain of the right lower abdomen. Right ureteral obstruction and hydronephrosis caused by the compression of the isolated right internal iliac artery aneurysm were revealed. Immediate percutaneous nephrostomy was followed by elective aneurysmectomy. Right ureter was adhered to the surface of the right internal iliac artery aneurysm (4cm in diamter) and was compressed and stretched. Ureterolysis and resection of the aneurysm were performed. She took an uneventful course with restored right ureteral flow. Although the aneurysm was atherosclerotic in origin, there supposed to be an inflammatory process between the ureter and the aneurysm. this is the fourth reported case in Japan about the internal iliac artery aneurysm associated with ureteral obstruction.

We describe a case of Behcet’s disease (BD) which showed the ileocecal ulcer and cecocecal fistula. This 38-year-old man had appendectomy six years ago because of colicky pain in the right lower abdomen (RLA). There are some reports on fistula formation in BD. In those, some are related to surgery and others are not. BD with cecocecal fistula, possibly associated with a past operation, has not been reported in the literature.

A 22 year old man presented to the clinic with a history of chronic intermittent abdominal complaints. He reported postprandial colicky pain, nausea, and loud abdominal sounds since his youth. The severity …

A male patient presented with seven days history of severe epigastric colicky pain and vomiting. The patient was anxious and dehydrated. Blood tests and ultrasound reports were unremarkable. . Upper Gastrointestinal (GI) Endoscopy revealed a strip of capsule impacted at pyloric ring which was removed endoscopically and the patient became symptom free. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16252 J Shaheed Suhrawardy Med Coll, 2013;5(1):67-68

Leiomyosarcoma arising from the ovarian vein is extremely rare: only one case was found in the literature. We report a case in a sixty-one-year-old woman who had unexplained attacks of pain in her left lower abdomen and flank for two years.

A 45-year-old-woman presented with a mimicking renal stone colicky pain that was finally attributed to radiculalgia T12 caused by a calcified T11–T12 disk herniation.

A 52-year-old male weighing 74 kg presented with a twoday history of colicky pain in the supra-umbilical region. He complained of nausea and anorexia. On the day of presentation, his pain migrated to the right iliac fossa and became constant. Examination revealed a pulse of 90 bpm with a temperature of 98.7 F. He was found to be tender in the right iliac fossa with voluntary guarding and rebound. His white cell count was found to be 11.3 per m with a shift in the neutrophils to the left. His MANTREL score was estimated at 9. A mini-Lanz incision approach for appendicectomy was performed. Serosanguineous peritoneal fluid was noted on entering the cavity. The appendix was macroscopically noninflamed. Intraperitoneal ischemia was suspected at this time, and on mobilization of the intraperitoneal contents, a 1080 torsion of a 8 10 cm lip of omentum was noted (Fig. 1). The ischemic segment was excised between ligatures. An incidental appendicectomy was performed. The patient recovered uneventfully.

Neurotropin, an extract from the inflamed skin of vaccinia virus-inoculated rabbits, was effective in the relief of sharp or burning pain induced by pyrexia, hot weather, bathing, or exercise in 2 siblings with Fabry disease. Neither neurotropin nor carbamazepine monotherapy relieved the episodic colicky pain in 1 patient; however, therapy with both drugs eliminated the pain completely. This result suggests that the mechanisms underlying the analgesic actions of both drugs may be complementary in ameliorating the pain of Fabry disease, even though the mechanism underlying the pain has not been clearly elucidated.

Two patients in whom the right ureter was inadvertently catheterized at water cystometry are described. Accidental ureteral catheterization and filling was followed by colicky pain in the right flank and by an abrupt increase in the recorded pressure, up to 148 cm H2O. The pain disappeared and the intravesical pressure returned to baseline after the microtip catheter was withdrawn.

It is commonly reported that 3%–4% of all laparotomies are performed for intestinal obstruction. It has also been suggested that an increase in inguinal hernia repair during the last few decades, leading to a decrease in obstructions secondary to hernia, along with increasing numbers of elective abdominal surgery has led to the net effect that intestinal obstruction now is primarily caused by intra-abdominal adhesions [4].

An unusual clinical presentation of appendicitis with violent colicky pain as seen classically in urolithiasis is here presented. The pathophysiology of colic and the differential diagnosis of appendicolithiasis is briefly discussed.

Although perhaps not one of the most common symptoms encountered in specialist palliative care units, health professionals frequently come across malignant bowel obstruction in general hospital wards, emergency rooms and in the community. The age-old approach to management of this problem using a nasogastric tube and intravenous therapy may still have its place for some patients, but specialists in palliative care have pioneered a kinder approach aimed at treating associated symptoms of colicky pain, nausea and vomiting. We owe it to our patients to ensure that all our colleagues are familiar with the most up-to-date treatment of malignant bowel obstruction to minimize distress and enhance quality of life.

A case of papilloma of the gallbladder is reported. The gallbladder was associated with cholesterosis but not with stones. The causes of colicky pain in this case are discussed. Papillomas of the gallbladder exhibit no characteristic clinical picture; the symptoms are similar to those of any type of gallbladder disease. Papillomas of the gallbladder may be associated with malignant degeneration. Cholecystectomy is the treatment of choice.

1)尿管結石による疼痛発作患者21例において, Buprenorphine 0.2 mgを筋注後のIVPで, 腎盂尿管像が描出され, 結石の位置の確認が容易であった.2) 19例で疼痛が改善された.3)重篤な副作用はなく, 6例に軽度のふらつきが認められたが安静にて軽快した, Buprenorphine, a new analgesic, was administered at a dose of 0.2 mg by intramuscular injection to 21 patients with acute ureteral colic. The patients consisted of 14 males and 7 females with a mean age of 42. In all cases, the diagnosis was confirmed based on intravenous urography performed after the treatment. In 19 of the 21 patients, colicky pain was reduced at least within one hour after the administration of buprenorphine. No significant changes in the pulse or blood pressure were observed. In 6 patients, mild dizziness or nausea was observed, and none of the patients required withdrawal of the treatment. Clinical use of buprenorphine was considered to the effective and safe in patients with ureteral colic.

Presentation of Case First admission. An eighty-six-year-old woman entered the hospital because of pain in the abdomen. She had been well until the onset of nausea and colicky pain in the right upp...

THE term “ileus” is derived from the Greek, meaning to twist. Dorland's dictionary defines it as “severe colic, due to intestinal obstruction.” Bottomley states that “ileus is a term used to designate as a whole that group of symptoms (colicky pain, constipation or obstipation, distention of the intestine, and nausea and vomiting) which indicate the existence of an intestinal obstruction. Most writers, however, use the term “ileus” as synonymous with “intestinal obstruction,” and such is our interpretation. It will be noted that no mention is made of peristaltic action in the above descriptions, and the reason is that its absence or presence depends upon the type of ileus, namely, whether it is paralytic or mechanical. In paralytic, reflex or adynamic ileus, the peristalsis is absent in the affected gut, although it is possible that active peristalsis may exist in the unaffected gut proximal to the obstructed segment. In the mechanical and dynamic types, peristalsis is hyperactive, until late in the cours...

Two cases of ureteric diverticulum are presented. Repeated infective episodes were the main presenting features in one, whereas intermittent attacks of colicky pain brought the other patient in for clinical assessment. Fluoroscopic evaluation of the latter patient demonstrated free ureterodiverticular reflux and yo-yo phenomenon. Following diverticulectomy the pain completely disappeared.

Buprenorphine, a new analgesic, was administered at a dose of 0.2 mg by intramuscular injection to 21 patients with acute ureteral colic. The patients consisted of 14 males and 7 females with a mean age of 42. In all cases, the diagnosis was confirmed based on intravenous urography performed after the treatment. In 19 of the 21 patients, colicky pain was reduced at least within one hour after the administration of buprenorphine. No significant changes in the pulse or blood pressure were observed. In 6 patients, mild dizziness or nausea was observed, and none of the patients required withdrawal of the treatment. Clinical use of buprenorphine was considered to the effective and safe in patients with ureteral colic.

A case of lactobezoar is described in a toddler with an acute history of abdominal pain, vomiting, and lethargy. Despite normal dietary habits, he had developed a gastric milk coagulum which led to a palpable epigastric tumor. Intussusception was suspected but disproven by barium enema. In retrospect, plain abdominal radiographs demonstrated characteristic mottled filling defects in the stomach from a lactobezoar. Conservative therapy led to prompt disintegration of the lactobezoar.

The ascaris is a common human parasite and has a world wide distribution. In areas where it is endemic, biliary complications are common. In our locality it occurs mainly in children, presenting with upper abdominal colicky pain usually without jaundice. We have analyzed the positive roentgenological findings of 67 cases which presented in one year. The findings on cholangiography are diagnostic. The worm is seen as a linear translucent filling defect in a dilated common bile duct. Usually it is only faintly outlined by thin tram lines and occasionally there may not be excretion of the contrast material. The attention of radiologists is brought to this condition and the appearances of ascariasis infestation of the intestines are also noted.

A case of giant gallbladder is presented. A 36-yr-old female complaining of colicky pain and a mass in the right upper quadrant underwent cholecystectomy, when the giant gallbladder, 18 cm in length and 4 cm in maximum diameter, and an extremely long cystic duct was confirmed. Since neither marked biliary inflammation nor biliary obstruction was observed, this giant gallbladder is considered to be congenital.

Diverticula are small outpouchings of colonic mucosa. In Western society they are found in approximately 40% of those over 60 years of age.