Laboratory results demonstrated a leucocytes count of 18.1♱0 9/L, CRP 4 mmol/L and no abnormal kidney or liver function parameters. A rectal and vaginal exam showed no abnormalities. The lower abdomen was tender and a mass was palpated. On physical examination she had a tachycardia and was tachypnoeic. The medical history included a laparoscopic cholecystectomy. Within the last six months she had several attacks of abdominal pain. She presented in the ED with acute intense pain in the lower abdomen. The second patient was a 60 years-old woman. When the patient deteriorated he was abstained from further treatment after consultation with patient and family. Within a few days on the ward he developed a pneumosepsis, which was treated with Augmentin. The lactate levels and CRP concentrations decreased to near normal values (Figure 1). Complications included re-intubation, a central venous line infection with Enterococcus Faecium, an ischemic cerebrovascular accident in the left fronto-occipital region, an ileus and a segmental ischemic colitis with deep ulcers in the transverse colon. A Positron Emission Tomography- Computed Tomography scan (PET-CT scan) and several CT-scans were performed, but did not show a focus.Īfter a stay on the ICU of one month with several complications he stabilized and was discharged. At that time, the patient was treated with Tobramycine and Cefotaxim as prophylaxis for ventilator-associated pneumonia in combination with Orabase protective paste. The first blood cultures showed a staphylococcus aureus. Continuous Venovenous Hemofiltration (CVVH) for acute kidney failure was started. He was admitted into the Intensive Care Unit (ICU) for pulmonary and cardiovascular support.ĭuring the first five days of admission he was septic and required cardiovascular and pulmonary support. Based on the clinical presentation and laboratory results we performed a laparotomy, which showed no abnormalities. Additional conventional chest X-rays was also made without pathological findings. Laboratory results showed a leucocytes count of 8.4♱0 9/L (normal reference value: 4–10 ♱0 9/L), CRP concentration of 661 mg/L (0.8-2 mg/L), creatinine level of 548 μmol/L (45–100 μmol/L) with a glomerular filtration rate of 9 mL/min/1.73 m 2 and a lactate level of 3.9 mmol/L (<1.8 mmol/L). No acute pathology was seen except a dilatation of the stomach and small intestine. Suspicion of an aneurysm of the abdominal aorta raised at presentation and a CT-scan was made. He was recently admitted into an orthopedic ward for two days with lumbar pain due to discopathy of all lumbar vertebrae with signs of spondylodicitis. Our first case was of a 65 years-old man who presented in the emergency department (ED) of our tertiary health care institute with acute abdominal pain which irradiated to the back in combination with hypotension. Furthermore, we discuss the usefulness of these markers in practice and their contribution to establish a diagnosis by means of interventions in the emergency department. This report presents three patients with non-traumatic acute abdominal pain and abnormal C-reactive protein and/or lactate concentrations with a negative laparotomy. The pitfall of relying on laboratory values could lead to over treatment or under treatment. The question remains if these parameters are reliable to diagnose an acute abdomen. Examples of those biochemical parameters are high concentrations of C-reactive protein (CRP) or lactate concentrations. Physicians in the emergency department often base their decisions for consultation of the surgeon for a laparotomy on clinical presentation combined with biochemical abnormalities. In addition to history taking and physical examination, clinicians often use laboratory tests and radiological examinations to exclude diagnoses that can mimic acute abdominal pain for example pneumonia. Diagnosing patients who present in the emergency department with acute abdominal pain can be challenging.

Gastric bubble in diabetic coma x ray