It is abdominal pain that persists, repeats itself and become chronic outside of an emergency context. Irritable bowel or functional colopathy are the most common pathologies. The rarer causes are numerous and difficult to diagnose, the obsession of the general practitioner and the urgent request of the painful patients will lead to the realization of many complementary examinations to not neglect an organic pathology. These examinations are extremely varied and it is important to know that, in the last place, it is sometimes necessary to entrust the patient to the surgeon for a diagnostic laparoscopy.
The interrogation and the complete clinical examination are, as in the acute abdominal pains, very important.
A clinical element can be decisive in the choice of exams and represent the breadcrumb of the etiological quest.
They will be guided by the clinic and by the location and type of pain.
Abdominal ultrasonography, endoscopic examinations and abdominal CT scan are the main examinations that will be performed in these painful chronicles. It must be emphasized, however, that they are often negative in this area.
Sometimes only surgical exploration by laparoscopy will be able to make an etiological diagnosis in a patient who presents a painful symptomatology for months.
The context and the location of the pain seem to be the best guides.
Epigastric and chronic peribilical pain:
– Gastroduodenal and biliopancreatic pathology in the first place: ultrasound and high endoscopy.
– Intestinal parasitosis : search for lamblia, roundworm, tapeworm, not to mention anisakiasis (ingestion of raw fish).
– Pathology of hail :
• celiac disease: if there is an associated malabsorption syndrome;
• small malignant, benign or malignant tumor with a very difficult diagnosis: radiological transit or fibroscopy or endoscopic capsule;
• Meckel’s diverticulum more often discovered in laparoscopy than on radiological transit.
– Mesenteric arteritis must be evoked on a vascular field in front of rhythmic pains
by food intake.
Pain of the right hypochondrium:
– Hepatobiliary and pancreatic pathology : ultrasound, scanner, even bili-MRI.
– Hepatitis or Fitz Hugh Curtis Syndrome secondary to genital infection more often due to Chlamydia trachomatis as in the gonococcus, confirmed by serology and laparoscopy.
– A heart liver with dilation of the hepatic veins on ultrasound.
– Budd-Chiari syndrome : Thrombosis of the hepatic veins confirmed by CT angiography.
– Acute viral hepatitis or more often alcoholic.
– A parasitosis : hydatidosis, blood eosinophilia distomatosis and serological confirmation.
– Think about the frequent right angular air distention (the right colon is the place of fermentations!) Which will be diagnosed after eliminating a tumoral pathology.
Chronic pain of the left hypochondrium:
– Gastric, pancreatic and colic pathologies.
– Ischemic colitis confirmed by colonoscopy and arteriography.
– Pseudomembranous colitis in general post-antibiotic therapy, confirmed by colonoscopy and bacteriological evidence of clostridium difficile and its toxins on stool analysis.
– A non-digestive condition : spleen, kidney, pleura, lungs to explore by ultrasound, and thoraco-abdominal CT scan.
Chronic pain of the right iliac fossa:
– In addition to functional and organic, tumoral, infectious or inflammatory colic pathology.
– Peritoneal tuberculosis confirmed by laparoscopy with biopsies and demonstration of BK in bacteriological cultures.
– An urogenital pathology confirmed by ultrasound, CT scan, UIV, cystoscopy, hysterosalpingography and laparoscopy.
Chronic pain of the left iliac fossa:
Intra- and extra-abdominal etiologies:
INTRA – ABDOMINAL ATHOSIS:
– Hematomas of the right muscles and psoas: in patients on anticoagulants, to search by ultrasound.
– Peritoneal carcinomatosis often preceded by a meteorism, difficult to evoke in the absence of known cancer, ultrasound and CT are often defeated and laparoscopy is essential.
– Adhesive disease peritoneum or material forgotten in case of abdominal surgical history.
– Retroperitoneal fibrosis objectified by the scanner.
EXTRA – ABDOMINAL DISEASES:
– The porphyries and in particular acute intermittent porphyria with urinary elimination of the precursors: amino-levulinic and porphobilinogenic Δ acid and demonstration of the enzymatic deficiency.
– Periodic disease to be evoked in case of identical family history in a patient from the eastern Mediterranean basin.Efficacy of the colchicine test and search for the gene.
– Hypertriglyceridemia, especially if they exceed 10 g / L, through a pancreatic reaction.
– Hypercalcemia, whatever the cause.
– Hemolysis who evolve by thrusts, especially sickle cell disease, Machiafava- Micheli’s disease …
– The lead poisoning very rare: diagnosis by determination of blood lead and leaduria.
– Gastrointestinal vasculitis may develop by flares in the polyarteritis nodosa, rheumatoid purpura. In principle, there is an evocative context and a fairly acute evolution, but sometimes the diagnosis is made by endoscopies or laparoscopy.
– Some neurological disorders: shingles before the characteristic rash, certain radiculalgia (diabetes, infections, rare tumors).