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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is increasing evidence that immunological mechanisms play a role in the pathogenesis and pathophysiology of endometriosis. It was therefore of interest to study interleukin-8 (IL-8), a chemokine, in the peritoneal fluid and peripheral blood of women undergoing laparoscopic procedures. The presence and concentrations of IL-8 in relation to endometriosis, infertility and abdominal pain were evaluated. Samples of peritoneal fluid (n = 49) and peripheral blood (n = 50) were obtained from 50 consecutive patients undergoing laparoscopic surgery for various gynaecological indications (abdominal pain, infertility, sterilization). IL-8 was present in the peritoneal fluid of most women (87%). The concentration of IL-8 in the peritoneal fluid was higher in women with endometriosis compared to women without (P = 0.02). This difference was more pronounced in early (stage 1) endometriosis (P = 0.001). IL-8 concentrations in the peritoneal fluid were also higher in women with early endometriosis compared to women with later stages of the disease (P = 0.003). Peripheral blood concentrations did not correlate with peritoneal fluid concentrations of IL-8 and/or the presence of endometriosis. We conclude that IL-8 is an important factor that may contribute to the pathogenesis of endometriosis possibly by promoting neovascularization. This information can be a guide in the development of new therapeutic approaches for the treatment of endometriosis.
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PMID:Peritoneal fluid concentrations of interleukin-8 in women with endometriosis: relationship to stage of disease. 974 Apr 57

Gynecologic disorders occur commonly in women with Crohn's disease and ulcerative colitis. Frequently, these women also suffer menstrual disorders with gastrointestinal symptoms that overlap with those related to inflammatory bowel disease (IBD). Knowledge of the range of gynecologic problems--for example, dysfunctional uterine bleeding, fistula or abscess of the perineum or vagina, dyspareunia, subfertility possibly due to tubal blockage, and ovarian dysfunction related to bowel disease--that have been associated with IBD will assist practitioners in treating these women. Prostaglandins, released by the endometrium at menstruation, cause contraction of uterine smooth muscle, resulting in the cramping pain of dysmenorrhea. Prostaglandins also are an important component of the inflammatory process in active IBD; by increasing contractility of GI smooth muscle, they are associated with diarrhea and abdominal pain. Menstrual pain and menses-related GI symptoms may be difficult to distinguish from symptoms related to IBD. Endometriosis may present with symptoms similar to an acute episode of IBD. Mucosal changes in the bowel can occur in association with endometriosis, and can be confused with the histologic features of IBD. The distinction is important. For example, while nonsteroidal anti-inflammatory drugs may relieve symptoms of dysmenorrhea, they often are contraindicated in IBD. To provide optimal evaluation and treatment, all health care professionals who treat women with IBD should be aware of the spectrum of gynecologic conditions that may be encountered.
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PMID:Inflammatory Bowel Disease--A Complicating Factor in Gynecologic Disorders? 974 78

The recurrence of endometriosis varies from 6% to 10% and, among the non-gynaecological sites, the bowel is involved in 12%-37%. Various symptoms, such as dysmenorrhea, dyspareunia, chronic pelvic pain, diarrhoea, constipation, cyclic rectal bleeding, colic-abdominal pain up to intestinal occlusion characterize this pathology. Surgery seems to be the best treatment especially for gastrointestinal symptoms; conservative surgery should be performed, particularly in young patients. Four cases of intestinal endometriosis were reevaluated.
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PMID:Rectosigmoid endometriosis: diagnosis and surgical management. 985 8

Retrospective analysis performed on medical records of 129 adolescents and young women treated surgically at I Dept. of Surgical Gynaecology during the nine years period (1989-1998) revealed 22 cases (17%) of endometriosis. Main indication for surgical intervention, apart from dysmenorrhoea and cyclic abdominal pain, had been the presence of endometriod cyst, as disclosed by ultrasound investigation (66%). Despite of negative result of imaging or clinical examination subjective complaints necessitated laparotomy in 27% of cases. According to American Fertility Society endometriosis classification, 17% subjects presented endometriosis in I stage, 17%--in stage II and remaining 66%--endometrioid cysts with stage III. Authors conclude, that in cases with persistent abdominal pain, not responding to conventional therapy, diagnostic laparoscopy/laparotomy in young women should not be delayed, unless endometriosis is suspected.
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PMID:[Endometriosis in adolescents and young women. Can we afford to delay the diagnosis?]. 1046 61

Vaginal agenesis combined with a functional uterus is a rare condition in which treatment modalities that preserve reproductive function are controversial. A 21 year old female presented with congenital vaginal agenesis combined with cervical atresia. She was treated with gonadotrophin-releasing hormone (GnRH) agonists for a total period of over 5 years when a non-functioning pituitary tumour was detected by brain magnetic resonance imaging (MRI). A laparoscopically assisted reconstruction of a neovagina and neoendocervical canal was performed utilizing lyophilized porcine dermal skin to line the neovagina. Endometriosis of the pelvis was revealed and adhesiolysis and cauterization were also carried out under laparoscopy. The GnRH agonist was discontinued and the patient resumed cyclic menses with no abdominal pain. The pituitary tumour decreased in size 6 months after the cessation of GnRH agonists. We raise the question as to whether pituitary MRI should be performed for patients who need long-term administration of GnRH agonists.
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PMID:Non-functioning pituitary tumour after long-term treatment with gonadotrophin-releasing hormone agonists in a patient with vaginal agenesis who underwent neovaginoplasty and cauterization of endometriosis under laparoscopy. 1052 4

Various estimates suggest that 6-44% of women of reproductive age have endometriosis, that is, functioning endometrial tissue lying outside its usual intrauterine location. Although this condition may be asymptomatic, common symptoms include dysmenorrhoea, dyspareunia, cyclical pelvic and abdominal pain, and subfertility. Here we discuss ways of managing endometriosis.
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PMID:Managing endometriosis. 1056 61

Neurologic disease as a cause of chronic pelvic pain may be more common than previously reported. We report three cases wherein patients with complaints of pelvic pain were subsequently found to have neurologic disease involving the lumbosacral spine. In all three cases, the presenting features were complaints of cyclic or noncyclic lower abdominal pain attributed to endometriosis, pelvic inflammatory disease, or uterine fibroids. When conventional therapies failed to resolve the pain, magnetic resonance imaging (MRI) of the lumbosacral spine showed a neoplasm in one patient and disk herniation in two patients. Evolving lumbar disk disease or intradural neoplasms in the upper lumbar area can produce symptoms interpreted as pelvic pain. Symptoms consistent with radiculopathy occurred late in the course of each of the three cases reported.
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PMID:Neurologic disease presenting as chronic pelvic pain. 1058 42

We present nine cases of endometriosis presenting to general surgeons over a period of 4.5 years at Gwynedd Hospital, Bangor. A total of 83 cases of endometriosis was found on analysis of pathology records. Of these, 73 presented to gynaecologists, one to a dermatologist and nine to general surgeons. The presentation to general surgeons includes swelling related to Pfannanstiel scar (two), swelling in inguinal canal (two), umbilical nodule (one), rectal bleeding (one), recurrent abdominal pain (one), mimicking ovarian tumour (one) and presenting as pelvic peritonitis (one). Six were elective admissions and three were admitted as an emergency. All were premenopausal (range 19-49 years) women. None had any previous history of endometriosis or subfertility. Two patients with cyclical symptoms were correctly diagnosed clinically, and the others were postoperative diagnosis. Six patients required gynaecological referral and four of these required further medical treatment. None of them has required further surgical intervention in follow-up (range 4 weeks to 3 years). Endometriosis usually presents to general surgeons with deposits at extragonadal sites. Some patients may present as an emergency with abdominal pain. Endometriosis should be included in the differential diagnosis of women presenting with swellings related to umbilicus, surgical scars, inguinal canal and pelvis, especially if symptoms are cyclical. Usually, surgical excision is adequate. Selected cases require gynaecological referral and further medical therapy.
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PMID:Endometriosis: presentation to general surgeons. 1061 93

The clinicopathologic features of neoplasms arising in gastrointestinal endometriosis have not been well characterized. In this series, we report 17 cases of gastrointestinal endometriosis complicated by neoplasms (14 cases) or precancerous changes (three cases). Four patients, one of whom also had hypermenorrhea, presented with chronic abdominal pain and five had obstructive symptoms; one of these also had rectal bleeding. One patient presented with an acute abdomen and fecal peritonitis, one had vaginal bleeding, and one had a progressive change in bowel habits. Nine patients had a long history of endometriosis, 11 patients had had hysterectomies, and eight of these had also received unopposed estrogen therapy. The lesions involved the rectum (6), sigmoid (6), colon, unspecified (2), and small intestine (3), and comprised 8 endometrioid adenocarcinomas (EA), 4 mullerian adenosarcomas (MAS), 1 endometrioid stromal sarcoma (ESS), 1 endometrioid adenofibroma of borderline malignancy (EBA) with carcinoma in situ, 2 atypical hyperplasias (AH), and one endometrioid adenocarcinoma in situ (ACIS). The tumors ranged in size from 2 to 15 cm and all involved the serosa and muscularis propria. Two tumors extended into the mucosa, with mucosal ulceration in one. Follow-up was available in 11 cases. One patient with EA was dead of disease at 1 year, one had two recurrences at 1 and 2 years, and three were alive with no evidence of disease (ANED) at 9 months to 13 years (mean, 68 mos). The patient with the EBA was ANED at 3 months. Two patients with MAS were ANED at 2 and 3 years. The patient with ESS had a recurrence at 3 years and was ANED 6 years after her original diagnosis. One woman with AH was ANED at 60 months and the patient with ACIS was ANED at 16 months. One of the carcinomas was originally misdiagnosed as a primary intestinal adenocarcinoma. The pathologist should be aware of the possibility of a tumor of genital tract type when evaluating intestinal neoplasms in females, particularly if they have a history of endometriosis and have received unopposed estrogen therapy.
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PMID:Neoplastic and pre-neoplastic changes in gastrointestinal endometriosis: a study of 17 cases. 1075 98

We report a 27-year-old female with Crohn's disease clinically misdiagnosed with intestinal endometriosis. Her complaints were abdominal pain and fullness, which occurred monthly during her menstrual period. Although we had no histopathological evidence, we diagnosed her as bowel endometriosis on the basis of her clinical course. Since nafarelin acetate therapy started, the symptoms due to mechanical subileus have improved. The transverse colon, a 70 cm segment of the ileum, including the terminal ileum, were resected because of repeated symptoms of bowel obstruction despite prolonged nafarelin therapy. Histopathological findings of the resected specimen revealed Crohn's disease without endometrial tissue. In our patient, an increased cortisol and ACTH secretion, a side effect of nafarelin, was noted during the therapy. This case showed that nafarelin therapy could increase serum concentration of ACTH and cortisol, which was considered to suppress the pathology of Crohn's disease by its anti-inflammatory action. We emphasize that intestinal examination must be performed with Crohn's disease in mind, even if nafarelin acetate is effective.
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PMID:Crohn's disease mimicking as bowel endometriosis. Are the symptoms reduced by nafarelin acetate? 1076 42


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