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

2 cases of unrecognized oviduct pregnancy receiving therapeutic abortion by uterine aspiration are reported. A 29-year-old white female, gravida 4, para 2 with a Dalkon Shield in place for 2 1/2 years and with 6 weeks amenorrhea received a therapeutic abortion. 3 days later the patient complained of fever and severe suprapubic cramps. Minocycline was given in the belief that the patient was suffering from endometritis. 17 days after uterine aspiration the pain increased. At laparoscopy a corpus luteum was seen in the left ovary and blood was present in the pelvis. Histological examination of the oviducts revealed signs of an aborted oviduct pregnant. A 2nd case concerned a 26-year-old white female, gravida 2, para 2, using the Ogino-Knaus method of contraception and who had a normal menses 7 weeks previously. 12 days after uterine aspiration the patient complained of continued vaginal bleeding, lower abdominal cramps, and chills. After uterine aspiration was repeated minocycline therapy was initated. 20 days after the initial aspiration the patient reported a return of vaginal bleeding and lower abdominal pain. Laparotomy revealed a ruptured oviduct. Histology showed salpingitis and fusion of the right fimbria and a large blood clot and trophoblastic villi in the lumen of the right ampulla. In the future it is suggested that histological examination of the aspiration should be performed to aid in finding oviductal or ovarian pregnancies.
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PMID:Case reports: unrecognized oviduct pregnancy and therapeutic abortion by uterine aspiration. 97 19

There is a 24% complication rate after first trimester induced abortions using traditional methods. This rate increases significantly in women who have a history of severe gynecological diseases (SGDs), e.g., uterine myoma, scars on the uterus, and developmental defects of the genitals. The goal of this investigation was to shed light on the effectiveness of miniabortion among pregnant women with SGDs. 61 patients aged 21-43 years with SGDs (33 with uterine myomas, 22 with scars, and 6 with uterine developmental defects) who underwent abortion by vacuum aspiration were studied. All women had had 1-3 births and 1-11 abortions. Only one patient with scars required dilatation of the cervix to Hegar 6. 85% of the patients tolerated the operation well, while 15% either had lower abdominal pain or vertigo, which abated soon after the procedure. 3-10 days after the operation slight menstruation reactions developed in 97% women that lasted 1-3 days. In 11% of cases the menstruation reaction was accompanied by pain. In two patients with uterine myoma the bleeding did no stop within 5 days after the abortion. One of these patients had profuse bleeding with clots, and 13 days after abortion she developed postabortal endometritis. One patient with scars became pregnant. The rate of complications amounted to 3.3%. The high risk of postabortal complications owing to the defects of the myometrium necessitated the administration of weak uterine drugs, such as ergotal. Trihopol was also administered for the prevention of inflammation. Starting the fifth day after the beginning of menstruation-like reactions, the patients were started on estrogen-gestagen preparations for contraception for three menstrual cycles. After the end of the menstrual reaction, they were enrolled in rehabilitative physiotherapy: electrophoresis or ultrasound applied to the area of the uterus. Regular menstruation usually resumed 20-30 days after the beginning of the menstrual reaction. The highly effective miniabortion curettage is recommended because of negligible risk of trauma.
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PMID:[A method of vacuum aspiration in early pregnancy in women with a history of severe gynecologic diseases]. 147 26

2 cases of pelvic Actinomycosis both in women 40 years of age, with IUDs in place for 8 and 10 years respectively, were diagnosed with the aid of radiologic techniques including barium enema, computed tomography (CT) and magnetic resonance imaging (MR). The 1st woman had experienced malaise, night sweats and a weight loss of 15 lb. over 2-3 months, then felt an epigastric mass for 5 days. She has endometritis, elevated white blood cell count, and large, tender, bilateral adnexal masses. Inflammatory changes and multilocular fluid collections were demonstrated by enhanced CT. Aspiration of the epigastric mass yielded sulfur granules and anaerobic bacteria. She was successfully treated with penicillin, gentamycin and clindamycin. The 2nd woman had a 2-month history of abdominal pain, a pelvic mass and an elevated white blood cell count. Enhanced CT, barium enema and sigmoidoscopy demonstrated a mass between the uterus and bowel, with mural invasion of the sigmoid colon. A 5 x 6 cm left-sided tubo-ovarian abscess adhering to the colon, bladder and left pelvic sidewall was excised at laparotomy. She remained asymptomatic at 6 months. This lethal but curable condition is caused by Actinomyces israelii, an opportunistic gram-positive bacteria usually introduced by foreign bodies, surgery or trauma. CT and MR were helpful in diagnosing the relatively nonspecific signs and symptoms in these cases.
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PMID:Pelvic actinomycosis associated with intrauterine devices. 291 83

In Nairobi, Kenya, researchers enrolled 35 women at 7-9 days postpartum who delivered vaginally and had clinical endometritis (purulent lochia, fever, uterine tenderness, or uterine subinvolution) and 30 puerperal women without endometritis in a case control study. The study aimed to examine the association between clinical criteria and microbial and histological findings in diagnosing postpartum endometritis and the role of various microorganisms in the etiology of this infection. Cases were significantly more likely to have foul lochia (51.1% vs. 20%; p = .005) and abdominal pain (77.1% vs. 46.7%; p = .02). Laboratory personnel were able to isolate both Neisseria gonorrhoeae and Chlamydia trachomatis significantly more often from the cervices and the endometria of the patients than from the controls. Each of these 2 microorganisms were also isolated more often from the endometria of patients than of controls (3 patients vs. 0 patients for both N. gonorrhoeae and C. trachomatis), but the difference was not significant. The researchers could not determine the etiology of postpartum endometritis in the remaining two-thirds of cases. Isolation rates for Mycoplasma hominis and Ureaplasma urealyticum from the cervices and endometria were essentially the same in both patients and controls. Moderate or severe plasma cell infiltration occurred in 24% of cases and 4.5% of controls (p = .06). No correlation between histology and microbiology existed, however. These findings suggest that controlling maternal sexually transmitted disease would reduce postpartum pelvic infections and secondary infertility.
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PMID:Microbial aetiology and diagnostic criteria of postpartum endometritis in Nairobi, Kenya. 313 52

The case-study of genital actinomycosis in a 33-year old woman wearing a "Copper T200" IUD is presented. She was hospitalized and treated for lower abdominal pain and non-characteristic signs of adnexitis twice. Adnexectomy on the left side was performed to remove an orange-size cyst. Histo-pathological examination of a prepared tissue sample revealed a colony of Actinomyces. Following the operation the patient was treated with 3 x 500 mg Flagyl (metronidazole) 3 x 80 mg of Gentamicin im. The wound healed in 19 days after operation. This woman had worn the IUD continuously for more than 3 years, thus there was an increased risk of uterine lesions. The most frequent consequences of wearing IUDs for a long time are dysmenorrhea and endometritis and therapeutic approaches are detailed. Since its first description in the literature in 1857 actinomycosis has not been mentioned frequently. However, with the spread of IUDs, the number of actinomycosis-like cases has increased and this justifies the need for improved diagnosis. The frequency of actinomycosis occurring in women wearing IUDs ranges between 1.6% and 19.7%
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PMID:[Adnexal actinomycosis in a woman using an intrauterine contraceptive device (IUD)]. 358 37

Abdominal pain and fever after an uncomplicated elective abortion usually point to incomplete abortion and endometritis. We treated a woman for acute suppurative appendicitis one week after such an abortion. When fever, nausea, vomiting and pain are not relieved by the standard doses of medication, acute appendicitis must be added to the usual gynecologic differential diagnoses.
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PMID:Ruptured appendix after elective abortion. A case report. 622 52

In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.
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PMID:Pelvic actinomycosis. 686 30

Pelvic actinomycosis of the female genital tract is an indolent suppurative inflammation involving the adnexal tissues and occasionally, the endometrium. It is becoming increasingly associated with IUD use, and its diagnosis is seldom made preoperatively. This report presents a case of widespread, unrecognized pelvic actinomycosis involving the rectum in an IUD-wearer. It also illustrates the difficulty in diagnosing and managing this disorder. A 43-year old woman admitted to the University Hospitals presented with a severe process which mimicked a pelvic malignancy. 8 months prior to admission, she had an IUD in place for 11 years removed due to irregular menstrual bleeding; dilatation and curettage revealed tissues associated with acute endometritis and several Actinomyces colonies were observed in a cervical smear. At the University Hospitals, diagnosis of pelvic actinomycosis was not suspected preoperatively. Exploratory laparotomy, hysterectomy, and bilateral salpingo-oophorectomy revealed no gross evidence of malignancy. Modified abdominoperitoneal resection was performed, leaving a sigmoid colostomy in place. Multiple histologic sections necessitated the confirmation of the diagnosis of actinomycosis. Presence of bilateral salpingo-oophoritis and the fact that Actinomyces colonies were observed in cervical smear strongly indicate that the initial focus of infection was related to the IUD rather than an intestinal site. The patient recovered uneventfully and was well at a 3-month follow-up. This case demonstrates also the progression of suppurative disease despite prior removal of IUD. Pelvic actinomycosis should be considered in patients with IUD, or those who have had them removed recently and those who are experiencing abdominal pain, recurrent vaginal bleeding, and adnexal masses.
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PMID:Intrauterine device-associated actinomycosis simulating pelvic malignancy. 723 38

Spontaneous perforation is a rare complication of pyometra and is usually associated with uterine cervical occlusion. We report a very rare case of spontaneously perforated pyometra without cervical occlusion. A 56-year-old woman with severe abdominal pain was admitted to our hospital. Exploratory laparotomy was performed because of suspicion of gastro-intestinal perforation with generalized peritonitis. There was no perforation of the stomach, gallbladder, or bowels, but examination of the uterus revealed a perforation of the uterine fundus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, the condition must be born in mind with regard to elderly women with acute abdominal pain.
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PMID:Spontaneous perforation of pyometra: a case report. 781 Nov 91

The charts of 340 patients who underwent an endometrial suction procedure using Karman's cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted.
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PMID:Karman's cannula and vacuum aspirator in gynecological practice. 858 87


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