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

The purpose of this case report is as follows: to attempt to establish an association between the observed increase in hydrosalpinx and the phenomenal increase in surgical sterilization; to present a credible etiology for iatrogenic hydrosalpinx; and to discuss the pathogenesis of a disease process henceforth referred to as post tubal ligation syndrome. A 36-year-old white woman was admitted to Park View Hospital in Nashville, Tennessee on January 7, 1981 for evaluation of continuous lower abdominal pain, abdominal pressure, and dyspareunia for several months. The woman had 2 children who were delivered vaginally. An abdominal tubal ligation was performed for sterilization when she was 27, and vaginal hysterectomy, with anterior and posterior colporrhaphy, was done for symptomatic pelvic relaxation at age 33. Physical examination showed tenderness without palpable masses in the pelvic adnexal areas. Laboratory studies were within normal limits. On January 9, 1981, the patient underwent exploratory laparotomy, and bilateral salpingo-oophorectomy. She was found to have bilateral hydrosalpinx. Historically, hydrosalpinx has been considered an intermediary step in pelvic inflammatory disease. Iatrogenic hydrosalpinx is, in essence, initiated by an initial insult, e.g., tubal ligation, fulguration, or application of a mechanical clip or band. Theoretically, single point interruption of a fallopian tube should produce no ill effects. The popularity and success of tubal ligation attest to single point interruption of an otherwise normal fallopian tube as an innocuous procedure. A schematic drawing is provided of the same tube insulted a 2nd time and consequently the situation is prefactory to development of hydrosalpinx, i.e., a tube lined with secretory epithelium is closed at both ends. Secretion within this closed system will produce dilatation. This "2nd" insult to the normal fallopian tube, post tubal ligation, may take 1 of several forms. The symptoms of iatrogenic hydrosalpinx are not pathognomonic. The most useful diagnostic tools are a high degree of suspicion, history of previous tubal ligation, and history of tubal ligation followed by hysterectomy with conservation of ovarian function.
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PMID:Post tubal ligation syndrome or iatrogenic hydrosalpinx. 731 12

A pelvic abscess is the end stage in the progression of a genital tract infection and is frequently preventable. The abscess may fill the pelvis and occasionally the lower abdomen, and is usually posterior to the uterus and bound by the sigmoid colon, loops of small bowel, cul-de-sac, and sidewalls of the pelvis. A tubo-ovarian abscess may occur in the acute stage of pelvic inflammatory disease (PID) but is more common with chronic or subacute PID. An abscess occurs when pus from the fallopian tube spills onto the ovary and infects it at the site of follicular rupture or by direct penetration. Pelvic and abdominal pain which is bilateral and aggravated by motion and intercourse, and fever possibly exceeding 103 degrees fahrenheit with leucocytosis, tachycardia, and prostration are the most common symptoms of pelvic abscess. The pelvic examination may reveal all gradations of pathology, but because of the degree of guarding and tenderness it elicits, the abscess may elude the examiner. The rectal examination, computerized tomography, and ultrasonography are useful in diagnosis. Other disorders such as acute appendicitis and ecoptic pregnancy may be mistaken for abscess. Patients with pelvic abscesses should be immediately admitted to hospital regardless of the size of the abscess because the broad-spectrum anerobic antibiotic coverage needed is most effectively provided there. Preservation of normal tubal function is rarely possible in patients developing tubal abscesses. Bed rest, fluid and electrolyte replacement, nasogastric suction when indicated, and antibiotics are the basis of medical treatment. Controversy exists regarding appropriate antibiotic therapy, but the probable presence of anaerobic organisms should be kept in mind. Patients with pelvic abscesses are frequently given a triple antibiotic regimen including clindamycin, gentamicin, and aqueous penicillin. Guidelines for the failure of medical management in patients with a pelvic abscess include persistent fever, increase in size of abscess, persistent ileus, suspicion of rupture, septic shock, and uncertainty of the diagnosis. A posterior colpotomy is preferable to a laparotomy if surgical treatment is necessary, but it is only suitable for selected patients. Removal of a pelvic abscess frequently involves a total abdominal hysterectomy. Operating instructions and diagrams are included. Rupture of a pelvic abscess is life threatening and requires immediate surgery.
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PMID:Medical and surgical management of the pelvic abscess. 733 45

20 cases of pelvic actinomycosis associated with the use of an IUD have been reported. A case of a patient with IUD-associated pelvic actinomycosis, in which the organism was identified by histologic testing and culture, is reported. The 26-year-old woman, gravida 2, para 1, had had a therapeutic abortion in March 1971. She used a Dalkon Shield IUD from 1971 to April 1975. It was removed at that time because of menometrorrhagia. The patient noted pain in the lower left quadrant of her abdomen in June 1975. A mass in the left ovary was palpated on pelvic examination, but the patient refused further evaluation. The patient returned in August 1976 complaining of continued abdominal pain. On physical examination, she had a firm, slightly tender, 7 centimeter mass in the left adnexa, contiguous with the uterus. No other abnormalities were revealed in physical examination. There were 11,200 peripheral blood leukocytes per cubic millimeter with 73% polymorphonuclera cells and 6% band forms. A laparotomy was performed in August 1976, and a 5- by 2.5 centimeter tubo-ovarian abscess on the left side was found. Adhesions and clubbing of the right fallopian tube were observed during the operation. The left ovary and fallopian tube were excised. Inflammatory disease involving the right ovary and fallopian tube was evident, but the right adnexa was left in place in accordance with the patient's preoperative request. In October a 2nd laparotomy was performed, and the ovary and the right fallopian tube were removed.
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PMID:Tubo-ovarian Actinomycosis and the Use of Intrauterine Devices. 740 3

Two typical adenocarcinomas of the fallopian tube in a thirty two and thirty-eight-year-old patients are presented. Clinically both tumors were discovered after episodes of vaginal bleeding, abdominal pain and leukorrhen. Both patients were treated by total hysterectomy including removal of the ovaries and the fallopian tubes. One of the patients remains well after two and a half years postoperatively without signs and symptoms of tumor up to date. Microscopically the tumors were classified as poorly differentiated adenocarcinomas. A brief review of the pertinent literature, was done.
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PMID:[Primary carcinoma of the Fallopian tube. Presentation of two cases and review of the literature]. 774 88

Isolated fallopian tube torsion is a rare entity that most frequently occurs during the menstruating years, but has also been reported in premenopausal and postmenopausal women. Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain. A case of a 13-year-old girl with isolated left fallopian tube torsion is presented. A high index of suspicion must be maintained for adnexal torsion in women with abdominal pain so that an attempt can be made to salvage the adnexal structures.
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PMID:Torsion of the fallopian tube. 775 26

Primary leiomyosarcoma of the fallopian tube is an extremely uncommon neoplasm. We report a 39-year-old premenopausal woman with leiomyosarcoma confined to the right fallopian tube, who is alive without evidence of disease 2 years after surgical resection followed by adjuvant doxorubicin and cisplatin chemotherapy. An accompanying literature review indicates that the clinical signs and symptoms of fallopian tube sarcomas are usually nonspecific and include lower abdominal pain and pelvic pressure. The age at diagnosis varies from 21 to 70 years, with a median of 47 years. Prognosis is poor, however, several longterm survivors have been reported. The primary treatment remains surgical excision, although adjunctive chemotherapy or radiation may be of some benefit.
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PMID:Primary leiomyosarcoma of the fallopian tube. 811 53

Both heterotopic pregnancies and primary neoplasms of the fallopian tube are rare occurrences. A patient presented with early pregnancy, abdominal pain and ultrasound findings of an intrauterine gestation and a fallopian tube mass. Laparotomy revealed a primary leiomyoma of the fallopian tube.
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PMID:Leiomyomas of the fallopian tube. A case report. 825 1

Malignant mixed mullerian tumors of the female genital tract are rare and occur least commonly in the fallopian tube. A case is reported and 51 other cases in the literature are reviewed. The mean age at diagnosis is 59 years. Abdominal pain is the most common presenting complaint. A pelvic or abdominal mass is present in 75% of patients. The diagnosis is not usually established until surgery, with the most common preoperative diagnosis being ovarian malignancy. Seventy-five percent of cases had tumor extension beyond the fallopian tube at the time of surgery. Treatment has focused on surgery with postoperative radiation and/or chemotherapy. Prognosis is poor, with fewer than half of patients surviving 2 years. Recent reports suggest improved outcome with platinum-based chemotherapy but data are limited.
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PMID:Malignant mixed mullerian tumors of the fallopian tube. 839 54

Extensive radiographic evaluation of children with recurrent abdominal pain (RAP) is rarely diagnostic or cost-effective. The authors sought to define the role of laparoscopy in the evaluation of children with RAP. Fifteen children underwent laparoscopy for RAP in a 2-year period. Their mean age was 12 years (range, 6 to 16 years), 13 (87%) were female, and the mean duration of symptoms was 11 months (range, 2 to 60 months). Thirty-eight imaging studies (excluding plain films) had been obtained before laparoscopy, including 19 abdominal sonograms, 9 upper gastrointestinal series, four abdominal computed tomography scans, 3 barium enemas, 2 isotope scans, and 1 magnetic resonance examination of the head. Only two (5%) of these studies provided an accurate diagnosis. Eleven of the 15 children (73%) had positive findings diagnosed and treated laparoscopically. These included eight appendiceal abnormalities (in six patients), three Meckel's diverticula, one inguinal hernia, one urachal cyst, one para-fallopian tube cyst, and one adhesion to an appendectomy stump. Eight of 11 (73%) children with positive findings had immediate resolution of symptoms after laparoscopic treatment. Three children with pathological findings at the time of laparoscopy had persistent symptoms, which resolved completely within 4 months of the laparoscopy. Laparoscopy is an accurate technique for the evaluation and treatment of children with RAP. Its early application could provide economic benefit by eliminating many low-yield imaging studies and minimizing lost time from school.
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PMID:Laparoscopy for diagnosis and treatment of recurrent abdominal pain in children. 886 55

Symptomatic uterine lymphangioleiomyomatosis (LAM) simulating high-stage uterine sarcoma in a patient with tuberous sclerosis complex is reported. A 49-year-old female presented with abdominal pain and anemia. Preoperative workup revealed a uterine mass and a large amount of peritoneal free fluid and possible metastatic implant along the lateral edge of the liver. The patient also had a large right pleural effusion. A fungating anterior uterine fundal mass with apparent perforation and intraabdominal hemorrhage was found on laparotomy. A portion of the mass was excised and initially interpreted as an endometrial stromal sarcoma. Microscopic examination revealed multiple vascular epithelioid smooth muscle proliferations in the uterus and serosal surface of the fallopian tube and periaortic lymph node lymphangioleiomyomas. The uterine, fallopian tube, and nodal lesions were positive for smooth muscle actin, desmin, and HMB-45, findings characteristic of LAM. Additional examination of the patient revealed stigmata of tuberous sclerosis complex. Although uterine LAM is uncommon, it may be associated with pelvic and/or abdominal symptoms and may simulate a primary uterine mesenchymal neoplasm.
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PMID:Lymphangioleiomyomatosis of the uterus simulating high-stage endometrial stromal sarcoma. 894 80


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