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

The medical literature includes reports of necrotizing fascitis after Bartholin abscesses, vaginal delivery, cesarean section, abdominal hysterectomy, sterilization by bilateral total salpingectomy, and diagnostic laparoscopy. This paper presents the 1st documented report of necrotizing fascitis after sterilization by bilateral partial salpingectomy. The patient, a healthy 41-year-old, presented with severe abdominal pain, nausea, and vomiting 1 day after undergoing bilateral partial resection and ligation of the fallopian tubes through a suprapubic minilaparotomy incision (Pomeroy procedure). Disseminated intravascular coagulopathy developed soon after admission. Surgery, performed once the patient has been stabilized through corticosteroids and broad-spectrum antibiotics, revealed extensive necrotizing fascitis involving the entire abdominal wall. There was no perforation of the bowel or uterus. Escherichia coli was cultured from the patient's abdominal wall, urine, and blood. The patient was treated successfully with piperacillin, gentamicin, and clindamycin. 15 days later, multiple reconstructive procedures were initiated to close the abdominal defect. This patient's good recovery was due to the speed of the diagnosis and wide surgical debridement of all devitalized tissue. Since she showed no evidence of salpingitis at the time of the sterilization procedure, the source of bacterial inoculum in this case was most likely the patient's skin.
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PMID:Necrotizing fasciitis of the total abdominal wall after sterilization by partial salpingectomy. Case report and review of literature. 214 53

The relationship between IUD and oral contraceptive (OC) use and tubal infertility of infectious origin was retrospectively studied in 89 French women undergoing operations for tubal infertility between 1978- 87, 178 women who had spontaneously become pregnant regardless of outcome formed the control group, which was matched for age, socioprofessional status, and ethnic origin. Chlamydia trachomatis was responsible for 73% of cases of tubal infertility. 22 of the 89 women had a history of diagnosed salpingitis and 20 had had abdominal pain of unknown origin. 47 had had no symptoms of salpingitis. The average age was 29.68 years for the tubal infertility group and 29.7 for the fertile women. The socioprofessional status of the 2 groups was similar and higher than that of the general French population. 58% in the tubal infertility group and 36% in the fertile group were nulligestes. 60.1% of fertile vs. 47.2% of infertile women had used OCs. More infertile (22.5%) than fertile (14.6%) women had used IUDs, but the difference was not statistically significant. 45% of infertile women who had used IUDs had a history of diagnosed salpingitis, vs. 19% of pill and 18.5% of other contraceptive method users. The rate of chlamydia infection was similar for OC, IUD, and other method users. The rate of use of IUDs was similar for nulliparous fertile and infertile women, but for multiparous women it was significantly higher among infertile women. The finding that the infertile group had used OCs less often than controls suggest that OCs have a protective effect against this type of infertility. The role of the IUD is harder to establish, but a significant relationship was found between infectious tubal infertility and IUD use among multiparas and among women aged 25-34 years. The study also demonstrated that chlamydia infections are not related to contraceptive method used. In the light of this study it appears important to advise OCs rather than IUDs for women who are likely to desire a future pregnancy, even for multiparous women.
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PMID:[Contraception and tubal sterility of infective origin]. 232 37

A case of salpingitis with pyosalpinx subsequent to tubal ligation is described. The procedure was performed at the time of cesarean section 7 years earlier. The pyosalpinx included the distal portion of the ligated tube, with no evidence of infection in the proximal segment. Although pelvic peritonitis, salpingitis and tubo-ovarian abscess are rare following tubal ligation, they should be suspected in any patient presenting with lower abdominal pain.
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PMID:Pyosalpinx subsequent to tubal ligation. 252 Jul 96

This is a clinical case report of a 23-year-old female admitted to St Paul's district hospital in North-East Zambia with a chief complaint of abdominal pain. Her past medical history included amenorrhea for 7 weeks, no vaginal blood loss, a previous delivery in 1986, postpartum abdominal pains which lasted for 3 months. On physical examination, she presented with slight anemia, normal temperature, normal blood pressure and a normal pulse. Pressure applied to the lower abdominal area was painful. Vaginal examination revealed an enlarged uterus; the rectovaginal pouch was extremely sensitive to pressure. Hemoglobin level was 8.5% and a pregnancy test was negative. On Laparotomy, a left sided ampullar tubal was found, with the right tube exhibiting an intact elastic swelling in the isthmus. Right salpingostomy was done to shell out the ectopic gestinal tissue and the left salpingectomy was performed to clean the recto vaginal pouch. The diagnosis made was bilateral ectopic pregnancy. The likely etiology was simultaneous ovulation from both ovaries, fertilization and subsequently implantation. The fallopian tubes had been previously affected by postpartum salpingitis.
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PMID:Bilateral ectopic pregnancy: a case report. 273 42

We encountered seven female adolescents with the Fitz-Hugh-Curtis syndrome and no signs or symptoms of salpingitis. Six of the patients had cervical cultures positive for Chlamydia trachomatis. The Fitz-Hugh-Curtis syndrome should be included in the differential diagnosis of right-sided abdominal pain in the sexually active female adolescent to avoid unnecessary diagnostic procedures and to reduce the prevalence of chlamydial infection and its complications.
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PMID:Chlamydia trachomatis Fitz-Hugh-Curtis syndrome without salpingitis in female adolescents. 341 33

An analysis of the clinical data of 552 patients treated for ectopic pregnancy during 1973-82 in our hospital showed that the prevalence of this complication rose twofold (P less than 0.01) from an annual rate of 10.9 per thousand in 1973 to 20.9 per thousand in 1982. As regards parity distribution, the proportion of the 2-paras increased significantly (P less than 0.05) and this increase was significantly greater (P less than 0.001) than in the total population of parturients during this period. The increasing incidence of ectopic pregnancies had a significant positive correlation (P less than 0.05) with the use of an intrauterine device (IUD), but not with previous or present pelvic inflammatory disease or gynaecological or abdominal surgery. Because the 158 patients with an IUD in situ (34%) had a significantly less frequent past history of salpingitis, pelvic operation, infertility, ectopic pregnancy or spontaneous abortion and had less actual pelvic inflammatory changes than the 259 patients without contraception (57%), the IUD seemed to be directly involved with the increased risk of ectopic pregnancy. In the present study lower abdominal pain occurred in 97% of the patients and menstrual disorders in 93%; pelvic examination revealed adnexal mass in 63% and adnexal tenderness in 90% of the patients. Laparoscopy, a sensitive urinary pregnancy test (detection limit 75 IU/1) and culdocentesis were the most important factors in the diagnosis of ectopic pregnancy as evidenced by positive results in 97, 90 and 83% of the cases, respectively. Due to improved diagnostic procedures the annual rate of an unruptured tube at operation increased from 49% to 73% during the study period.
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PMID:Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases. 348 6

The purpose of this study was to determine whether selected clinical features can distinguish salpingitis associated with endocervical Neisseria gonorrhoeae from that caused by Chlamydia trachomatis in black, inner-city adolescents. We reviewed retrospectively the charts of teenagers presenting to a university hospital outpatient department between January 1982 and January 1984 who were diagnosed as having salpingitis. We included all teenagers who presented with a history of low abdominal pain plus (1) either cervical motion tenderness (n = 15), adnexal tenderness (n = 13), or both (n = 57); and (2) either cervical cultures positive for N. gonorrhoeae and negative for C. trachomatis (n = 31) or cervical cultures negative for N. gonorrhoeae and positive for C. trachomatis (n = 54). Discriminant analysis indicated that the presence of breakthrough vaginal bleeding (standard regression coefficient [SRC] = 0.301; P = 0.023), current usage of oral contraception (SRC = 0.408; P = 0.009), and an elevated erythrocyte sedimentation rate (SRC = 0.522; P = 0.0002) were significantly more often related to the presence of endocervical C. trachomatis. However, we found no significant differences between the two groups for other variables that have been described as distinguishing features (i.e., duration of pain, fever, and leukocyte count).
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PMID:Pelvic inflammatory disease associated with Neisseria gonorrhoeae and Chlamydia trachomatis: clinical correlates. 366 Jan 68

2 case reports involving the use of steroid hormones in the treatment of pelvic infections are presented. The first was a young woman with bilateral salpingo-oophoritis. The patient continued to have low abdominal and pelvic pain and to remain febrile following closure of the posterior cul-de-sac and antibiotic therapy. 2 days after cortisone was added to the treatment the patient was afebrile and after 5 days she was discharged and received diminishing doses of corticosteroid. The second case involved a young married woman with acute salpingo-oophoritis who suffered recurring episodes of salpingitis and urinary tract infection and continued to have disabling abdominal pain, especially with her menses. The infection was treated with sulfasoxisole, and menstruation was suppressed with medroxyprogesterone for 1 year. At the time of writing she had been menstruating regularly for 8 months and was free of abdominopelvic pain.
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PMID:Two unusual uses of steroid hoones in pelvic infections. 579 36

This report presents a case of pelvic actinomycotic infection that was accurately diagnosed preoperatively by means of fine needle aspiration. The patient was a 40-year-old black female, gravida 6, para 6, who presented to the emergency room complaining of intermittent, crampy lower abdominal pain of approximately 1 month's duration. She also complained of a recent onset of urinary frequency and urgency without dysuria as well as a change in bowel habits, with recent constipation. Review of the patient's medical history was notable for the placement of a Dalkon Shield IUD 10 years before without subsequent removal, a history of irregular menses in the past year, and treatment for gonorrhea 10 years previously. The patient's last menstrual period was 2 weeks prior to admission. She denied fever and night sweats but had lost 20 pounds in the past 2-3 months. Vital signs were normal. Pelvic examination revealed a firm, fixed uterus, approximately the size of a 14-week pregnancy, and an associated mass extending to the left and inferiorly into the rectovaginal septum. An intravenous pyelogram showed left hydronephrosis and hydroureter, with compression of the ureter at the level of the sacrum. Sigmoidoscopy revealed extrinsic compression of the rectum at 12 cm, the some mucosal edema. A CT scan of the pelvis disclosed an 8 cm mass in continuity with the uterus extending into the lower pelvis, with possible focal erosion of the sacrum. The clinical impression was advanced cervical carcinoma. Transvaginal fine needle aspiration was performed using a 21-gauge spinal needle and a Franzen needle guide. Following a diagnosis of actinomycotic abscess, the patient was placed on tetracycline, due to her penicillin allergy, and taken to surgery. The abdomen was opened and revealed a slightly enlarged uterus. The uterus and cervix were adherent to the left pelvic wall and posteriorly to the rectum by firm, friable tissue. The left fallopian tube and ovary were adherent to this . With some difficulty the uterus was freed, and a total hysterectomy and bilateral salpingo-oophorectomy were performed. The postoperative course was unremarkable, and the patient was discharged on tetracycline. A morphologic diagnosis of actinomycotic infection with abscess formation was made. Sections of the left parametrium revealed multiple microabscesses and sinus tracts surrounded by abundant granulation tissue. Some of the abscesses contained actinomycotic organisms. Chronic endometritis and cervicitis as well as acute and chronic left salpingitis were documented.
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PMID:Diagnosis of pelvic actinomycosis by fine needle aspiration. A case report. 620 95

This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology (number of sexual partners, age, IUDs, previous PID, previous gonorrhea, untreated male sexual contacts, and perihepatitis associated with PID); diagnosis (physical examination, laboratory examination, culdocentesis, examination of the male partner, cultures, and ultrasonography); treatment; and sequelae (recurrent PID, infertility, ectopic pregnancy, and pain). The majority of infections are caused by bacteria and a polymicrobial bacterial infection is common. Neisseria gonorrhea, Chlamydia trachomatis, and a wide variety of aerobic and anerobic bacteria are most frequently isolated from women with PID. Primary PID is usually and acute infection in which organisms ascend into the uterus and fallopian tubes from the cervix. Chronic active infections are unusual except in neglected cases and in Actinomyces infection, but sterile chronic inflammatory adhesions are common residuals of acute infection. Except for women who have an IUD in place or the 15% who have had uterine instrumentation, spontaneous PID is almost totally confined to women who are sexually active. There is a much higher PID rate among younger than older women. Women who use an IUD for contraception are at least 2-4 times more likely to develop PID than nonusers. Women who have had PID are twice as likely to develop the infection as those who have never had it. A history of a prior uncomplicated gonococcal infection is more common among women with PID than among women without disease. Untreated males with urethral N. gonorrhea and possibly with C. trachomatis infection are an important source of infection both for the initial and for recurrent episodes of PID. Abdominal pain is the most common symptom although the pain may be mild or even absent in at least 5% of patients with PID verified by laparoscopy. In patients who have overt PID, it is possible to establish the diagnosis with reasonable certainty by a combination of history, physical examination, Gram stain of cervical secretions, culdocentesis, and examination of the male sexual partner. Adequate treatment of salpingitis includes an assessment of the severity of the infection, administration of appropriate antibiotics, employment of other health measures, close patient follow-up, and treatment of the male sexual patner. 25% of women with 1 episode of salpingitis develop a subsequent episode.
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PMID:Acute pelvic inflammatory disease. 636 7


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