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Query: UMLS:C0000737 (abdominal pain)
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Paired sera from 60 consecutive patients with acute salpingitis, confirmed by laparoscopy, were examined for serum antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae. By a microimmunofluorescence (MIF) test IgM or IgG antibodies to C trachomatis or both were present in sera from 80% of the patients' by indirect haemagglutination (IHA) tests antibodies to M hominis and N gonorrhoeae pilar antigens were present in 40% and 18% respectively. In a control group of 50 pregnant women antibodies to the same three organisms occurred in 8%, 8%, and 6%. Evidence of current chlamydial infection was found in 35 (58%) and of current gonococcal infection in five (8%) of the 60 patients by culture or serological tests or both. The results of chlamydial antibody tests correlated with the severity of the tubal inflammation (as shown by laparoscopy) and the duration of the lower abdominal pain before attendance. The predictive values of a positive and a negative MIF test result were 44% and 83% respectively and of the IHA gonococcal antibody test 36% and 100% respectively. Significant rises in titre of antibodies to M hominis were found in 12% of patients. A four-fold or greater rise in titre indicated probable double infections with chlamydia and mycoplasmas in 7% of patients. Thus, at present gonococcal salpingitis appears to form only a small proportion of all cases of salpingitis in southern Sweden, and in patients with nongonococcal salpingitis infections with C trachomatis and M hominis commonly occur.
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PMID:Antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae in sera from patients with acute salpingitis. 678 61

Acute salpingitis is an important complication of sexually transmitted disease in young women and should be considered in the differential diagnosis of abdominal pain in all young women. Many organisms, in addition to N. gonorrhoeae, have been associated with this tubal infection giving support to polymicrobial etiology. However, the exact pathophysiologic role of these organisms needs to be clearly defined. The microbiology of acute salpingitis, through direct culture from the site of infection, the fallopian tubes, needs to be clearly elucidated. Early recognition and treatment of acute salpingitis is essential in preventing the major long-term problem, involuntary infertility. Curran has estimated the reproductive outcome for a cohort of adolescent women reaching reproductive age in 1970. By the year 2000, there will have been one episode of salpingitis for every two women; 15% will be hospitalized for salpingitis with over half of these women requiring major gynecologic surgery; 10% will be rendered nonsurgically sterile; and 3% will have experienced an ectopic pregnancy. Adolescent females may be more susceptible to upper genital tract infection than older women due to possible unique biologic characteristics and sexual behaviors. Prospective microbiologically controlled studies of women with salpingitis using laparoscopy need to be developed to evaluate treatment regimens. Until such studies are undertaken, diagnosis, treatment, and fertility in women with acute salpingitis will remain unsatisfactory.
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PMID:Acute salpingitis in the adolescent female. 703 72

In the five-year period 1974 to 1978, there were 23,256 deliveries and 204 ectopic pregnancies at Fairfax Hospital. Forty-six patients (22.5%) had had previous pelvic surgery, including 14 salpingectomies for previous ectopic pregnancies. Only 27 patients (13.2%) had a history of salpingitis, but chronic salpingitis was evident in 91 patients (44.6%). Twenty-one patients (10.3%) had an IUD in situ at the time of diagnosis. Presenting symptoms included abdominal pain (95.1%), amenorrhea (73.7%), and abnormal uterine bleeding (63.7%). Abdominal pain (91.2%) and adnexal tenderness (94.6%) were the common pelvic findings. The correct diagnosis was made on admission in 77.5% of cases. Culdocenteses and pregnancy tests were positive in 82.4% and 81.2% of patients, respectively. Unilateral salpingectomy was the primary operative procedure in 78% of patients. Postoperative morbidity was limited almost exclusively to nonspecific fever (41.2%) and urinary tract infection (9.3%).
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PMID:Ectopic pregnancy: a five-year experience. 740 9

Teso District in eastern Uganda with low fertility (crude birth rate in 1969 was 37/1000), and Ankole District in western Uganda with high fertility (55/1000), were selected to study malaria, nutrition, gonorrhea, and syphilis. The gonorrhea methodology for women included genital examination and endocervical smears and cultures. Husbands of gonococcal-negative fertile and infertile women also were examined for the presence of gonorrhea and evidence of infection in the past. Three hundred and forty-three women in Teso and 250 in Ankole underwent medical examination. In the Teso District, 84 (25%) of the women, as compared with 22 (8.9%) in Ankole, complained of lower abdominal pain (p 0.001). Seven women in Teso but none in Ankole had signs of bartholinitis. Mucopurulent discharge in the vagina was found in 56 (19%) of the Teso women as compared with 17 (10%) of the Ankole women (p 0.02). 90 (30.5%) of the women in Teso but only 21 (12.5%) women in Ankole had an eroded and/or infected cervix (p 0.001). Evidence of salpingitis was obtained in 56 (19%) of the Teso women as compared with 10 (5.9%) Ankole women (p 0.001). A tender adnexal mass was felt in 23 (7.8%) of the Teso sample but in only one (0.6%) in Ankole. Among the women in Teso, 54 (18.3%) had a positive cervical smear or culture for gonorrhea, but only four (2.4%) in Ankole had similar positive tests (p 0.001). Evidence of pelvic inflammatory disease was present in 17% of the infected Teso women. None of the infected Ankole women, however, had PID. Cervical secretions showed gonococci in only 10% of the infertile women as compared with 23% of the fertile women. However, 24.5% of husbands of the gonococcal-negative infertile women, as compared with 6.7% of husbands of the gonococcal-negative fertile women, were found to have active gonorrhea (p 0.01). In this group 75.5%, and 57.7% of husbands, respectively, had a past history of urethral discharge (p 0.05), while 18.4% and 5.8%, respectively, had bilaterally thickened epididymides (p 0.05).
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PMID:Gonorrhea and female infertility in rural Uganda. 746 80

A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness. She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out. The culture of the endocervix was positive for Neisseria gonorrhoeae. Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy. The patient was placed on intravenous antibiotics. Postoperative course was unremarkable, and the patient was discharged on oral antibiotics. Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive. Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester. Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy. Fetal wastage seems to be significant in spite of aggressive management. Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results. The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.
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PMID:Acute suppurative salpingitis with concomitant intrauterine pregnancy. 836 86

In September 1993 a 43-year-old female patient with cancer underwent left mastectomy followed by immediate reconstruction. 6 days passed without problems, but then she presented at the emergency ward with abundant exudation of serous material from the cicatrices. Microbiological test showed evidence of Staphylococcus epidermitis. Drainage of the skin and smooth muscle was performed and the secretion was immediately reduced and seemed to disappear in a short time. In the next 3 days fever arose accompanied by abdominal pain. Blood test showed leucocytosis (24,500 GB), increase of the suppressor lymphocytes (CD8) and the reduction of CD4/CD8 ratio. Abdominal-pelvic echogram showed evidence of an enlarged right adnexum as well as that of the homolateral tube, but no discharge of fluid in the pelvic cavity. Gynecological examination in this patient, who had worn an IUD two months prior, excluded lesions in the portio or vagina and the vaginal flora did not show fungi or parasites. Diagnostic laparoscopy followed, which demonstrated in the pelvic cavity a large para-uterine tumefaction. The pelvic organs were adhering to the parietal layer of the peritoneum and in the whole peritoneal cavity, including the interhepatic-diaphragmatic space, fibrin plaque and pus was observed. Laparotomy was performed, which confirmed a parauterine mass and a tubo-ovarian complex with numerous recesses containing fetid, grayish pus. Complete right adnexectomy was carried out with abundant lavage and multiple drainage of the peritoneal cavity. Subsequently, the abdominal situation improved, but a new examination of drained liquid showed the presence of cutaneous bacterial flora but no fungi or parasites. Ovarian actinomycotic abscess with acute peritonitis and salpingitis was demonstrated. Subsequent antibiotic therapy consisted of piperacilline for 15 days, and 4 months after the episode the patient was well without return of the foci of infection.
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PMID:[A rare case of primary abdominal actinomycosis]. 908 36

Endometritis are upper genital tract infections. They are part of the Pelvic Inflammatory Diseases and are often difficult to differentiate from salpingitis. C. trachomatis, a sexually transmitted micro-organism, is a major pathogen of the genital tract. Most of the time, the upper genital tract infections are polymicrobial and C. trachomatis can be combined with other aerobes (E. coli, streptococci...) and anaerobes. Diagnosis of chlamydial endometritis is difficult since the clinical symptoms--lower abdominal pain, cervical discharge--often lack specificity or can be completely absent. Bacteriological studies from intra-uterine or intra-cervical samples are necessary. A laparoscopy can be useful to ascertain the integrity of Fallopian tubes. The treatment requires broad spectrum antibiotics effective against C. trachomatis and other probable pathogens, for 2 to 3 weeks.
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PMID:[Chlamydia trachomatis endometritis]. 981 Jan 39

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.
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PMID:Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women. 1018 53

The diagnosis of salpingitis based solely on clinical criteria is inaccurate, with both low specificity and sensitivity. Laparoscopy has therefore become a valuable diagnostic tool in clinical practice and essential in clinical research on salpingitis. Different types of evidence indicate that atypical salpingitis without abdominal pain and discrete or absent symptoms is a common etiology of tubal factor infertility. A low threshold for suspecting salpingitis has been recommended to augment the sensitivity of clinical diagnosis. This leads to lower specificity and thereby a greater number of false positive diagnoses and unnecessary antibiotic treatment. Outpatient biopsy from the endometrium for histopathology and chlamydia testing might augment the specificity in cases with discrete symptoms, and should be investigated further. The sensitivity of laparoscopy is low for endosalpingitis without affection of the serosa, and might be augmented by using minibiopsies and chlamydia PCR from the tubal mucosa. The most significant measure toward reducing the sequelae of salpingitis is the combatting of chlamydia infection through screening programs and qualified partner management.
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PMID:[Silent salpingitis. Does it exist?]. 1140

Salmonella spp. infections can be particularly challenging when they manifest as acute abdominal problems and lead to emergency surgery. Examples of such serious conditions are Salmonella-related intestinal perforation, gallbladder involvement, salpingitis, and peritonitis. Mesenteric lymphadenitis associated with Salmonella typhimurium mimics acute appendicitis and can make it difficult to establish a timely and definitive diagnosis in young patients who present with right lower abdominal pain. Paralytic ileus is a fairly common manifestation of Salmonella infection at all ages, but complete intestinal obstruction requiring surgical intervention is very rare. Because of the nature of the diagnostic process, a significant number of patients with Salmonella infection present with acute abdomen and undergo needless operations. This report describes the cases of 2 pediatric patients who underwent surgery to address persistent pain in the right lower abdominal quadrant and complete intestinal obstruction, respectively. The first patient had inflamed mesenteric lymph nodes that caused appendicitislike symptoms, and the second had dense adhesions between the mesentery and the terminal segments of the ileum that led to intestinal blockage. Serology results showed that both patients' titers for BO ("B and O agglutinating [BO]") antibodies rose to 1:640 in the week after their admission to hospital, a pattern and level that is indicative of S typhimurium infection. J Pediatr Surg 36:1849-1852.
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PMID:Acute abdomen caused by Salmonella typhimurium infection in children. 1173 22


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