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

Case reports are presented on 2 patients to show the importance of following up apparently false positive results of pregnancy tests. In case 1, a 25-year-old woman was admitted to the hospital with severe breathlessness in September 1987. After she had stopped using oral contraceptives (OCs) in 1985 her periods were irregular and on 4 occasions the results of pregnancy tests bought over the counter were positive. She was twice referred for ultrasound examinations, but the uterus was empty each time. In April 1987, dysfunctional uterine bleeding was diagnosed; she was treated with clomiphene. She then experienced intermittent pleuritic chest pain and breathlessness on exertion. In early September she was admitted with acute breathlessness and chest pain. A further pregnancy test was positive; results of laparoscopy of the pelvis were normal. A radioisotope ventilation-perfusion lung scan showed multiple filling defects in the left lung and no perfusion to the right. A presumptive diagnosis of choriocarcinoma was made with the syndrome of tumor growing in the pulmonary arteries. In case 2, a 32-year-old woman was admitted to the hospital in March 1988 with acute lower abdominal pain. A pregnancy test was positive, and she underwent laparoscopy for suspected ectopic pregnancy. A macroscopic tumor was found on the surface of the right ovary and a right salpingo-oophorectomy was performed. A subsequent histological examination showed choriocarcinoma. The 2 cases reported show the importance of seeking a definitive explanation for a false positive result of a pregnancy test. If the test has been performed correctly and proteinuria and drug interference, for instance, are ruled out, then a raised human chorionic gonadotropin concentration, particularly in young women, is virtually certain. In most cases this will be due to a pregnancy that ends in a 1st trimester abortion, but in a small minority it will be due to the hormone producing a tumor such as choriocarcinoma.
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PMID:Don't ignore a positive pregnancy test. 284 5

Chorioangioma of the placenta is an uncommon benign tumor of the placenta. Large tumors are rare and they often cause increased maternal morbidity and fetal morbidity and mortality. A patient with continuous abdominal pain at 29 weeks gestation was clinically diagnosed to have acute polyhydramnios. Multiple pregnancy was suspected because of a tense uterus much larger than the dates and three palpable "fetal poles". An ultrasound examination revealed the third pole to be a large chorioangioma. She went into premature labor and a cesarean section was performed because of a cord presentation. Both mother and infant had an uneventful recovery. The complications of chorioangioma is discussed.
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PMID:Acute polyhydramnios and cord presentation--complication of chorioangioma of the placenta--a case report. 287 72

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

One hundred and forty-one women were planned to be sterilized by the Falope-ring technique after vaginal term delivery. Two pregnancies (1.55%) occurred during an average observation period of 43.2 months. Tearing of the mesosalpinx with bleeding requiring laparotomy occurred in 2 cases, and was the major operative complication seen. In 3 cases, laparotomy was performed because of reduced visual field caused by the enlarged uterus and in 2 cases because of technical problems with maintaining pneumoperitoneum. In 10 patients, hysterosalpingography was performed. In 2 cases leakage was demonstrated and these patients were readmitted to laparoscopic sterilization in the interval phase. One woman was admitted to the hospital with acute lower abdominal pain one year after sterilization; laparotomy showed the salpinx to be twisted three times around the ring. The Falope-ring technique is recommended as a safe, easy and quick method for sterilization in the puerperium.
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PMID:Laparoscopic sterilization with the Falope-ring technique in the puerperium. 294 70

The clinical course of a case of vesicosigmoidal fistula is presented. The patient, a 76-year-old woman, became aware of terminal micturition pain and pollakisuria in February, 1985. She was first treated under the diagnosis of cystitis to be relieved of her subjective symptoms, although there was no improvement of pyuria. She also began to feel lower abdominal pain on April 3, 1985. After various examinations including intravenous pyelography, enteroclysis and cystoscopy the diagnosis of vesicosigmoidal fistula originating from sigmoid diverticulitis was established. Careful observation at operation revealed remarkable adhesion among the sigmoid colon, bladder, uterus and left ovary. The sigmoid colon, was resected followed by end-to-end anastomosis. Because of considerably extensive inflammatory changes over the mucosal membrane of the bladder, the hole of fistula on the vesical wall was simply closed from outside of the bladder without performing partial cystectomy. Histological examination only demonstrated non-specific inflammatory changes without evidence of malignancy. She had a favorable progress postoperatively.
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PMID:[A case of vesicosigmoidal fistula]. 304 80

An 18-year-old mare, 285 days pregnant, was evaluated for apparent abdominal pain of 8 hours' duration. A large volume of sanguinous fluid was obtained on abdominocentesis, and digital vaginal examination revealed a dilated cervix and blood in the uterus. Abdominal palpation per rectum revealed the uterus to be large and distended with fluid. Ultrasonography revealed a dead fetus on the floor of the cranial portion of the abdomen. The mare was euthanatized, and necropsy confirmed that the uterus had ruptured, and that the fetus, within its chorioallantois, was in the abdomen. The amniotic sac contained approximately 96 L of amniotic fluid. Torsion of the amniotic sac separated the fetus from the fluid-filled compartment. Hydramnios was diagnosed on the basis of the excessive amniotic fluid and was believed to be the cause of the uterine rupture.
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PMID:Hydramnios causing uterine rupture in a mare. 305 48

A total of 252 women with amenorrhoea and with abdominal pain or vaginal bleeding, or both, had an emergency high-resolution ultrasound sector scan. In 100 women the symptoms were unrelated to any identifiable abnormal ultrasound finding, none of them was pregnant and their symptoms settled spontaneously; 33 other women had follicular or luteal cysts and 30 had pelvic inflammatory disease. Histological examination confirmed an ectopic pregnancy in 60 women (24%); in seven a live fetus was observed outside the uterus allowing a confident diagnosis of ectopic pregnancy; in 27 the thickness of the endometrium was greater than 10 mm (sensitivity 50%, specificity 84%, positive predictive value 28%, negative predictive value 87%); in 15 the uterine area measurement was less than 20 cm2 (sensitivity 72%, specificity 41%, positive predictive value 20%, negative predictive value 79%); and 43 had an adnexal mass volume greater than 10 ml separate from the ovary (sensitivity 85%, specificity 37%, positive predictive value 23%, negative predictive value 90%). Only three had negative ultrasound findings. The negative predictive value of an ultrasound examination could be increased to 96% by using a combination of these ultrasound features. The addition of hCG (greater than 25 i.u./l) improved the specificity to 98% and the negative predictive value to 100%. These criteria may improve the ultrasound diagnosis of ectopic pregnancy.
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PMID:Can ultrasound reliably diagnose ectopic pregnancy? 306

Appendicitis caused by a misplaced IUD was found in a 29-year-old pregnant woman. The woman had had the device inserted 8 years before. About 5 months after placement and a severe experience of right lower quadrant pain, medical examination revealed that she was pregnant. Abdominal and pelvic X-ray films were thought to be consistent with IUD expulsion, a fairly common occurrence, with an estimated rate of 2-20% within 1 year of placement. Over the next 7 years, the woman continued to experience right lower quadrant pain, but the pain was mild until 20 weeks into her next pregnancy when she was hospitalized with nausea, anorexia, fever, and severe pain. Surgery revealed that her appendix and cecum were bound to an inflamed mass of tissue. During the course of an appendectomy, this tissue mass was found to contain a copper-coated IUD, which was removed by blunt dissection and gentle traction. The IUD had probably partially perforated the uterus on insertion; complete perforation followed in 2-3 months; and copper from the device caused inflammation that eventually involved the appendix. Several months after the appendectomy, it was discovered that the inflammatory mass had been replaced by dense adhesions. This case shows that abdominal and pelvic X-ray examinations may not be sufficient to locate a misplaced IUD in a pregnant woman. If a misplaced device is not clearly visible on X-ray films, further workup may be necessary to avoid the possibility of chronic abdominal pain and complications.
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PMID:IUD appendicitis during pregnancy. 307 60

The effect of misoprostol, a PGE1 methyl analogue, on the pregnant human uterus was unknown at dosage levels normally used in the treatment of gastric and duodenal ulceration. Data from animal fertility and teratology studies suggested no activity at an anti-ulcer dosage level. In a double-blind placebo-controlled study, 300 patients (9.-12. week of gestation) were treated with two doses of misoprostol (study A: 2 X 400 micrograms; study B: 2 X 200 micrograms) or placebo during the evening before a legally permitted termination of first-trimester pregnancy. A partial or complete abortion occurred spontaneously in 11% of patients receiving misoprostol 2 X 400 micrograms, 9% of patients receiving misoprostol 2 X 200 micrograms and none of the patients receiving placebo. The incidence of vaginal bleedings (A: 45%, B: 34%), abdominal pain (A: 42%, B: 43%) and the softening of the cervix were all significantly increased by misoprostol treatment. These results show that the sensitivity of the human pregnant uterus to prostaglandin analogues cannot be reliably predicted from animal studies. Furthermore, misoprostol should not be used in human first-trimester pregnancy. The effect of misoprostol on second and third-trimester pregnancy (e.g. labour induction) is still unknown.
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PMID:[Effect of the PGE1 methyl analog misoprostol on the pregnant uterus in the first trimester]. 311 31

This article describes a case in which tubal torsion occurred as a complication of bipolar electrocoagulation via a laparoscope. The patient, a 37-year old woman who had undergone bipolar electroagulation of her fallopian tubes via a laparoscope 11 months earlier, presented with an acute abdomen. A preoperative diagnosis of torsion of an ovarian cyst was made. The right adnexa, including the entire fallopian tube and ovary, was infarcted and presented as a 10 x 7 x 4 cm mass that had undergone a torsion of 540 degrees. A right salpingo-oophorectomy and a left salpingectomy were performed, and microscopic examination confirmed the gross finding of infarction of the right adnexa and a left hydrosalpinx. Altogether, 14 case of tubal torsion following tubal sterilization have been reported since 1956. Of these, this is the 6th case associated with electrocoagulation. The interval between the sterilization procedure and presentation with torsion has ranged from 5 months to 8 years. Many patients present at the middle of their menstrual cycle. There is generally a history of acute onset of abdominal pain which may be generalized or localized to the lower abdomen or either iliac fossa (most commonly the right). The pain is usually not associated with gastroin estinal symptoms. Unlike acute salpin gitis, there is no fever or leucocytosis in early cases. There are signs of peritoneal irritation in the involved iliac fossa and an adnexal mass can usually be palpated on vaginal examination. Abnormal mobility and an abnormal bulk of tube appear to be required before the fallopian tube will undergo torsion. Increased mobility is caused by severing or at least constricting the attachment of the tube to the uterus. The increased bulk of the tube is produced when secretions from the tube can no longer travel into the uterus, resulting in a hydrosalpinx.
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PMID:Torsion of the fallopian tube following tubal sterilization by electrocoagulation via a laparoscope. 316 Jun 15


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