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

A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.
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PMID:Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease. 2 3

A total of 415 women treated for laparoscopically verified pelvic inflammatory disease (PID) were reviewed after 9.5 years. Of these, 88 (21.2 per cent) were involuntarily childless after one or more infection; in 72 cases (17.3 per cent) this was due to tubal obstruction; 263 (63.4 per cent) women became pregnant; 64 (15.4 per cent) were voluntarily childless. Tubal occlusion was diagnosed after one infection in 12.8 per cent, after two infections in 35.5 per cent, and after three or more infections in 75 per cent of the women. Tubal occlusion was more common after nongonorrheal than after gonorrheal salpingitis. Infertility varied with the inflammatory changes seen at laparoscopy. The ratio between ectopic and intrauterine pregnancies after the infections was 1/24. Chronic abdominal pain was reported by 18.1 per cent of the women. Corresponding findings in 100 healthy control subjects were: involuntary childlessness in three despite normal Fallopian tubes, one ectopic in 147 intrauterine pregnancies, and chronic abdominal pain in five cases.
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PMID:Effect of acute pelvic inflammatory disease on fertility. 12 23

313 patients with ectopic pregnancy were treated at Chicago Lying-In Hospital in 1968-1975, for a frequency of 1 in 72 deliveries. Historical and physical findings, diagnostic procedures, causative factors, and patient management were reviewed for 284 of these patients. 97.5% of the pregnancies were tubal. 25% of the patients were nulliparas and 31.7% were primiparas. 34.9% had had 1 or more previous abortions. The mean age of the patients was 28. Most had been using no contraception, and only 3.9% had an IUD in situ. The most common symptoms were abdominal pain (96.7%) and amenorrhea (73.6%), while the most frequent abdominal findings were tenderness (83.4%), rebound pain (41.2%), and guarding (28.9%). Adnexal tenderness was found in 72.2% and 30% had distinct adnexal masses. An initial misdiagnosis of pelvic inflammatory disease was made in 132 (46.5%) cases. A culdocentesis and slide latex agglutination inhibition pregnancy test performed in 167 and 102 patients, respectively, gave 82.6 and 73.5% positive rates. Diagnostic laparoscopy was used routinely after 1970 on all nonacute patients in whom ectopic pregnancy was suspected, and this led to a significant drop in the rate of ruptured pregnancies (63% pre-1970 and 45% post-1970). 25% of patients were sterilized, but the treatment of choice was salpingectomy unless the opposite tube was absent or damaged. Gross evidence of pelvic inflammatory disease was noted in 36% of patients and 31% had salpingitis. The most common postoperative complication was fever (42.2%). 3 deaths occurred in the series (2 due to acute pulmonary edema resulting from fluid overload), for a maternal death rate from ectopic gestation of 13.83/100,000 live births. No fetuses survived.
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PMID:Ectopic pregnancy. An eight-year review. 43 84

Three case histories of patients who were treated for gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome) are reviewed. The incidence rate of this disease process is believed to be increasing, and a surgical consultation is often asked for in the evaluation of these individuals. The diagnosis of FHCS requires a high index of suspicion. However, if a patient has signs and symptoms of acute cholecystitis plus the recent onset of a purulent genitourinary infection, the diagnosis of FHCS is suggested. Confirmation of this diagnosis is obtained with the culturing of N. gonorrheae from urethral or cervical secretions. The clinical presentation may vary from a moderately symptomatic to an acutely ill individual. Most commonly there is an abrupt onset of sharp right upper quadrant pain. The finding of any degree of lower abdominal or pelvic tenderness in addition to the upper abdominal pain, should make one highly suspicious of pelvic inflammatory disease and concommitant FHCS. Although no deaths have been reported from this syndrome, it is important to make a prompt clinical diagnosis and commence appropriate antibiotic therapy. The currently recommended therapeutic regimen is procaine penicillin, 1,200,000 U, twice a day for 10 days.
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PMID:Gonococcal perihepatitis (the Fitz-Hugh-Curtis syndrome): a diagnostic dilemma. 45 27

Within a 1 year period, 3 patients presenting to the University of Chicago, Chicago Lying-In Hospital with a complaint of lower abdominal pain were diagnosed at laparotomy to have ovarian pregnancies according to the criteria of Spiegelberg. All of the patients were at the time using the Copper 7 IUD for contraception. There are now 50 known cases of ovarian pregnancies in patients using the IUD. The characteristics of these patients do not differ markedly from those previously reported in studies of tubal pregnancies, with and without the IUD, but the presentation of patients tends to be more variable than in tubal pregnancies. 2 factors appear consistently in the studies on IUD-associated pregnancy. 95.3% of the patients presented with abdominal pain and 87% of the patients had positive pregnancy tests. The latter factor may indicate that the ovary may be better able to incorporate trophoblastic tissue than the fallopian tube. The increasing incidence noted here, in a population already known to be particularly prone to pelvic inflammatory disease and therefore ectopic pregnancies in general, lends further credence to a questioning of the desirability of the IUD in such a population.
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PMID:The intrauterine device and ovarian pregnancy. 45 28

The efficacy of intravenous cephalothin was studied prospectively in 20 patients with acute pelvic inflammatory disease, all of whom presented with lower abdominal pain, cervical and adnexal tenderness, fever, and leukocytosis. Blood, cervical, and cul-de-sac cultures were obtained on admission. The latter was transported anaerobically and inoculated in routine and prereduced medium. Transgrow medium with trimethoprim was used for endocervical cultures. Neisseria gonorrhoeae was isolated from the endocervix in 15 patients and from the cul-de-sac in four patients. All received intravenous cephalothin, 2 gm every four hours for seven days. Clinical improvement was observed in 48 to 78 hours. The cervical cultures were negative for N. gonorrhoeae after 48 hours, at the completion of treatment, and two weeks post-treatment. The drug was well tolerated. It was concluded that cephalothin intravenously is an acceptable alternative antibiotic for the treatment of gonococcal pelvic infection.
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PMID:Parenteral cephalothin therapy for pelvic gonococcal infections. 63 81

The case of a 31-year-old female patient with 2 children who was sterilized 7 years ago at age 24 years and has a 3-year history of low bilateral abdominal pain is discussed. The patient was investigated at the surgical outpatient department and has been recommended to a gynecologist. The symptoms lack suggestion of gynecological disease. Some of the questions to be asked are why she was sterilized, why not her husband, and what method was used. Were there any complications in sterilization operations 7 years ago that resulted in abdominal pain? Whoever takes on the case should question what the quality of the woman's life was before the operation and how it has since changed. It would be helpful to know if she would have liked a 3rd child and if her sexual feelings have changed. At the time she was sterilized, it was unusual for a woman to be sterilized at the age of 24 years with 2 children. There were probably strong medical or psychiatric indications then. One suspects either tubal disease after sterilization or chronic pelvic inflammatory disease as the likely diagnosis. If it becomes apparent that she wants another baby perhaps tubal reanastomosis could be accomplished.
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PMID:Clinics in general practice. A case for the gynaecologist? 87 74

A survey of all women between the ages of 15-50 who underwent laparotomy at the Women's Hospital, Liverpool, from January 1970 to December 1974, was performed to identify etiological factors in ectopic pregnancy. There were 49 ectopic pregnancies during this peirod. The majority of patients were 30-35 years of age (20), 16 were in the 25-29 group. 63.3% had a previous viable pregnancy, 16.3% had a previous abortion, and 3 patients had a previous ectopic pregnancy. The major sysmptoms were vaginal bleeding followed by abdominal pain. Only 16.3% gave a history of previous pelvic infection. However, 53.5% were found to have evidence of previous pelvic infection. 4 patients. Results indicate that pelvic inflammatory disease is still the greatest cause of ectopic pregancy.
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PMID:Ectopic pregnancy: a five year review. 95

Pelvic inflammatory disease (PID) is a syndrome unrelated to pregnancy or surgery and characterized by lower abdominal pain and tenderness, cervical motion tenderness, and adnexal tenderness. Fever, leukocytosis, and the results of laboratory tests are used to support the diagnosis. Participants in clinical trials should be stratified into two groups: those with and those without tubo-ovarian abscess--i.e., those with complicated and those with uncomplicated PID. Diagnostic studies and treatment should be directed at four major groups of pathogens: Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and facultative bacteria such as Escherichia coli. Women requiring hospitalization should generally be treated as inpatients for at least 4-7 days; outpatient therapy should then be instituted to complete a 14- to 21-day course. Clinical and laboratory evaluations should be conducted daily during hospitalization and both 2-4 days and 2-4 weeks after the completion of therapy.
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PMID:Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease. Infectious Diseases Society of America and the Food and Drug Administration. 147 52

In Ohio, a 33-year old woman who had never had an ectopic pregnancy presented at an emergency facility not physically attached to a hospital with abdominal pain over 24 hours which had become more intense during the preceding 4 hours. She did not have vaginal bleeding, diarrhea, vomiting, or pain while urinating. 2 weeks earlier she had a voluntary intrauterine abortion at 8 weeks' gestation. She had intercourse 1 week before coming to the emergency facility. She had widespread tenderness in her abdomen, especially in the lower areas. Blood cell studies suggested an infection. The attending physician presumed her to have pelvic inflammatory disease (PID) as a result of either sexual intercourse or the elective abortion. The physician called for a urinary beta human chorionic gonadotropin test to determine whether placental tissue remained in the uterus. It was positive. 60 minutes after admission, the supine patient's pain increased and her blood pressure dropped to 80/50 mm Hg from 100/60 mm Hg at admission. After administering Ringer's solution, the health team sat her up and she fainted. A repeat cell count indicated sepsis. Her blood pressure decreased to 60 by Doppler and the physician continued to give her fluids and began dopamine. After the team stabilized her, they transferred her to a hospital. Her private physician examined her and then began surgery. The physician found a tubal pregnancy and removed the affected tube and ovary. She recuperated completely. Combined intrauterine and extrauterine pregnancy occurs once in every 30,000 cases. Previous PID, use of ovulation inducing medication, and in vitro fertilization with embryo transfer increases the likelihood of this type of pregnancy occurring. Physicians should consider this possibility if a woman has any of these histories and a combination of abdominal pain, adnexal mass with pain and tenderness, peritoneal irritation, and an enlarged uterus.
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PMID:Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion. 157 Sep 21


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