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

The presentation, diagnosis, and treatment of ectopic pregnancy are reviewed. The current trend in treatment of tubal ectopic pregnancy is toward preservation of reproductive function whenever possible. The incidence of ectopic pregnancy has not increased as much over the past several years as some reports indicate; the discrepancy is due to bias introduced by excluding numbers of abortions from the denominators. Pelvic inflammatory disease (PID) is the principal etiologic factor in ectopic pregnancy, and Neisseria gonorrhoeae is the causative agent in most primary tubal infection. Patients with previous abdominal surgery, a history of PID, or who use IUDs have more ectopic pregnancies. The clinical presentation of ectopic pregnancy is variable, and women may be asymptomatic. Any sexually active woman with abnormal bleeding, abdominal pain, or an adnexal mass should be examined immediately to rule out ectopic pregnancy. Culdocentesis may be used to determine whether intraperitoneal hemorrhage is present. The beta human chorionic gonadotropin (hCG) radioimmunoassay is unsurpassed as an endocrine test for diagnosis of ectopic pregnancy, but is time consuming. Diagnostic laparoscopy should not be postponed if a ruptured ectopic gestation is suspected. Ultrasound identification of an intrauterine gestational sac and a serum concentration of beta hCG that exceeds 6500 IU/1 rules out ectopic pregnancy. A sonographically normal uterus and a serum concentration of beta hCG that does not exceed 6500 IU/1 is highly indicative of ectopic pregnancy. Diagnostic laparoscopy to confirm the presence of tubal pregnancy has become routine since technical improvements restored interest in the laparoscope in the early 1960s. Early diagnosis is crucial for preservation of fertility. When a tubal pregnancy is diagnosed, the physician must choose a radical or conservative approach based on the patient's immediate medical condition and desire for future fertility as well as the surgeon's experience. Salpingectomy is the procedure of choice if a fallopian tube is irreparably damaged or if there is a hemoperitoneum associated with shock or profuse bleeding. Rigorous cornual resection is not recommended because it does not exclude a subsequent interstitial pregnancy and may also weaken the myometrium. Colpotomy is rarely indicated, and the removal of a normally functioning ipsilateral ovary is unwarranted. If a conservative approach is feasible, salpingostomy and closure by secondary intention is preferred over salpingotomy and primary closure, which may be complicated by bleeding and edema. Fimbrial evacuation is the easiest procedure but has the highest number of undesirable effects. Midsegment anastomosis, tubouterine implantation, and the Gepfert procedure are either controversial or are associated with poor prognoses. Of all conservative procedures, only salpingostomy offers better results in term pregnancy rates than the radical operations. Salpingectomy is the most efficient treatment for tubal gestation if the patient does not desire future fertility.
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PMID:Ectopic pregnancy. 241 Jan 72

The sudden drop of circulating estrogen in the premenopausal phase causes somatic and psychosomatic symptoms in women around the age of 40, which necessitates hormonal substitution and also reliable contraception because of the risk of pregnancy owing to irregular cycles. At this age the risks of pregnancy-related thrombosis, hypertension, and diabetes, perinatal mortality congenital anomalies, and maternal mortality are higher. Only 6.3-7.3% of women giving birth are over 35 years of age in Austria, but still 26% of women having an abortion are 36 years old or older. The rate of conception ranges between 2% and 5%, and when it falls below 1%, contraception is no longer necessary (around age 45-49). The IUD is acceptable and safe, and pelvic inflammatory disease does not play a significant role at this age. The most frequent side effects are spotting, hypermenorrhea, lower abdominal pain, and difficulties with intercourse. The introduction of micropills with an ethinyl estradiol dose of under 50 mcg and several agents, such as desogestrel, gestoden, and norgestimate, has made it possible to use them over the age of 40, provided no risk factors, such as metabolic disorders or smoking, are present. However, prior determination of lipid status is required. Sterilization is a final form of contraception when an increase of family size is no longer desired; whether the husband or the wife should be sterilized also poses a question. For female sterilization laparoscopy is used almost exclusively with bipolar diathermy, thermocoagulation, or binding with clips or rings. Hysterectomy is recommended in the case of myomatous uterus with cycle irregularities and hypermenorrhea. The condom, the diaphragm, or the natural temperature, Billings, or symptothermal methods have much higher failure rates. The physician has to advise women about the most suitable method.
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PMID:[Contraception and the climacteric]. 262 31

The relative frequencies of various sonographic patterns and features of pelvic inflammatory disease (PID) were examined in retrospective analyses of sonograms in 36 proven cases. The original sonographic reports correctly predicted PID in 34/36 patients (sensitivity = 94.4%). Two cases were found to be tubo-ovarian abscess although at first they were reported to be ovarian neoplasia. The most frequent finding was dilatation of the fallopian tube (72.2%). String sign within the dilated tube that would reflect increased interface within the endosalpinx was found in 50.0%, fluid collection in the Douglas' pouch in 47.2%, which was confirmed by the culdocentesis and aspiration in 16 cases, and/or tumor formation at the adnexal region in 38.9%. These findings were characteristic but not specific in PID. Careful sonographic scrutinization should improve the diagnostic accuracy of PID in patients with low abdominal pain, high temperature and low back pain.
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PMID:Ultrasonographic evaluation of pelvic inflammatory disease. 267 71

To investigate further the apparent increase in the incidence of ectopic ovarian pregnancy and its possible association with IUD use, the 7 such pregnancies recorded in the authors' Barcelona hospital practice in 1976-86 were reviewed. During this period, ectopic pregnancies accounted for 1 of every 141 deliveries, which ectopic ovarian pregnancies represented 1 in every 18 ectopic pregnancies. 6 of the 7 ectopic ovarian pregnancies occurred in recent years: 1 in 1984, 2 in 1985, and 3 in 1986. The patients' mean age was 31 years (range, 28-33 years). All cases displayed both ovarian and trophoblastic tissue within the same microscopic field, while the macroscopic appearance of the homolateral tube was normal. The clinical symptoms (predominantly abdominal pain and menstrual disturbances) and physical examination results (the presence of an adnexal mass and pain at the level of the Douglas pouch) in women with ovarian pregnancies did not differ from those in women with ectopic pregnancies. Echography was highly accurate in the detection and localization of early ovarian pregnancies. 2 of the risk factors considered--pelvic inflammatory disease and previous abdominal surgery--were not present in this series of 7 cases; a 3rd-- endometriosis--was reported in 1 case, making this the most apparent risk factor.
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PMID:Increasing incidence of ovarian pregnancy. 278 61

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

We compared the clinical and epidemiological characteristics of 89 women with pelvic inflammatory disease (PID) seen at a clinic for sexually transmitted diseases during 1982 and 1983. Patients were classified into four groups by having endocervical cultures positive for Neisseria gonorrhoeae only (24), Chlamydia trachomatis only (16), both organisms (14), or neither organism (35). More women with cultures positive for N gonorrhoeae were black (p less than 0.005), had a sexual partner with gonorrhoea (p less than 0.005), and had a purulent vaginal discharge (p less than 0.05). No other significant differences were found between groups regarding age, exposure to a sexual partner with non-gonococcal urethritis, history of trichomoniasis, parity, use of antibiotics, contraceptive history, duration of abdominal pain, relation of pain to the phase of the menstrual cycle, abdominal rebound tenderness, reproductive tract signs, or febrility. In women presenting to outpatient clinics, PID tends to be mild and the diagnosis unreliable. Though C trachomatis is emerging as an important aetiological agent, we found no clinical indicators that could distinguish chlamydial from gonococcal PID.
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PMID:Comparison of clinical and epidemiological characteristics of pelvic inflammatory disease classified by endocervical cultures of Neisseria gonorrhoeae and Chlamydia trachomatis. 308 8

Diagnosis of the cause of lower abdominal pain in women may be difficult because appendicitis and pelvic inflammatory disease often present similarly. In a prospective study of 118 women, we found that several criteria are useful in establishing this differential. These include (1) duration of symptoms, (2) the presence of nausea, vomiting or both, (3) a history of venereal disease, (4) cervical motion tenderness, (5) adnexal tenderness, and (6) isolated peritoneal signs in the right lower quadrant. Although no single finding can define the diagnosis, the history and physical findings reported herein provide a number of criteria which, when taken together, will usually allow a confident diagnosis of either appendicitis or pelvic inflammatory disease to be made. Attention to these items can improve precision in diagnosis and lessen the incidence of unnecessary laparotomy, which carries a well-documented complication rate of 10 to 20 percent.
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PMID:Differential diagnosis of appendicitis and pelvic inflammatory disease. A prospective analysis. 316 Feb 52

Sixty-three women with abdominal pain and adnexal tenderness were enrolled in a study of ambulatory treatment of acute pelvic inflammatory disease. Treatment consisted of 2 g of cefoxitin intramuscularly and 1 g of probenecid orally, followed by doxycycline, 100 mg by mouth twice daily for 14 days. Patients were stratified into groups indicating whether pelvic inflammatory disease was probable, possible, or unlikely, based upon endometrial biopsy and clinical criteria. Among 52 women who were evaluated, Chlamydia trachomatis and/or Neisseria gonorrhoeae were initially recovered from 16 (67%) of 24 with probable pelvic inflammatory disease, three (33%) of 11 with possible pelvic inflammatory disease, and three (18%) of 17 in whom pelvic inflammatory disease was considered unlikely. Of the 24 patients with probable pelvic inflammatory disease, 22 (92%) were clinically cured or improved. Of 22 patients initially infected with C trachomatis and/or N gonorrhoeae, 20 were culture-negative for both organisms after therapy. Both microbiologic failures had been reexposed. This study suggests that the combination of cefoxitin and doxycycline is effective for ambulatory treatment of pelvic inflammatory disease.
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PMID:Outpatient treatment of pelvic inflammatory disease with cefoxitin and doxycycline. 335 51

Disorders of urachal remnants are uncommon. While a urachal cyst usually is asymptomatic, infection may mimic a variety of acute intra-abdominal or pelvic processes. We describe 10 patients in 2 distinct age groups (the young child and the young adult) with an infected urachal cyst. The presenting symptoms and signs in most patients included dysuria, severe lower abdominal pain and fever. In 7 patients the correct preoperative diagnosis was made. Diagnoses at referral included Crohn's disease, bladder carcinoma and pelvic inflammatory disease. A single procedure was performed in 7 cases and a staged technique was used in 3. The differential diagnosis of acute abdominal and pelvic pain or a midline lower abdominal mass in the pediatric or young adult age group should include infection of a urachal remnant.
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PMID:Infected urachal cysts: a review of 10 cases. 339 41

Ultrasonically guided transvesical oocyte aspiration is a safe and efficient method in most in vitro fertilization (IVF) units. It entails very rare severe complications, even though transvesical punctures performed may unintentionally pierce the bowel or even major blood vessels. Nevertheless, mild complications are rarely noted and reported. During a 9-month period 140 ovum pickups were performed: 102 by transabdominal ultrasound-guided puncture and 38 by means of laparoscopy. In the former group, abdominal pain (11.6%), exacerbation of previous pelvic inflammatory disease (2.9%), mild hemoperitoneum (2.9%), urinary tract infections (5.8%) and transient macroscopic hematuria (5.8%) occurred following the procedure. In the latter group, abdominal pain followed in 7.8%; no urinary tract complications were noted in women undergoing laparoscopic ovum aspiration. In spite of the fact that ultrasonically guided transvesical oocyte collection is an atraumatic method with rare complications, they should be reported in order to draw attention to their not-so-rare occurrence and with the aim of their prevention.
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PMID:Abdominal complications following ultrasonically guided percutaneous transvesical collection of oocytes for in vitro fertilization. 343 15


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