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

Abdominal pregnancy is such an unusual form of ectopic gestation that the diagnosis is often missed or delayed. We report three cases, each with a different clinical presentation. A careful history and evaluation in the Emergency Department (ED), along with liberal and timely use of ultrasonography, are critical for prompt diagnosis and treatment. Features such as abdominal pain inconsistent with a previous presumptive diagnosis, or repeated ED visits, in a patient with a positive beta-HCG test, are suggestive of this diagnosis.
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PMID:Abdominal gestation. 777 90

Sterilization by tubal occlusive methods is not always successful. This fact is not, however, well recognized among general surgeons. When failures occur, ectopic pregnancy is the usual outcome, most commonly in the Fallopian tube. Ectopic pregnancy has a reported mortality of approximately 3.5/1000, with the majority of deaths associated with delay in diagnosis. The failure to consider this possibility of ectopic pregnancy after tubal ligation when female patients present with right-sided abdominal pain causes health personnel to commonly misdiagnose the condition of appendicitis. A 26 year old woman presented to the Accident and Emergency Department of the Royal Hobart Hospital with lower abdominal pain mainly in the right iliac fossa. Pain was intermittent for two weeks prior to presentation. On the morning of presentation, the pain became severe and was exacerbated by coughing and movements. The patient was nauseated, but had not vomited; there was neither fever nor rigors. Four years earlier, in England, the patient had undergone elective laparoscopic sterilization. Sexually active, she believed that she was menstruating at the time of presentation, especially since her last menstruation occurred four weeks previously. The patient was noted upon examination to have a "grey look," pulse rate of 80 beats/minute, blood pressure of 120/80 mmHg, and a generally tender abdomen, maximally in the right iliac fossa. There were no bowel sounds and rectal examination proved to be extremely painful in all directions. The accident and emergency staff took blood for a full blood count, serum human chorionic gonadotrophin, and arranged surgical consultation. The surgical diagnosis was for acute appendicitis and the patient was transferred to the operating theater for appendectomy. Just prior to anesthetic induction, the pathology results became available, indicating a hemoglobin of 10.3 g/dl and a positive serum HCG. The diagnosis was thus revised to ruptured ectopic pregnancy and laparotomy was performed through a Pfannenstiel incision. 1000 ml of blood was removed from the peritoneal cavity, a ruptured tubal pregnancy was found in the right distal tube, and the appendix was normal. A right salpingo-oophorectomy was performed after which the patient recovered uneventfully and was discharged five days postoperatively. Histopathology confirmed a ruptured ectopic gestation.
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PMID:Misdiagnosis of appendicitis in tubally sterilized women. 846 65

A total of 59 female patients with suspected extrauterine pregnancy were admitted to the Department of Gynecology and Obstetrics of Zabok General Hospital from January 1, 1990 to December 31, 1994. The incidence of extrauterine pregnancies is 1.3% with regard to a total number of deliveries. Dominant clinical symptoms were amenorrhea, abdominal pain and abnormal bleeding from the uterus. Seven (14%) patients developed hemorrhagic shock. Resuscitation had not postponed the surgical procedure. The average value of serum beta HCG was 1700 IU/L. Amenorrhea was from 6-12 weeks. The age of patients ranged from 20 to 40 years. Seven (14%) patients had intrauterine device. There were 14 (27%) nulliparas, 15 (29%) primiparas, 20 (39%) secundiparas and two (4%) women had three pregnancies. The evaluation included ultrasound of the abdomen in 22 (37%) patients, culdocentesis in 31 (53%) of which 4 (13%) procedures were negative punctures. Laparoscopy was performed in 15 (25%) patients and exploration of the uterus in 36 (61%). Pathohistological finding of decidua was seen in 19 (53%) patients, Arias-Stella reaction in 3 (8%) and histological finding of the endometrium in secretion was obtained in 14 (39%) patients. Laparotomy was done in 44 (75%) patients; adnexectomy in 23 (39%), salpingectomy in 30 (51%), and expression of the ovum in 3 (5%). One patient underwent laparoscopic administration of carboprost. Postoperative course was uneventful. Ectopic pregnancy is still the cause of 10% of the maternal deaths and is the leading cause of deaths in the first trimester of pregnancy of which more than 80% of deaths are due to massive hemorrhage. We have emphasized that efforts should be made to improve the diagnosis and, thus, the treatment.
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PMID:[Hemorrhagic shock--an emergency in extrauterine pregnancy]. 864 49

Ectopic pregnancy (EP) is becoming a more and more frequent problem in many developed countries, but the cause of such increase is not fully understood. Improved diagnosis certainly explains part of it, but also the changing lifestyle and sexual habits might play an important role. During the years 1990-1993, 56 women were admitted into the Divisione di Ostetricia e Ginecologia of the Istituto per l'Infanzia of Trieste because of EP diagnosed on the basis of clinical history and signs, transvaginal echography and serum HCG levels. 33 of them underwent surgical operation for the presence of severe abdominal pain, hemoperitoneum greater than 50 cc, and increases HCG level. The other 23 women were treated conservatively. Taking into account the approximate date of conception both for ectopic and other pregnancies, the monthly incidence of EP was computed and showed a statistically significant peak during the summer period (14.4%) compared to the other periods (6%). The increased frequency of EP among pregnancies started during the warmer months is interesting not only as a descriptive result, but also because it may contribute to a better understanding of the conditions under which the ectopic development of the fertilized ovum may take place.
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PMID:[Seasonal incidence of extrauterine pregnancy]. 882 Mar 95

The aim of this study was to elucidate the clinical presentation of ectopic pregnancy in the emergency department and highlight the atypical presentations and pitfalls in its diagnosis. This was a 4-year retrospective descriptive study carried out at a tertiary teaching hospital. Two hundred and seven cases of ectopic pregnancy treated in a tertiary teaching hospital were reviewed. Among the risk factors, 4.9% had a history of tubal ligation. Two patients developed ectopic pregnancy while breastfeeding. Of the patients, 43.7% did not have the triad symptoms of lower abdominal pain, vaginal bleeding and amenorrhoea. One patient presented with rectal bleeding while three patients presented with epigastric pain and central abdominal pain instead of lower abdominal pain. All who had tachycardia (10.4% of all cases) had ruptured ectopic pregnancy. Of the cases, 30% and 49% did not have abdominal pain and rebound tenderness respectively; 37.5% had negative cervical motion tenderness; 3.1% and 2.6% of cases had negative urine HCG and plasma beta HCG tests respectively. Ultrasound missed 1.6% of ectopic pregnancies. Missed pregnancy, normal ultrasound study and diagnosis of other gynaecological conditions were reasons for the delayed diagnosis of 5.8% of cases. There was one mortality. Any female in the reproductive age group with syncope, abdominal symptoms or any of the components of the classical triad must have ectopic pregnancy excluded. Patients with normal ultrasound studies should have their serum beta HCG levels and ultrasound scans repeated until the condition can be completely excluded. Transabdominal or transvaginal ultrasound studies done within the emergency department would enable earlier diagnosis and management.
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PMID:Ectopic pregnancy--a diagnostic challenge in the emergency department. 1114 70

A 57-year-old man presented with a 1-month history of progressive abdominal pain and weight loss. A palpable, nonpulsatile, firm abdominal mass was felt below the xiphisternum down to the pelvis. A pregnancy test performed on a urine sample was positive. Testicular examination and testicular ultrasound were normal. Computerized tomography of the abdomen revealed a retroperitoneal mass measuring 30 x 21 x 13 cm. Serum beta-human chorionic gonadotropin (beta-HCG) was serially increased (19.71-22.71 mIU/mL). Results of histopathology tests confirmed the diagnosis of leiomyosarcoma. The level of serum beta-HCG decreased to < 0.2 mlU/mL after chemotherapy. Beta-HCG is usually increased in germ-cell tumors but few reports in the literature describe beta-HCG-secreting leiomyosarcomas. The incidence of increased levels of beta-HCG in sarcomas in general, and its potential role as a tumor marker, is not known. A simple urine pregnancy test may be done in the work-up of abdominal masses.
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PMID:Retroperitoneal leiomyosarcoma and enlarged epididymis associated with a positive pregnancy test. 1218 3

Point of care testing (POCT) is widely viewed as possibly improving ED care and reducing length of stay (LOS). However reports are mixed, and regulatory barriers complicate considerations. We studied a simple urine pregnancy assay (human chorionic gonadotropin-HCG). LOS was evaluated when HCG was moved from central lab (HCGLab) to POCT (HCGED) in 2 pre-post 3-month periods (958 HCGLab and 1075 HCGED). HCG patients were compared with a similar control group, and staff perceptions were evaluated. There was no change in LOS for HCG patients (36.8 v 50.85 min, P = .33), although there was one marginal finding of improved LOS for patients presenting with abdominal pain diagnosed as pregnant (P = .17). Staff (28/53 physicians, 18/81 nurses) reported HCGED as positive. POCT does not improve LOS for broad groups of patients, although POCT does change the ED environment. Further study is needed to evaluate how the information flow of POCT changes patient care.
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PMID:Point of care pregnancy testing provides staff satisfaction but does not change ED length of stay. 1552 Sep 40

Omental pregnancy is an uncommon form of abdominal pregnancy; it has never been previously reported after IVF. A 35-year-old patient underwent IVF for tubal factor infertility. The treatment cycle was uneventful, but 3 weeks following embryo transfer the patient was diagnosed with a right tubal ectopic pregnancy on ultrasound. A laparoscopic salpingectomy was performed and the patient was discharged home. Two weeks later, the patient presented with abdominal pain and rising serum beta-human chorionic gonadotrophin (beta-HCG). A repeat laparoscopy showed omental and peritoneal trophoblastic implants. These were excised laparoscopically and confirmed on histology to be trophoblastic tissue. The HCG returned to < 3 IU/l, 1 week post-operatively. This case emphasizes the importance of intra-operative care during laparoscopic surgery for ectopic pregnancy and the need for post-operative surveillance of serum beta-HCG. An abdominal pregnancy, though rare, has a seven times higher mortality rate than non-abdominal pregnancies. Early diagnosis and treatment can prevent intra-abdominal haemorrhage, as haemorrhagic shock is the commonest cause of mortality from omental pregnancy.
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PMID:Omental and peritoneal secondary trophoblastic implantation - an unusual complication after IVF. 3316 93

In our paper we described a rare case of heterotopic pregnancy after in vitro fertilization (IVF-ET). Heterotopic pregnancy (coexistence of intrauterine and ectopic pregnancy) appears in 1 per 30 thousand cases of natural pregnancies and in 1% of pregnancies after IVF. The pregnancy was obtained after ICSI and transfer of 2 embryos. The pregnancy was confirmed by HCG serum presence--13 days after ET. On day 39 after IVF procedure, the patient was admitted to the hospital because of abdominal pain. At admission, ultrasound examination confirmed an 8 week intrauterine pregnancy and enlarged polycystic ovaries. After 3-day-long observation, patient status worsened and laparoscopy procedure was performed. The ectopic pregnancy was confirmed during operation and the ovum was removed a long with fallopian tube. Ultrasound examination on the 6th day after operation confirmed single intrauterine viable fetus. in order to diagnose the possible complications, women undergoing IVF procedure should be carefully observed by IVF performing physicians.
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PMID:[Heterotopic pregnancy after in vitro fertilization]. 1708 Jul 49

A 31-year-old man presented with abdominal pain. Abdominal computed tomography (CT) demonstrated heterogeneously enhanced liver masses and chest CT revealed an anterior abnormal mass. He was admitted for further examination and treatment. The patient's serum beta-HCG level was markedly elevated (2,300ng/ml) and liver biopsy revealed the presence of choriocarcinoma and positive immunostaining for HCG. The patient was suspected to have combined germ cell tumor in the mediastinum with multiple liver metastases. He was treated with 8 cycles of BEP therapy (cisplatin. etoposide, bleomycin) and the beta-HCG level was normalized. We report a case of germ cell tumor with multiple and diffuse hypervascular masses in the liver as the initial clinical manifestation.
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PMID:[Multiple hepatic metastases due to germ cell tumor on initial clinical presentation]. 1749 9


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