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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of a 23-year-old woman with a paraovarian tumor is presented. The patient complained of pelvic pain and abdominal swelling. Cystectomy was the initial surgical treatment, but after the histological diagnosis, a staging surgery was carried out. The clinical aspects and subsequent management of related cases are discussed, and a literature review is made.
Int J Gynecol Cancer
PMID:Paraovarian tumor of borderline malignancy--a case report. 1530 66

The ovarian remnant syndrome, a complication of bilateral salpingo-oophorectomy, is progressively receiving more attention in the gynecological surgery literature. The syndrome is manifested by pelvic pain and a palpable or sonographic finding of a pelvic mass. However, in rare cases, patients can present with large masses and radiographic suggestion of malignancy. We present the case of a 76-year-old white female, 23 months after bilateral salpino-oophorectomy at the same institution, complaining of 3.5 months of right flank and abdominal pain. Clinical and radiological evidence of a right ovarian remnant was discovered. Subsequent laparoscopic resection was consistent with a well-encapsulated mucinous adenocarcinoma in a right ovarian remnant. Curiously, this patient had no history of endometriosis, dense pelvic adhesions, pelvic inflammatory disease, or difficulty encountered during the original hysterectomy. This is the seventh published case report in the international literature about carcinoma developing in an ovarian remnant. However, this case differs in that the patient had no preexisting gynecologic conditions at the time of hysterectomy and bilateral salpingo-oophorectomy to account for residual ovarian tissue. Additionally, the oophorectomy was performed vaginally, in contrast to multiple previous case reports.
Int J Gynecol Cancer
PMID:Mucinous adenocarcinoma in an ovarian remnant. 1530 67

Of the first 500 women in Oxford to undergo transcervical resection of the endometrium, 101 (20%) have subsequently undergone hysterectomy. This study was undertaken to assess the reasons for failure of endometrial resection. An audit of the case notes of the 101 women requiring hysterectomy was performed. Data collection included the patient's age, weight, parity, reasons for endometrial resection, details of the endometrial resection, reasons for hysterectomy, hysterectomy findings and uterine histology. Six (6%) hysterectomies were performed as emergency operations during endometrial resection, 33 (33%) were performed for persistent menorrhagia, 39 (39%) for recurrent menorrhagia and in 18 women (18%) for pelvic pain. The duration of success following endometrial resection ranged from 0 to 21 months. Hysterectomy was significantly more common in older women under 40 years of age, in the presence of an enlarged fibroid uterus, when complications at endometrial resection had occurred and in women operated on by relatively inexperienced surgeons. Endometrium ws present in 96% of hysterectomy specimens. Uterine malignancy that had not been diagnosed at transcervical resection of the endometrium was present at hysterectomy in two women. Hysterectomy should be considered in preference to endometrial resection for treatment of menorrhagia in women who are less than 40 years old and in the presence of large intramural fibroids.
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PMID:Hysterectomy following failed endometrial resection. 1551 76

Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differences; identifying red and yellow flags early; understanding and differentiating tolerance, dependence and addiction; minimizing side effects; and being familiar with and using CAM therapies when good evidence of efficacy exists. The pharmacologic management of pain requires thorough knowledge of nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors, and opioids. A table of equianalgesic dosages is useful because patients may need to move from one opioid to another. Accompanying this article are papers discussing 5 common pain disorders seen by family physicians, including: neck pain, low back pain, joint pain, pelvic pain, and cancer/end of life pain. The family physician who learns these principles of pain management and the algorithms for these common pain disorders can serve patients well.
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PMID:Pain management by the family physician: the family practice pain education project. 1557 25

This report presents a case of endometrioid adenocarcinoma arising from endometriosis of the mesenterium of the sigmoid colon following total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyoma of the uterus and infiltrating pelvic endometriosis, and hormone replacement therapy. A 62-year-old woman presented with an abdominal tumor. Based on the diagnosis of mesocolonic tumor, sigmoidectomy with lymph node resection was performed. The tumor cells were immunopositive for cytokeratin 7, but negative for cytokeratin 20, and the tumor was histologically diagnosed as endometrioid adenocarcinoma of the mesocolon. Hyperestrogenism has been implicated as a risk factor for the development of cancer from endometriosis. The patient had been receiving high-dose unopposed estrogens for 14 years after a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Physicians should recognize that endometriosis-associated neoplasms are able to cause symptoms or signs such as abdominal and/or pelvic pain, pelvic mass, and vaginal bleeding, especially if the patient has been treated with hormone replacement therapy. It is important to recognize the possibility of tumors arising from endometriosis when evaluating intestinal or mesenteric neoplasms in women, even in the patient who has previously undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy, particularly if the patient has a history of endometriosis and has received hormone replacement therapy.
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PMID:Endometrioid adenocarcinoma arising from endometriosis of the mesenterium of the sigmoid colon. 1574 6

We present a case of a 24-year-old woman, gravida 0, with menometrorrhagia and pelvic pain. A uterine hemorrhagic fibroid was diagnosed after ultrasound and magnetic resonance imaging (MRI). The endometrial biopsy was negative for malignancy. Laparoscopic sentinel lymph node sampling, lavage, and myometrial biopsy with negative results were performed before dissection of the uterine vessels. The final diagnosis of endometrial stromal sarcoma was made by myomectomy and hysterectomy one year later. This case should demonstrate the difficulty of making the right diagnosis of sarcoma before laparoscopic dissection of uterine vessels in patients with symptomatic fibroids.
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PMID:Laparoscopic uterine artery dissection in an undiagnosed endometrial stromal sarcoma. Case report. 1575 16

Non-Hodgkin's lymphoma involving the ovaries is unusual and may cause confusion for the clinician since its presentation might resemble other, much more frequent tumors. Malignant lymphoid cells may occur in the ovary either as a primary neoplasm or as a secondary manifestation of a disseminated occult or known disease. The most common presenting signs or symptoms of malignant lymphomas involving the ovaries are abdominal or pelvic pain or mass. We present here a unique case of non-Hodgkin's lymphoma involving the ovaries presenting as advanced ovarian cancer with a pelvic mass, pleural effusion, and marked elevation of CA-125.
Int J Gynecol Cancer
PMID:Non-Hodgkin's lymphoma presenting as advanced ovarian cancer--a case report and review of literature. 1588 85

Superior hypogastric plexus block has been advocated for the treatment of cancer related pelvic pain. Neurolysis is usually established using the classical posterolateral approach in the prone position, in which correct placement of the needle is sometimes difficult due to vertebral anatomy and the patient's inability to lie prone. We describe an alternative posteromedian transdiscal approach under fluoroscopic guidance for the treatment of intractable pelvic pain in three patients, in whom the classical approach was not possible. The L5-S1 interdiscal space was identified with fluoroscopy. The needle was then introduced through the disc and advanced under lateral fluoroscopic control. After verifying correct needle placement, neurolysis was performed with 8 ml of 10% phenol solution. All patients had significant pain relief immediately after the block, lasting from 6 to 12 months, and their pain severity scores and opioid consumption were reduced by more than 50%. There were no complications such as discitis, disc rupture or nerve injury. Since this new posteromedian transdiscal approach provides easy access to the superior hypogastric plexus with a single puncture and with any patient position, it may be an alternative to the classical approach.
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PMID:A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. 1594 58

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (71), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with Gn RH analog was performed and full remission was obtained after 6 months. One year later the ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of thehigh risk of recurrence.
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PMID:[Endometriosis with massive hemorrhagic ascites: a case report and review of the literature]. 1613 62

Positron emissions tomography/computed tomography (PET/CT) scan has been used in many types of cancer to characterize the extent of disease as well as to identify the presence of metastases. However, the utility of PET/CT in patients with both cancer and osteoporosis is less well delineated. In this case, a patient with known metastatic colorectal cancer who was investigated by many forms of conventional imaging for back and pelvic pain was found to have osteoporotic fractures using PET/CT. At the same time malignant disease was excluded.
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PMID:PET/CT F-18 FDG scan accurately identifies osteoporotic fractures in a patient with known metastatic colorectal cancer. 1616 36


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