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

The primary use of laparoscopy is as a surgical tool, with sterilizations being the overwhelming indication. The laparoscope is used less frequently as a non-surgical tool, with the major indication being for diagnosing infertility and/or amenorrhea, and for evaluation of obscure pelvic pain. There would seem to be several indications for laparoscopy that have been neglected, these being in confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain. Lapar-The majority of these contraindications are relative, and depend soley on the laparoscopist's ability and his clinical judgment. The problems of hernias seem to have been over-emphasized. The laparoscopist should be aware of potential problems with umbilical hernia, and he probably can ignore hiatal hernias except when they are large and quite symptomatic. However, generalized abdominal peritonitis, significant hemoperitoneum with intestinal obstruction are felt by most authors to be absolute contraindications. The most frequent complications of laparoscopy involve the physoperitoneum. Except for cardiac arrest the most serious complications involve electrical burns to small bowel.
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PMID:Indications, contraindications and complications of laparoscopy. 12 9

Laproscopic sterilization techniques and the diagnostic use of laparoscopy are discussed. In a series of 1000 laparoscopic sterilizations by the 2-incision technique, there was a total failure rate, surgical and operative, of .4%. In a similar series with the 1-incision technique and electrocagulation only, the total failure rate was 1.6%, though the complication rate was considerably reduced. The high failure rate was attributed to incomplete transection resulting in recanalization. The failure rate with a single-incision, 3-burn technique was .25% in a series of 2000 patients, and complications were few. Tubal occlusion with hemoclips has produced poor results (failure rate: 8-27%). The results with silastic bands, however, have been comparable to those for electrocoagulation, but with fewer complications. Means by which the cost of laparoscopic equipment may be reduced are discussed. Laparoscopy can be helpful in the diagnosis of infertility-endocrinology, ectopic pregnancy, pelvic pain, pelvic inflammatory disease, adnexal masses, and the retrieval of foreign bodies in the pelvic region. Contraindications to laparoscopy are reviewed. It is concluded that laparoscopy is a safe and effective means of sterilization on an outpatient basis, and is of value in the diagnosis of gynecologic disorders.
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PMID:Laparoscopy. 13 20

Between July, 1974 and February, 1979, 109 adolescent girls, ranging in age from 10 1/2 to 19 yr. with unexplained chronic pelvic pain, underwent diagnostic laparoscopy. Endometriosis was the most common finding occurring in 49 patients (45%), followed by postoperative adhesions in 17 patients (16%) and congenital abnormalities of the uterus in 10 patients (9%). Other important causes were chronic pelvic inflammatory disease with peritubal and periovarian adhesions in 9%, chronic hemoperitoneum in 5%, functional ovarian cysts in 5%, and uterine serositis in 2%. No pathology could be seen in 10 patients (9%). Analysis of the presenting symptoms and physical findings revealed in most instances that the presence of significant pelvic pathology as a cause of the chronic pelvic pain was predictable and had been previously misdiagnosed. Intraoperative and postoperative management of the major problems encountered stress the importance of conservative surgery and the need for long-term follow-up.
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PMID:New insights into the old problem of chronic pelvic pain. 16 46

One of the most significant factors necessitating IUD removal is pelvic pain, which includes insertional pain, intermenstrual cramps, often associated with spotting and bleeding, and increased dysmenorrhea. The larger and stiffer devices and those whose shape does not conform to that of the endometrial cavity produce localized endometrial ulceration and inflammation, which contribute to these symptoms. Endometrial prostaglandin release secondary to the presence of an intrauterine foreign body may also play an important role. In patients who have pelvic pain with an IUD it is of utmost importance to completely evaluate them and exclude other causes of pain, such as pelvic inflammatory disease, with and without abscess formation, and ectopic gestation.
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PMID:Pelvic pain and the IUD. 34 74

Six cases of pelvic endometriosis are discussed and their ultrasonic appearances presented. The literature is reviewed concerning the ultrasonic appearance of pelvic endometriosis. The clinical significance of endometriosis in the differential diagnosis of females with pelvic pain is stressed. In this series endometriosis could not be differentiated from cystic lesions of the ovaries and from pelvic inflammatory disease ultrasonically. Other confirmatory measures or studies such as laparoscopy and biopsy were usually needed.
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PMID:Pelvic endometriosis as demonstrated by gray scale ultrasound. 43 62

A qualitative assay for the presence of C-reactive protein (CRP), with a threshold of approximately 1 mg per deciliter, was performed on 121 gynecologic patients who presented to the University of Chicago, Chicago Lying-In Hospital for various complaints. CRP results divided patients with inflammatory processes from those without inflammation or necrosis with an accuracy of over 98%. The method, which is quick and inexpensive, allows CRP to be a useful tool in the differential diagnosis of pelvic pain and masses and further may be useful in the assessment of the efficacy of antibiotic regimens in the treatment of pelvic inflammatory disease.
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PMID:C-reactive protein in the differential diagnosis of gynecologic pathology. 52 81

A study was conducted to define IUD complication and discontinuation rates among a family practice residency patient population. The study group included 220 randomly selected IUD acceptors and a control group of 100 similarly selected pill acceptors. The rate of pelvic pain and bleeding found in this study were comparable to results of other IUD studies; both were causes of IUD discontinuation. The difference between the 8.6% pelvic inflammatory disease rate among IUD patients and the 2% rate in pill patients was highly significant. 4% of the IUD users, compared to only 1% of the pill users, required gynecologic/obstetric-related hospitalization during the study period. Most of these hospitalizations were for serious conditions and most were at least partially related to IUD use. Both the discontinuation and complication rates for IUDs were found to be high enough that the method is not recommended for young, otherwise healthy women without careful consideration of the alternatives available.
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PMID:Complications associated with IUD use in a family practice setting. 75 49

Three cases of coccidioidomycosis of the female genital tract are reviewed. The diagnosis was made by laparotomy in 2 patients who presented with tender adnexal masses, and by endometrical curettage in a third patient with disseminated coccidioidomycosis. Hysterectomies were performed in all 3 patients; 1 had a bilateral salpingo-oophorectomy and the others a bilteral salpingectomy and unilateral oophorectomy. Two patients received chemotherapy with amphotericin B. One patient died 4 years after her operation from disseminated and meningeal coccidioidomycosis. In a female patient who has resided in an endemic region and who presents with pelvic pain of obscure origin, unexplained infertility, a menstrual disorder, or a chronic, refractory pelvic inflammatory disease, genital coccidioidomycosis should be considered in the differential diagnosis.
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PMID:Female genital coccidioidomycosis. 111 94

The diagnosis of acute pelvic pain in the woman of reproductive age represents a major clinical challenge. In approaching such a patient, the clinician must differentiate between pregnancy-related causes, gynecologic disorders, and nonreproductive tract causes. A careful history and physical examination, along with selective and knowledgeable use of diagnostic tests and procedures, are essential to the diagnostic process. Diagnostic laparoscopy represents the reference standard for diagnosis of many of its possible causes and can obviate the need for exploratory laparotomy. Once competing diagnoses have been adequately excluded, an empiric trial of antibiotic therapy for acute pelvic inflammatory disease, coupled with close clinical follow-up, should be considered in patients with acute pelvic pain found to have cervical motion tenderness and bilateral adnexal tenderness on examination.
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PMID:Diagnosis of acute pelvic pain. 140 31

The frequency of infection following induced first-trimester abortion is 3-5%. Duration of hospitalization is often five days, and the total costs per abortion were 5,400 Dkr (approximately pounds 500) in Denmark in 1979. Sequelae of postabortal infection are similar to and occur with the same frequency as sequelae to "spontaneous" pelvic inflammatory disease. Thus, secondary infertility was found in 10% of women with postabortal infection, spontaneous abortion in 22%, dyspareunia in 20%, and chronic pelvic pain in 14%. The risk of ectopic pregnancy is probably also increased. Surgical scrub cannot sterilize the endocervix and, as a consequence, abortion is performed in a contaminated field. The presence of pathogenic bacteria, i.e. Chlamydia trachomatis, therefore increases the risk of postoperative infection. The organism is found in approximately 7% of those applying for abortion and the risk of sustaining infection is 20%. Other risk factors are previous pelvic inflammatory disease, vaginal infection, first pregnancy and young age. Prophylactic antibiotics halve the incidence of infection, but by applying prophylaxis to risk groups only, the amount of prescriptions can be reduced. Prophylaxis need only be administered peroperatively, and tetracyclines, metronidazol, and penicillin/pivampicillin have been found to be effective. Women applying for abortion should be examined for C. trachomatis and positive cases treated no later than at the time of the abortion.
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PMID:[Preventive antibiotics in induced first-trimester abortion]. 146 1


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