Factors Associated With Operatively Confirmed Adnexal Torsion Among Pregnant Women – A Multicenter Cohort Study

Abstract Purpose The aim of this study was to investigate the association of clinical, laboratory, and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. Materials and Methods A multicenter retrospective study of pregnant women who underwent urgent laparoscopy for suspected adnexal torsion during 2004–2019 in three tertiary medical centers. Results Adnexal torsion was found in 143/208 (68.8 %) cases. Women with adnexal torsion had lower parity and lower rates of previous cesarean section, but higher rates of fertility treatments and multiple gestations, and were more likely to report right lower abdominal pain, with shorter duration of symptoms (< 24 hrs) and vomiting but not nausea. Women with adnexal torsion were found to have higher rates of sonographic findings suggestive of ovarian edema, while normal-appearing ovaries on ultrasound were more common in women without torsion. A multivariate logistic regression analysis showed that complaints of right abdominal pain were positively associated with adnexal torsion (aOR [95 % CI] 5.03 (1.45–17.49), while previous cesarean delivery and ultrasound findings of normal-appearing ovaries were negatively associated with adnexal torsion (aOR of 0.17 (0.05–0.52) and 0.10 (0.02–0.43), respectively). Conclusion Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of pregnant women with suspected adnexal torsion.

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Management of hemoperitoneum due to rupture of the ovarian cyst

10.25083/2559.5555/6.1.2 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6-10

Author(s):

Oana Denisa Balalau ◽

Ileana Maria Conea ◽

Nicolae Bacalbasa ◽

Anca Silvia Dumitriu ◽

Stana Paunica ◽

...

Keyword(s):

Abdominal Pain ◽

Ovarian Cyst ◽

Lower Abdominal Pain ◽

Physical Exertion ◽

Sudden Onset ◽

Reproductive Age ◽

Adnexal Torsion ◽

Ultrasound Monitoring ◽

Chemical Peritonitis ◽

Rule Out

Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.

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P07.03: Deep lower abdominal pain caused by a hysterotomy defect in two post-caesarean non-pregnant women

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.2412 ◽

2005 ◽

Vol 26 (4) ◽

pp. 423-423

Author(s):

L. Skibsted ◽

G. Bennich ◽

M. Rudnicki

Keyword(s):

Abdominal Pain ◽

Pregnant Women ◽

Lower Abdominal Pain

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Lipoleiomyoma Causing Adnexal Torsion

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479316665864 ◽

2016 ◽

Vol 33 (1) ◽

pp. 47-49 ◽

Cited By ~ 1

Author(s):

Christopher Kiefer ◽

Joseph Minardi ◽

Debra Williams ◽

Shelley M. Layman

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Fibrous Tissue ◽

Lower Abdominal Pain ◽

Reproductive Age ◽

Emergency Physicians ◽

Adnexal Torsion ◽

Aged Woman ◽

Middle Aged Woman ◽

Patient At Risk

Abdominal pain in women of reproductive age is a frequently encountered chief complaint in the emergency department. Adnexal torsion is a time-sensitive diagnosis that is essential for emergency physicians to consider in the initial differential diagnosis. Bedside sonography can be used to assist the clinician in the detection of adnexal masses placing the patient at risk for torsion. Lipoleiomyomas are uncommon, benign neoplasms consisting of variable portions of mature lipocytes, smooth muscle, or fibrous tissue. Very few cases have been reported, with no cases previously reported by emergency physicians using bedside ultrasound. A case is presented of a middle-aged woman who presented to the emergency department with acute lower abdominal pain. At the time of the initial history and physical examination, bedside screening sonogram was performed, which allowed rapid diagnosis of a large, heterogeneous, relatively avascular adnexal mass that was later identified as a lipoleiomyoma, a rare adnexal neoplasm, that resulted in adnexal torsion.

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Torquálódott méhfüggelék laparoszkópos ellátása a 32. terhességi héten

Orvosi Hetilap ◽

10.1556/650.2021.32165 ◽

2021 ◽

Vol 162 (35) ◽

pp. 1418-1421

Author(s):

Márió Attila Vincze ◽

Gábor Németh ◽

Tibor Novák

Keyword(s):

Abdominal Pain ◽

Clinical Symptoms ◽

Operative Procedure ◽

Lower Abdominal Pain ◽

Pregnant Patient ◽

Adnexal Torsion ◽

Maternal Complications ◽

Increased Risk ◽

The University ◽

In Pregnancy

Összefoglaló. Terhességben az élettani és anatómiai változások miatt bizonyos patológiás szervi eltérések nem specifikus tünettannal járhatnak. A várandósság alatt fellépő hasi panaszok esetén lényeges felállítani a gyors és pontos diagnózist, a minél korábbi adekvát terápia érdekében. A klinikai tünetek hátterében többek között állhatnak szülészeti betegségek, illetve appendicitis, megnagyobbodott ovariumcysta, nephrolithiasis vagy diverticulitis is. Esetismertetésünkben egy 32 hetes gravida ellátását prezentáljuk, aki jobb alhasi panaszok miatt jelentkezett a Szegedi Tudományegyetem Szülészeti és Nőgyógyászati Klinikáján. A magzati paraméterek megfelelőek voltak. A klinikai vizsgálatok appendicitis gyanúját vetették fel, mely miatt laparoszkópia történt. Torquálódott jobb oldali tuba uterina miatt jobb oldali salpingectomiát végeztünk, az appendix kóros elváltozása nem igazolódott. Magzati, illetve anyai szövődmény a posztoperatív szakban nem volt. A további terhesgondozás során szövődményt nem észleltünk, majd a betöltött 40. terhességi héten hüvelyi úton egészséges újszülött született. A méhfüggelék megcsavarodásának operatív megoldása laparoszkópos úton alkalmazható módszernek tekinthető terhességben is. Az adnexcsavarodás ritka sürgősségi nőgyógyászati kórképnek számít, bár szakirodalmi adatok alapján az adnexum torsiójának rizikója fokozott lehet a terhesség korai szakaszában, kiváltképp asszisztált reprodukciós technikák alkalmazása esetén. Várandósság alatt hirtelen jelentkező alhasi panaszok esetén az anamnesztikus adatok tükrében, a klinikai vizsgálatok során szükséges az adnextorsio lehetőségére is gondolni. Orv Hetil. 2021; 162(35): 1418–1421. Summary. Due to physiological and anatomical changes in pregnancy, certain pathological organ abnormalities may be associated with non-specific symptoms. In the case of abdominal complaints during pregnancy, it is important to make a quick and accurate diagnosis to apply an early adequate therapy. The cause of the clinical symptoms can be obstetrical diseases, appendicitis, large ovarial cyst, rarely nephrolithiasis or diverticulitis. Through our case study, we present the treatment of a 32-week gravida. Examination of the pregnant patient occured at the Department of Obstetrics and Gynecology of the University of Szeged due to right lower abdominal pain. The fetal parameters were satisfactory. We assumed appendicitis, so after proper preparation laparoscopy was performed. Salpingectomy was performed because of torqued right fallopian tube and no pathological changes were detected on the appendix. In the postoperative period, there were no fetal or maternal complications. During further care of pregnancy, there were no complications and a healthy newborn was born by vaginal delivery at the 40th week of gestation. The operative procedure of adnexal rotation by laparoscopy can be considered as an applicable method even in pregnancy. Adnexal torsion is a rare emergency gynecological disease, although literature data suggest an increased risk in early pregnancy, especially in the case of assisted reproductive technology. In the case of sudden abdominal pain during pregnancy, in the light of anamnestic data, it is recommended to consider the possibility of adnexal torsion, too. Orv Hetil. 2021; 162(35): 1418–1421.

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Association Between Use of Pain Medication, Ultrasound Findings, and Adnexal Torsion Among Young Females Presenting With Acute Abdominal Pain

Journal of Pediatric and Adolescent Gynecology ◽

10.1016/j.jpag.2011.01.035 ◽

2011 ◽

Vol 24 (2) ◽

pp. e59

Author(s):

Xiomara M. Santos ◽

Nancy Sokkary ◽

Jennifer L. Bercaw-Pratt ◽

Jennifer E. Dietrich

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Pain Medication ◽

Adnexal Torsion ◽

Young Females ◽

Ultrasound Findings

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Acute appendiceal diverticulitis diagnosed in the postoperative context of appendectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20210493 ◽

2021 ◽

Vol 8 (3) ◽

pp. 1004

Author(s):

Sofia M. Frade ◽

Ana K. Andrade ◽

João S. Pimentel ◽

Luis M. Moniz ◽

Helder J. Viegas

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Age Groups ◽

Lower Abdominal Pain ◽

Vermiform Appendix ◽

Duration Of Symptoms ◽

Lower Quadrant ◽

Appendiceal Diverticulitis ◽

And Gender ◽

Histological Result

Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result. We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain. Laboratory and imaging studies led to the diagnosis of acute appendicitis. In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed. Later pathological exam showed diverticulitis of the vermiform appendix. Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings. Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms.

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Is elective appendicectomy is a valuable option in children, with chronic undiagnosed right lower abdominal pain? A prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20164475 ◽

2016 ◽

Vol 4 (1) ◽

pp. 385

Author(s):

Sudhir Singh ◽

J. D. Rawat

Keyword(s):

Abdominal Pain ◽

Prospective Study ◽

Lower Abdominal Pain ◽

Duration Of Symptoms ◽

Pain Abdomen ◽

A Prospective Study ◽

Inflammatory Changes ◽

Cause Of Pain

Background:Chronic right lower abdominal pain in children is an enigma with both diagnostic and therapeutic controversies. There are no well-defined management protocols. In this study we have tried to define the role of laparoscopy and elective appendicectomy in these children.Methods: It is a prospective study duration 2 years (2013-15), in which children with chronic right lower abdominal pain, after excluding infective causes of chronic pain all required investigations, children were selected for diagnostic laparoscopy and appendicectomy. Children were following up for relief of pain and complication related to procedure for minimum of 12 months.Results:Total 22 patients were included in study. Male: Female-14:8, average age was 9.2 years. Average duration of symptoms was 12.8 months. Investigations were not helpful in establishing the cause of pain abdomen in these children. On laparoscopy, appendices were found macroscopically abnormal in 14/22 cases, of which 12 show chronic inflammatory changes of histopathology of which 11 showed complete improvement of symptoms in follow up. Eight cases in which appendix were found macroscopically normal, in 6 cases appendicectomy was done. There were no procedure related complications.Conclusions:Laparoscopy in chronic right lower abdominal pain in children with persistent mesenteric lymphadenopathy is useful for both diagnostic and therapeutic purposes. Appendicectomy should be done even if it is macroscopically normal.

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Determination of Prevalence of Urinary Tract Infection Among the Pregnant Women with Lower Abdominal Pain

Pharmaceutical and Biosciences Journal ◽

10.20510/ukjpb/5/i2/155996 ◽

2017 ◽

Vol 5 (2) ◽

pp. 50

Author(s):

Chandra Bala Sekharan ◽

Devarajan Dinesh Kumar ◽

Koneru Ratna Kumari ◽

Cecilia Alphonce Joachim

Keyword(s):

Urinary Tract Infection ◽

Abdominal Pain ◽

Urinary Tract ◽

Tract Infection ◽

Pregnant Women ◽

Lower Abdominal Pain

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ACUTE APPENDICITIS DURING PREGNANCY: NO PLACE FOR MAYBE

Journal of Surgical Sciences ◽

10.33695/jss.v2i4.129 ◽

2015 ◽

Vol 2 (4) ◽

pp. 159-162

Author(s):

I. Negoiu ◽

S. Păun ◽

S. Hostiuc ◽

A. Moldoveanu ◽

M. Beuran

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Pregnant Women ◽

Operating Time ◽

Lower Abdominal Pain ◽

Negative Appendectomy ◽

Level Of Evidence ◽

Hospital Database ◽

History Of ◽

Obstetrical Emergency

Acute appendicitis is the most common abdominal non-obstetrical emergency in pregnant women;its management however is supported by a low level of evidence. The main objective of this studywas to evaluate the clinical management of pregnant women with acute appendicitis.We havereviewed the hospital database selecting the pregnant women with acute appendicitis managed inthe last 24 months. 8 appendectomies were performed in pregnant women. Mean age was 27.2±6.1years. All patients had a history of right lower abdominal pain of 36 hours or less. Generalanesthesia was used in 12.5% of cases and spinal anesthesia in the remaining of cases. In all casesappendectomy was performed through a McBurney’s incision with a mean operating time of 36.25minutes. There was no maternal or fetal mortality.The diagnosis of acute appendicitis ischallenging in pregnant women. A prompt, but a non-negative appendectomy should always beaimed, and no unecessary risks should be taken.

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