Lipoleiomyoma Causing Adnexal Torsion

2016 ◽  
Vol 33 (1) ◽  
pp. 47-49 ◽  
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.

scholarly journals Management of hemoperitoneum due to rupture of the ovarian cyst

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.

Ascites, abdominal pain, and acute renal failure in a middle-aged woman

2019 ◽  
Vol 15 (2) ◽  
pp. 299-302
Author(s):  
Giorgio Colombo ◽  
Ludovico Furlan ◽  
Francesco Mucci ◽  
Stefania Zannoni ◽  
Maria Carmela Andrisani ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Abdominal Pain ◽  
Middle Aged ◽  
Aged Woman ◽  
Middle Aged Woman

scholarly journals MP58: Have opioid prescription by emergency physicians changed significantly over five years?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
M. Wei ◽  
M. Da Silva ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Tertiary Care ◽  
Opioid Analgesia ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Chi Square ◽  
Opioid Prescription ◽  
Emergency Department Care ◽  
Undetermined Etiology

Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.

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

2020 ◽  
Author(s):  
Misgav Rottenstreich ◽  
Ido Moran ◽  
Ayala Hirsch ◽  
Reut Rotem ◽  
Shunit Armon ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pregnant Women ◽  
Clinical Laboratory ◽  
Multivariate Logistic Regression Analysis ◽  
Lower Abdominal Pain ◽  
Adnexal Torsion ◽  
Multicenter Cohort Study ◽  
Duration Of Symptoms ◽  
Ultrasound Findings ◽  
Previous Cesarean

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.

AJRTeaching File: Intermittent Chronic Abdominal Pain, Fever, and Fatigue in a Middle-Aged Woman

2011 ◽  
Vol 197 (1) ◽  
pp. W62-W65
Author(s):  
Mohammad Reza Rajebi ◽  
Abraham Albert Harari ◽  
Stuart A. Groskin
Keyword(s):  
Abdominal Pain ◽  
Chronic Abdominal Pain ◽  
Middle Aged ◽  
Aged Woman ◽  
Middle Aged Woman

scholarly journals Dysgerminoma: diagnostic impasse

2020 ◽  
Vol 7 (11) ◽  
pp. 3811
Author(s):  
Indrajit Anandakannan ◽  
Shanthi Ponnandai Swaminathan ◽  
Vikas Kawarat ◽  
Rajeshwari Mani ◽  
Kannan R.
Keyword(s):  
Abdominal Pain ◽  
Abdominal Mass ◽  
Germ Cell Tumour ◽  
Lower Abdominal Pain ◽  
Gastrointestinal Stromal Tumour ◽  
Reproductive Age ◽  
Ca 125 ◽  
Abdominal Radiograph ◽  
Bowel Loop ◽  
Plain Abdominal Radiograph

Dysgerminoma is a rare malignant ovarian tumour in women of reproductive age group, featuring lower abdominal pain and abdominal mass with elevated tumour markers. The tumour grows rapidly and diagnosed at an earlier stage. We present a short-statured 20 years girl with intermittent abdominal pain and distention for 4 months, on examination huge abdominal mass of size 20x15 cm, firm in consistency was palpable, lower limit not ascertained. Routine blood investigations normal, thyroid function test showed hypothyroidism. A plain abdominal radiograph shows a large homogenous mass fitting mid part of abdomen with displaced bowel loop. Contrast-enhanced computed tomography abdomen and pelvis show up 20x18.5x9.5 cm well defined heterogeneous mass, with areas of necrosis suggesting mesenchymal tumour or germ cell tumour. CA 125, alpha-fetoprotein, lactate dehydrogenase, beta human chorionic gonadotropin were raised. Magnetic resonance imaging abdomen and pelvis show 10x16x17cm hetero intense lesion, bilateral ovary normal. After tumour board discussion image-guided biopsy was done, suggestive of epithelioid gastrointestinal stromal tumour. Laparotomy displayed a large mass 22x16x10 cm arising from left ovary, no enlarged lymph node, completed with left salpingo-oophorectomy. Histopathology examination and immunohistochemistry definitive of dysgerminoma. In this clinical scenario, we narrate the importance of clinical examination and increased dependence on imaging modalities in diagnosing the patient. The treatment is based on the international federation of gynaecology and obstetrics staging with surgical treatment, adjuvant chemotherapy and radiotherapy.

scholarly journals Validation of the Diagnostic Score for Acute Lower Abdominal Pain in Women of Reproductive Age

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Kijja Jearwattanakanok ◽  
Sirikan Yamada ◽  
Watcharin Suntornlimsiri ◽  
Waratsuda Smuthtai ◽  
Jayanton Patumanond
Keyword(s):  
Abdominal Pain ◽  
Likelihood Ratio ◽  
Lower Abdominal Pain ◽  
Positive Likelihood Ratio ◽  
Clinical Score ◽  
Reproductive Age ◽  
Differential Diagnoses ◽  
Validation Data ◽  
Diagnostic Score ◽  
Development Data

Background. The differential diagnoses of acute appendicitis obstetrics, and gynecological conditions (OB-GYNc) or nonspecific abdominal pain in young adult females with lower abdominal pain are clinically challenging. The present study aimed to validate the recently developed clinical score for the diagnosis of acute lower abdominal pain in female of reproductive age.Method. Medical records of reproductive age women (15–50 years) who were admitted for acute lower abdominal pain were collected. Validation data were obtained from patients admitted during a different period from the development data.Result. There were 302 patients in the validation cohort. For appendicitis, the score had a sensitivity of 91.9%, a specificity of 79.0%, and a positive likelihood ratio of 4.39. The sensitivity, specificity, and positive likelihood ratio in diagnosis of OB-GYNc were 73.0%, 91.6%, and 8.73, respectively. The areas under the receiver operating curves (ROC), the positive likelihood ratios, for appendicitis and OB-GYNc in the validation data were not significantly different from the development data, implying similar performances.Conclusion. The clinical score developed for the diagnosis of acute lower abdominal pain in female of reproductive age may be applied to guide differential diagnoses in these patients.

Christmas Surprises

2020 ◽  
pp. 17-26
Author(s):  
Pat Croskerry
Keyword(s):  
Emergency Department ◽  
Cognitive Processes ◽  
Community Hospital ◽  
Rural Hospital ◽  
Middle Aged ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Case Outcome

Case 1 introduces a middle-aged woman with bradycardia who is transferred from a rural hospital to the emergency department of a community hospital. She has an external pacemaker and is unconscious on arrival. An account of the course of her management is provided, along with an exploration of prevailing conditions and cognitive processes and biases that led to the case outcome.

scholarly journals Epidemiology and Risk Factors of Pelvic Inflammatory Disease.

2015 ◽  
Vol 13 (1) ◽  
pp. 4-8
Author(s):  
Bandana Pandey
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Rural Areas ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Modern Contraceptive ◽  
Age Group ◽  
Increased Risk ◽  
Reproductive Age Group

Introduction: Knowledge of pelvic inflammatory disease and its epidemiology is essential to understand reproductive morbidity in women. This paper estimates the level of association between demographic factors and pelvic inflammatory disease in women in their reproductive age. Methods: A descriptive study done in Humla, Kritipur and Baudha by organizing a health camp. Women of reproductive age group and who have lower abdominal pain, pervaginal discharge, fever, and dysparunia were included in the study after taking informed verbal consent from the patient. Patients who have lower abdominal pain and pervaginal discharge were diagnosed as pelvic inflammatory disease. Results: Diagnoses of pelvic inflammatory disease were made in 30% of attendances amongst women aged between 16 to 48. Increased risk of pelvic inflammatory disease was associated with smoking (P<0.0001), age groups 31 – 40 yrs (44.6%),in rural areas(45%) and people who are illiterate (P<0.0001). Among 400, 383(95%) were reported ever using a modern contraceptive. Conclusion: The prevalence of pelvic inflammatory disease was 30% in reproductive age group and was significantly associated with smoking.doi: http://dx.doi.org/10.3126/mjsbh.v13i1.12992 

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