CLINCIAL PRESENTATION AND ULTRASONOGRAPHIC MARKERS OF PID

2021 ◽  
pp. 43-47
Author(s):  
Uma Jain ◽  
Deepali Jain ◽  
Urvi Gupta
Keyword(s):  
Abdominal Pain ◽  
Clinical Examination ◽  
Female Genital Tract ◽  
Lower Abdominal Pain ◽  
Abnormal Uterine Bleeding ◽  
Pelvic Examination ◽  
Acute Pelvic Pain ◽  
Number Of Patients ◽  
Pouch Of Douglas ◽  
Cervical Motion

INTRODUCTION: Pelvic inammatory disease (PID) comprises a spectrum of inammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, Tubo-ovarian abscess, and pelvic peritonitis. The CDC has estimated that more than I Million women experience an episode of PID every year. Studies have reported prevalence ranging from 5.2% to 17.2% PID in various parts of India. Ultrasound:- TAS was initially used followed by use of TVS with Doppler in diagnosis of PID, although there are no large studies evaluating its sensitivity and or overall usefulness. Itis a frequentlyordered study in patients with classic symptoms of PID or who have unexplained, acute pelvic pain. MATERIAL AND METHODS:A retrospective analysis of medical records of patients with a complaint of lower abdominal pain was included in the study. Diagnosis of PID was made and patient was followed in the outdoor clinic. Pelvic examination was made. USG was done. According to symptoms and clinical examination for PID patients, the data was recorded. Medical record of 120 patients from 1 January 2020 to 31 May 2021 from a private clinic in Dist. Shivpuri were studied. RESULTS: In our study out of 120 cases, most of the patients 50.83% belonged to 26-30 years of age, a maximum number of patients were rural 83.33%. Most of the patients were educated below HSC 56.66%. Most of them 85% were married and most of them were multipara 56.66%. The most common presenting complaint was a pain in the abdomen (100%), followed by per vaginal discharge (65%), pain in the lower back (43.33%), abnormal uterine bleeding (40%), dysmenorrhoea (31.66%), dyspareunia (24.16), fever (17.5%) and others. On clinical examination abnormal PV discharge was present in 61.66% of cases, xed and retroverted uterus with or without thickend appendages were found in 55% of cases. Cervical motion tenderness was found in 78.33% of cases. Adnexal tenderness was found in 80% of cases but adnexal mass was found in 10.83% of cases. The most common nding on ultrasound scan was uid in the pouch of douglas 48.33%, followed by distal hydrosalphinx 28.33%, endometritis 18.33%, pyosalpinx 15%, TO Mass 13.33% and Pelvic collection in 10.83% of cases. CONCLUSION:The focus of this study was to identied socio-demographic characteristics of PID, to see the variety of presenting complaints and pelvic examination ndings and to correlate the clinical ndings with the USG ndings of PID. Much studies about the sensitivity & specicity of USG are not available, but this is denitely the most frequently ordered investigation in cases of PID. Transabdominal ndings of 'incomplete septa' 'cog wheel' 'beads on a strings' signs helps in distinguishing a dilated fallopian tube from other cystic adnexal masses To prevent long term sequelae PID should be the part of differential diagnosis in all patients aged 15-44 year with non specic abdominal pain.

scholarly journals Primary Amenorrhoea - A review of 26 Cases

2016 ◽  
Vol 20 (3) ◽  
Author(s):  
Farhat Iqbal ◽  
Naheed I
Keyword(s):  
Abdominal Pain ◽  
Clinical Examination ◽  
Lower Abdominal Pain ◽  
Imperforate Hymen ◽  
Detailed History ◽  
Primary Amenorrhoea ◽  
Secondary Sex Characters

This is a study of twenty six subjects who presented to Sir Ganga Ram Hospital, Lahore 1999-2001 and were cases of primary amenorrhoea 20(76.9%) of patient presented between 15-25 years of age. Five (19.2%) had lower abdominal pain. Secondary sex characters were developed in 69.2%. Uterus was absent in 4(15.5%) and ovaries were present in 17(65.5%). FSH was high >40mIU in 12(46.5%) and low <3mIU in 2(7%), 14(53.5%) were put on HRT 1(3.8%) had gonadectomy. 5(19.3%) patients had imperforate hymen, where excision was done. It was concluded that detailed history, through clinical examination and minimal investigations are required to diagnose cases of primary amenorrhoea.

scholarly journals Heterotopic Pregnancy: A Clinical Case Report

1970 ◽  
Vol 39 (3) ◽  
Author(s):  
S Chowdhury ◽  
T Chowdhury
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Clinical Examination ◽  
Clinical Case ◽  
Lower Abdominal Pain ◽  
Tubal Pregnancy ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Ectopic Pregnancies

Heterotopic pregnancy is coexistence of intrauterine and extrauterine pregnancies that is ectopic pregnancies. It is said to be rare. Here we report a case of 27 years old woman with heterotopic pregnancy. Patient had a typical presentation of severe lower abdominal pain following amenorrhoea for 2½ months. On clinical examination, there was suspicion of ectopic pregnancy but ultrasonography revealed early intrauterine pregnancy along with right tubal pregnancy with huge collection in abdomen . Immediate laparotomy was done and diagnosis was confirmed as a case of heterotopic pregnancy.DOI: http://dx.doi.org/10.3329/bmj.v39i3.9950 BMJ 2010; 39(3)

scholarly journals Pelvic Abscess after Cesarean Section Treated with Laparoscopic Drainage

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Yumi Murayama ◽  
Tomohito Tanaka ◽  
Hiroshi Maruoka ◽  
Atsushi Daimon ◽  
Shoko Ueda ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Abdominal Pain ◽  
Cesarean Section ◽  
Lower Abdominal Pain ◽  
Pelvic Abscess ◽  
Laparoscopic Drainage ◽  
Pouch Of Douglas ◽  
Uterine Scar

Cesarean section (CS), the rate of which is increasing worldwide, may be associated with complications. Although pelvic abscess after CS is rare, it is difficult to treat. We herein report two cases of pelvic abscess treated laparoscopically after CS. The abscesses of the patients were located in the pouch of Douglas and the uterine scar after CS, respectively. Several days after CS, the patients presented with lower abdominal pain and fever. Laparoscopic drainage was performed because imaging revealed a pelvic abscess that was not amenable to drainage through interventional radiology. The patients recovered from infection and were discharged four days after drainage.

scholarly journals Laparoscopic Sacropexy: A Retrospective Analysis of the Subjective Outcome in 310 Cases

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
B. Bojahr ◽  
G. Tchartchian ◽  
M. Waldschmidt ◽  
R. Ohlinger ◽  
R. L. De Wilde
Keyword(s):  
Cohort Study ◽  
Abdominal Pain ◽  
Retrospective Cohort ◽  
Lower Abdominal Pain ◽  
Subjective Outcome ◽  
Body Sensation ◽  
Number Of Patients ◽  
Laparoscopic Sacropexy ◽  
Postoperative Symptoms ◽  
Subjective Outcomes

Background and Objective. The aim of this study was to assess the subjective outcome following laparoscopic sacropexy.Methods. We performed a retrospective cohort study among women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. 310 patients received questionnaires during followup assessing major pre- and postoperative symptoms and overall satisfaction.Results. 214 (69%) patients responded to the questionnaire. Mean followup was 24.5 months. The number of patients with back or lower abdominal pain, foreign body sensation in the vagina and prolapse-related symptoms, urinary symptoms, vaginal and bladder infections, and the need for pessary usage decreased significantly postsurgically. Bowel symptoms increased slightly but not significantly. Two years after surgery, nearly 2 thirds of the women were satisfied or very satisfied with the outcome.Conclusion. Laparoscopic sacropexy is an effective treatment of descensus, with favorable or satisfactory subjective outcomes.

Obstetrics and Gynaecology

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Female Genital Tract ◽  
Lower Abdominal Pain ◽  
Emergency Operation ◽  
First Trimester ◽  
Daily Basis ◽  
Waiting Room ◽  
Threatening Condition ◽  
Patient Will

O&G is one of the broadest hospital-based specialties, encompassing medicine, surgery, and childbirth; so it is no wonder that O&G patients with a diverse range of symptoms present to the ED on a daily basis. The most common symptoms are PV bleeding, in both pregnant and non-pregnant females, PV discharge, and lower abdominal pain. The majority of these cases are benign and the patient can be discharged after reassurance and arrangement of primary care follow-up, but a few of them may have an underlying life-threatening condition. One classic example is a ruptured ectopic pregnancy. About 10% of females who present to the ED with PV bleeding or abdominal pain in the first trimester of the pregnancy have an ectopic pregnancy. Such patients may present in shock following a catastrophic haemorrhage in the abdomen or arrive at the ED well but collapse in the waiting room. Management of these emergencies requires establishment of IV fluid resuscitation, analgesia, and involvement of an O&G specialist. Such patients are often rushed to the theatre for emergency operation to control the haemorrhage. In other situations, the normal practice of taking a history and physical examination should be followed. Bear in mind that close attention to privacy and confidentiality is most crucial during the procedure. Interview the patient without the other family members if possible, as the patient may be reluctant to tell the whole story in their presence. Pelvic examination is sometimes painful, undignified, and embarrassing to many patients especially if the examining doctor is a male. This can be avoided to a large extent by explaining the process of examination, and performing it gently in the presence of a chaperone. It must not be forgotten that vaginal bleeding during pregnancy produces maternal distress, for which also the patient will need support. Patients presenting with lower abdominal pain often have a disease related to the female genital tract or the urinary system. But the lower GI tract may also contribute to the pain and should therefore be included in the differentials. With regard to the reproductive system, there are a few causes of pain during pregnancy.

scholarly journals Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial

2020 ◽  
Vol 36 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kyung Jin Cho ◽  
Do Yeon Hwang ◽  
Hyun Joo Lee ◽  
Ki Hoon Hyun ◽  
Tae Jung Kim ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Controlled Trial ◽  
Vital Signs ◽  
Lower Abdominal Pain ◽  
Stapled Hemorrhoidopexy ◽  
Control Group ◽  
Lidocaine Group ◽  
Physical Status Classification ◽  
Number Of Patients ◽  
Lidocaine Injection

Purpose: This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.Methods: One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).Results: Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).Conclusion: Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

scholarly journals Isolated Fallopian Tube Torsion

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
S. Kardakis ◽  
A. Barranca ◽  
A. Vitelli ◽  
I. Amore ◽  
F. Trento ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Fallopian Tube ◽  
Pelvic Pain ◽  
Lower Abdominal Pain ◽  
Laboratory Findings ◽  
Clinical Imaging ◽  
Adnexal Masses ◽  
Preoperative Ultrasound ◽  
Cystic Component ◽  
Acute Pelvic Pain

Isolated torsion of the Fallopian tube is a rare gynecological cause of acute lower abdominal pain, and diagnosis is difficult. There are no pathognomonic symptoms; clinical, imaging, or laboratory findings. A preoperative ultrasound showing tubular adnexal masses of heterogeneous echogenicity with cystic component is often present. Diagnosis can rarely be made before operation, and laparoscopy is necessary to establish the diagnosis. Unfortunately, surgery often is performed too late for tube conservation. Isolated Fallopian tube torsion should be suspected in case of acute pelvic pain, and prompt intervention is necessary.

Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

2016 ◽  
Vol 76 (10) ◽  
Author(s):  
A Jurga-Karwacka ◽  
GM Karwacki ◽  
FD Schwab ◽  
A Schötzau ◽  
C Zech ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Pelvic Congestion Syndrome ◽  
Pelvic Congestion

scholarly journals Pyometra: An Atypical Cause of Abdominal Pain

2021 ◽  
Vol 9 ◽  
pp. 232470962110224
Author(s):  
Leonidas Walthall ◽  
Marc Heincelman
Keyword(s):  
Abdominal Pain ◽  
Vaginal Discharge ◽  
Elderly Women ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Laboratory Evaluation ◽  
Inpatient Service ◽  
Gynecologic Malignancy ◽  
Intravenous Contrast ◽  
Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

scholarly journals Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Michio Itabashi ◽  
Yoshiko Bamba ◽  
Hisako Aihara ◽  
Kimitaka Tani ◽  
Ryousuke Nakagawa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Anterior Wall ◽  
Middle Part ◽  
Presacral Space ◽  
Previous Surgery ◽  
Afferent Limb ◽  
Radiographic Findings ◽  
Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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