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Lower Abdominal Pain (lower + abdominal_pain)
Selected AbstractsUtility of eosinophilia as a diagnostic clue in lower abdominal pain in northern Australia: a retrospective case,control studyINTERNAL MEDICINE JOURNAL, Issue 4 2008P. J. Clark Abstract Acute eosinophilic enteritis is a difficult diagnosis to make. Insufficient consideration of eosinophilia may commit patients to surgical treatment when medical therapy may be appropriate. The aim of the study was to determine whether the eosinophil count was considered in the diagnostic evaluation of patients presenting with acute abdominal pain who subsequently underwent appendectomy and whether eosinophilia was related to subsequent histology. The method used in the study was retrospective case,control. None of three patients with increased eosinophil counts had histologically proven appendicitis (Fisher's exact test 0.025); worm segments were seen in two patients. None of 39 patients who had histologically proven appendicitis had increased eosinophil counts. Eosinophilia may be underutilized and helminth infection may not be considered in the differential diagnosis of abdominal pain. A normal eosinophil count in the setting of clinically suspected appendicitis may make the diagnosis of eosinophilic enteritis less likely, but does not exclude it. Patients with abdominal pain and peripheral eosinophilia appear less likely to have acute appendicitis on subsequent histology; however, further study is required to validate these findings. The decision to operate remains one of clinical judgement. [source] Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsionJOURNAL OF CLINICAL ULTRASOUND, Issue 8 2009Khatib Nizar MD Abstract Purpose. To evaluate the role of ovarian Doppler studies in diagnosing adnexal torsion. Methods. We included in that study all patients who had an adnexal mass with clinical symptoms of intermittent lower abdominal pain and were hospitalized for at least 48 hours of observation. Our protocol included: measurements of the size of the adnexal mass, presence or absence of ovarian edema, presence or absence of adnexal vascularity, presence or absence of ovarian artery flow, presence or absence of ovarian venous flow, pattern of ovarian venous flow. The ovarian artery and vein were sampled just above and lateral to the adnexa. Sensitivity, specificity, and positive and negative predictive values in the diagnosis of adnexal torsion were calculated for each of the gray-scale and Doppler sonographic (US) findings. Results. One hundred and ninety-nine patients presented with adnexal mass and intermittent lower abdominal pain. Sensitivity and specificity of tissue edema, absence of intra-ovarian vascularity, absence of arterial flow, and absence or abnormal venous flow in the diagnosis of adnexal torsion were: 21% and 100%, 52% and 91%, 76% and 99%, and 100% and 97%, respectively. All patients with adnexal torsion had absent flow or abnormal flow pattern in the ovarian vein. In 13 patients, the only abnormality was absent or abnormal ovarian venous flow with normal gray-scale US appearance and normal arterial blood flow. Of these 13 patients, 8 (62%) had adnexal torsion or subtorsion. Conclusion. Abnormal ovarian venous flow may be the only abnormal US sign observed during the early stage of adnexal torsion. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source] Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case reportJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2 2009Le-Ming Wang Abstract Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1, 1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall. [source] Interstitial Cystitis and the Therapeutic Effect of Suplatast TosilateLUTS, Issue 2009Yukio HAYASHI Painful bladder syndrome (PBS)/interstitial cystitis (IC) can be a chronic and debilitating disease characterized by urinary urgency, frequency, and bladder pain, which are often very difficult to treat, regardless of currently-proposed treatments. Suplatast tosilate (IPD-1151T) is an immunoregulator that suppresses Th2 cytokine production, immunoglobulin E (IgE) synthesis, chemical mediator release from mast cells, and eosinophilic recruitment. In a preliminary, open-label clinical study of IPD-1151T in 14 women with IC, treatment with IPD-1151T significantly increased bladder capacity and decreased urinary urgency, urinary frequency, and lower abdominal pain, as measured by the IC symptom index, in patients with non-ulcerative IC. A concomitant reduction in immunological parameters (eosinophils, IgE, and urine T cells) was observed. Also, in basic experimental studies using hydrochloric acid-induced chronic cystitis rats, the oral administration of IPD-1151T (0.1,100 mg/kg/day) for 7 days after the induction of cystitis dose dependently increased the intercontraction intervals and micturition volume. In addition, the infiltration of mast cells and eosinophils into the bladder was suppressed by IPD-1151T. These findings suggest that IPD-1151T could be a new medicine for treating debilitating symptoms, such as bladder pain and urinary frequency in PBS/IC. [source] Ovarian pregnancy: Report of four cases and review of the literaturePATHOLOGY INTERNATIONAL, Issue 11 2003Hiroshi Itoh Ovarian ectopic pregnancy is rarely seen; it constitutes only 0.5,3% of all ectopic pregnancies and the incidence is only 1 for every 7000,40000 deliveries. We herein report four cases of primary ovarian pregnancy encountered during the last 10 years in Miyazaki prefecture, Japan. The patients in all of these cases were admitted to their local hospitals with increased lower abdominal pain and intraperitoneal bleeding, and had surgery for total or partial oophorectomy. Grossly and microscopically, chorionic villi were exclusively found in the ovary but not in the fallopian tube, so that we diagnosed these cases as primary ovarian pregnancies. None of the patients were known to have used an intrauterine contraceptive device, which have been suggested as the cause of ovarian pregnancies in several studies. The incidence of ovarian pregnancy is recently increasing, and pathologists will have increased chances to diagnose this disease. [source] Malignant müllerian mixed tumor (carcinosarcoma) of the fallopian tube: an immunohistochemical study of neoplastic cells,APMIS, Issue 9 2005Case report The patient was a 65-year-old woman who complained of lower abdominal pain. Salpingo-oophorectomy and hysterectomy were performed due to suspicion of ovarian cancer. At surgery a polypoid mass was observed in the fimbria of the left fallopian tube. Histologically, proliferation of undifferentiated neoplastic cells with marked cytological atypia predominated in the tumor. Proliferation of rhabdomyoblastic cells or spindle cells, as well as adenocarcinoma arising from the mucosa of the fallopian tube, was observed. A diagnosis of malignant müllerian mixed tumor (MMMT) was made. CD10 was expressed in adenocarcinoma, undifferentiated, spindle and rhabdomyoblastic cells. Furthermore, rhabdomyoblastic cells were positive for desmin and myoglobin. Undifferentiated and spindle neoplastic cells were focally positive for ASMA and negative for h-caldesmon. Finally, our preliminary report suggests that MMMT of the fallopian tube may contain immature smooth muscle cells or cells with the myofibroblast-like immunohistochemical phenotype in the undifferentiated component. [source] Idiopathic ovarian vein thrombosis: A rare cause of pelvic pain , Case report and review of literatureAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Meghan STAFFORD Ovarian vein thrombosis is a condition most commonly identified in the puerperium and in association with malignancy, pelvic infections, surgery and thrombophilia. We report a case of idiopathic ovarian vein thrombosis and therefore highlight the importance of considering the diagnosis in women presenting with lower abdominal pain, in whom more common diagnoses cannot be identified. [source] Successful pregnancy outcome following first trimester pelvic inflammatory diseaseAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2000Michael L Stitely Summary: Pelvic inflammatory disease rarely complicates pregnancy. Although few in number, most of the previously reported cases have resulted in spontaneous abortion or intrauterine fetal demise. At 5 weeks gestation, a 20 year old gravida 2 para 1 underwent uterine curettage and diagnostic laparoscopy for a suspected ectopic gestation. Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. After 84 hours of intravenous cefazolin, gentamycin, and clindamycin, the patient had resolution of all symptoms. She then completed 14 days of outpatient antibiotic therapy with oral cephalexin. At 39 weeks gestation, she delivered a 3611 g male fetus via spontaneous vaginal delivery. Successful pregnancy outcome can occur after first trimester pelvic inflammatory disease. [source] Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008KS Oppegaard Objective, To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy. Design, Two separate but identical parallel, randomised, double-blind, placebo-controlled sequential trials, one in premenopausal women and one in postmenopausal women. The boundaries for the sequential trials were calculated on the primary outcomes of a difference of cervical dilatation ,1 mm, with the assumption of a type 1 error of 0.05 and a power of 0.95. Setting, Norwegian university teaching hospital. Sample, Eighty-six women referred to outpatient operative hysteroscopy. Methods, The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient operative hysteroscopy. Main outcome measures, Preoperative cervical dilatation (primary outcome), number of women who achieve a preoperative cervical dilatation ,5 mm, acceptability, complications and adverse effects (secondary outcomes). Results, In premenopausal women, the mean cervical dilatation was 6.4 mm (SD 2.4) in the misoprostol group and 4.8 mm (SD 2.0) in the placebo group, the mean difference in cervical dilatation being 1.6 mm (95% CI 0.5,2.7). Among the premenopausal women receiving misoprostol, 88% achieved a cervical dilatation of ,5 mm compared with 65% in the placebo group. Twelve percent of the women who received misoprostol were difficult to dilate compared with 32% who received placebo. Dilatation was also quicker in the misoprostol group. Misoprostol had no effect on cervical ripening in postmenopausal women compared with placebo, and 43% of the women were difficult to dilate. The trials were terminated after analysis of 21 postmenopausal women and 65 premenopausal women after reaching a conclusion on the primary outcome with only 28% of the number of women needed in a fixed sample size trial. Three of 45 women who received misoprostol experienced severe lower abdominal pain, and there was an increased occurrence of light preoperative bleeding in the misoprostol group. Most women did not experience misoprostol-related adverse effects. The majority (83% of premenopausal and 76% of postmenopausal women) found self-administered vaginal misoprostol at home to be acceptable. There were two serious complications in the premenopausal misoprostol group: uterine perforation with subsequent peritonitis and heavy postoperative bleeding requiring blood transfusion, but these were not judged to be misoprostol related. Complications were otherwise comparatively minor and distributed equally between the two dosage groups. Conclusions, One thousand micrograms of self-administered vaginal misoprostol 12 hours prior to operative hysteroscopy has a significant cervical ripening effect compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal misoprostol of 1000 micrograms at home the evening before operative hysteroscopy is safe and highly acceptable, although a small proportion of women experienced severe lower abdominal pain. There is a risk of lower abdominal pain and light preoperative bleeding with this regimen, which is very cheap and easy to use. [source] The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, IndiaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006V Patel Objective, To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India. Design, Cross-sectional survey. Setting, Catchment area of primary health centre in Goa, India. Population, Three thousand women aged 18,45 years randomly selected. A total of 2494 women consented to participate (83.1%). Methods, Eligible participants were asked standardised questions regarding menstrual complaints over the past 12 months, and socio-demographic, psychosocial and reproductive risk factors. Vaginal or urine specimens were collected for the diagnosis of reproductive tract infections. Main outcome measures, Dysmenorrhoea of moderate to severe intensity. Results, A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4,35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate,severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95% CI 1.5,34); other somatic complaints (OR 3.67, 95% CI 2.7,4.9 for highest somatoform symptom score category compared with the lowest); gynaecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3,2.3; dysuria: OR 1.98, 1.4,2.7); menorrhagia (OR 1.92, 95% CI 1.4,2.6); and illiteracy (OR 1.32, 95% CI 1.0,1.7). Having had a pregnancy (OR 0.53, 95% CI 0.4,0.7), older age of menarche (OR 0.70, 95% CI 0.5,0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3,0.6 for age 40,50, compared with 18,24 years) were protective. Conclusions, The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint. [source] | ||||||||||