1/56. An "enigmatic" cause of back pain following regional anaesthesia for caesarean section: septic pelvic thrombophlebitis.A case of septic pelvic thrombophlebitis is reported. This presented as back pain and leg weakness 18 days after regional anaesthesia for caesarean section. The patient was referred to the Department of Anaesthesia. Obstetric review of the patient at the request of the anaesthetist led to a CT scan that demonstrated the diagnosis. This condition may lead to fatal "on-table" pulmonary embolus if the thrombosed vein is handled during an exploratory laparotomy. Treatment should be conservative with antibiotics and anticoagulation. This case illustrates the need for awareness amongst anaesthetists of possible surgical causes for morbidity that may initially appear anaesthetic-related.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/56. Successful pregnancy outcome following first trimester pelvic inflammatory disease.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.- - - - - - - - - - ranking = 1.2988810668747keywords = abdominal pain, pain (Clic here for more details about this article) |
3/56. Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis.BACKGROUND: Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis. CASE: A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass. CONCLUSION: In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.- - - - - - - - - - ranking = 1.2988810668747keywords = abdominal pain, pain (Clic here for more details about this article) |
4/56. The value of laparoscopy in the diagnosis and therapy of violin-string like perihepatic nonpostoperative adhesions.We report three cases of Fitrz-Hugh Curtis syndrome (FHCs) that were diagnosed laparoscopically and showed microbiological or serological evidence of chlamydial infection. The case histories underscore the part played by abdominal right quadrant symptoms. In all three cases, right quadrant pain and tenderness constituted the presenting features. The patients were thought to have acute cholecystitis or acute appendicitis, but investigations proved negative. laparoscopy was the key to the diagnosis, revealing the violin-string-like perihepatic adhesions typical of this syndrome. Lysis of the adhesions resolved the patients' symptoms of persistent severe abdominal pain. In the first case, the pain lessened dramatically only after the third operation, when the perihepatic adhesions were lysed. In the two other cases, the lysis was performed laparoscopically by fulguration and cutting. We consider this procedure to be an excellent therapeutic modality for the pain associated with FHCs.- - - - - - - - - - ranking = 1.8988810668747keywords = abdominal pain, pain (Clic here for more details about this article) |
5/56. An unusual cause of pelvic mass.BACKGROUND: pelvic pain with an associated pelvic mass is a common problem in the emergency room (ER) or physician's office. Concerns about ectopic pregnancy, infection, or malignancy usually dominate the diagnostic evaluation. At the same time, domestic violence as the cause of a pelvic mass is seldom suspected by physicians. CASE: A 38-year-old woman came to the ER with left lower quadrant pain and a left pelvic mass. After four hospital days and multiple diagnostic imaging studies, the diagnosis of hematoma caused by physical trauma to the abdomen was elucidated. CONCLUSION: Proper diagnosis of the cause of the pelvic mass could have been made earlier by careful attention to the social history and by recognizing the high incidence of domestic violence as opposed to the relative infrequency of some other diagnostic entities for which the patient was tested.- - - - - - - - - - ranking = 0.4keywords = pain (Clic here for more details about this article) |
6/56. Pelvic actinomycosis in menopause: a case report.OBJECTIVE: To examine the association between the use of intra uterine device (IUD) and the risk of actinomycosis in postmenopausal women. methods: We report a case of pelvic actinomycosis in a postmenopausal woman who was wearing an IUD for 14 years until 20 months after the beginning of menopause. In the last 5 years the patient had been suffering occasionally from pain, abdominal tension and rectal tenesmus. The disease was revealed clearly 18 months after removing the intrauterine device. RESULTS: The diagnosis of pelvic actinomycosis was only possible after hysterectomy, bilateral oophorectomy and multiple biopsies. At histological features a focus with actynomycetes colonies was evident. CONCLUSIONS: This study supports the previously reported association between the pelvic location of actinomycosis and the use of the IUD. The removal of IUD should be mandatory in postmenopausal women.- - - - - - - - - - ranking = 0.2keywords = pain (Clic here for more details about this article) |
7/56. Laparoscopic diagnosis and management of Fitz-Hugh-Curtis syndrome: report of three cases.Perihepatic adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface characterizes Fitz-Hugh-Curtis syndrome (FHCS). FHCS is an extrapelvic manifestation of pelvic inflammatory disease and usually refractory to medical treatment and surgical intervention. With the increased incidence of pelvic inflammatory disease, chronic pelvic pain and sequalae of the process are becoming more common. Herein, we report 3 patients with pelvic inflammatory disease in whom medical treatment failed initially and FHCS was diagnosed via laparoscopy. Laparoscopic lysis of pelvic and perihepatic adhesions, irrigation of the abdomino-pelvic cavity, and antibiotics treatment after surgery successfully relieved these patients' symptoms. FHCS is not a new syndrome but most gynecologists might neglect this condition. laparoscopy is a less invasive procedure than exploratory laparotomy. We recommend laparoscopy in patients with lower abdominal and right upper quadrant discomfort when other organic disease has been ruled out and medical treatment has failed to relieve symptoms.- - - - - - - - - - ranking = 0.20222734720017keywords = pain, upper (Clic here for more details about this article) |
8/56. Tubo-ovarian abscess presenting as pneumoperitoneum.BACKGROUND: Tubo-ovarian abscess (TOA), a serious complication of pelvic inflammatory disease, often require the antibiotic administration, surgical resection or the transvaginal aspiration. pneumoperitoneum is often associated with the bowel perforation. We reported one case with TOA and pneumoperitoneum that have been mistaken for a perforated bowel with concomitant adnexal mass. CASE: A 30-year-old diabetic Chinese woman was transferred for diffused abdominal pain, mild fever, nausea, and low-grade fever for 5 days. The sonography revealed a 5-cm adnexal mass. The chest x-rays revealed the pneumoperitoneum. Under the impression of bowel perforation and concomitant adnexal cyst, the emergent laparotomy was performed and the TOA was resected. No evidence of gastrointestinal perforation was present. culture studies showed escherichia coli without other bacteria flora. The postoperative course was uneventful. CONCLUSION: We concluded that, beside the bowel perforation, TOA should be considered when a diabetic woman presents with pneumoperitoneum and adnexal mass.- - - - - - - - - - ranking = 1.2988810668747keywords = abdominal pain, pain (Clic here for more details about this article) |
9/56. pelvic inflammatory disease associated with enterobius vermicularis.A case of pelvic inflammatory disease in a sexually non-active 13 year old girl is described, with evidence of pinworms as the cause. albendazole treatment cleared the infestation but the patient suffered subsequent bouts of lower abdominal pain. The literature is reviewed regarding abdominal pathology associated with ectopic migration of pinworms.- - - - - - - - - - ranking = 1.2988810668747keywords = abdominal pain, pain (Clic here for more details about this article) |
10/56. Spectrum of abdominal and pelvic infections caused by pneumococci in previously healthy adult women.Eleven cases of pneumococcal infection of abdominal and pelvic origin that occurred in previously healthy adults are described. All cases occurred in women who were admitted to a county hospital in norway with acute abdominal symptoms such as pain, nausea, vomiting and diarrhea. Explorative laparotomy was performed in eight patients. Three patients had diffuse peritonitis and seven cases were classified as pelvic inflammatory disease; five of these seven patients had pelvic peritonitis. All patients but one were treated with antibiotics, and all survived without long-term sequelae. Although abdominal and genital infections caused by pneumococci are rare, their potential occurrence should not be neglected.- - - - - - - - - - ranking = 0.2keywords = pain (Clic here for more details about this article) |
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