Abstract
Background. Transvaginal ultrasound (TVU) in female patients with acute right lower quadrant (RLQ) abdominal pain is time and infrastructure intensive and not always available. This study aims to evaluate the role of TVU in these patients. Methods. Retrospective analysis identified 224 female patients with RLQ pain and TVU. Results. TVU revealed an underlying pathology in 34 (15%) patients, necessitating a diagnostic laparoscopy in 12 patients. Six patients (2%) had a true gynaecological emergency. The remaining 23 patients did not require surgery. The other 190 patients with RLQ pain had a bland TVU; 127 (67%) were discharged, while 63 patients (33%) received a diagnostic laparoscopy. Conclusion. The incidence of true gynaecological emergencies requiring urgent surgical intervention is very low in our patient cohort. TVU is a helpful tool if performed by a physician who is well trained in TVU.
Highlights
Evaluating acute right lower quadrant (RLQ) abdominal pain in nonpregnant female patients (NPF) remains a clinical challenge despite advances in—and more liberal use of—imaging techniques. Workup of this patient group is more difficult than with male patients, due to the local anatomical differences with many gynaecological pathologies potentially mimicking more common diseases such as acute appendicitis. This symptom is very common in emergency departments (EDs), there is no clear literature providing a thorough and systematic approach that should be followed by ED physicians when facing RLQ abdominal pain in NPF
The aim of this study is to review our ED experience in approaching NPF with RLQ abdominal pain and to describe the role of Transvaginal ultrasound (TVU) in supporting decisions made by ED physicians
Seven (3.1%) patients who presented to our ED with RLQ abdominal pain and in whom a TVU was carried out suffered from a gynaecological pathology necessitating immediate intervention
Summary
Evaluating acute right lower quadrant (RLQ) abdominal pain in nonpregnant female patients (NPF) remains a clinical challenge despite advances in—and more liberal use of—imaging techniques Workup of this patient group is more difficult than with male patients, due to the local anatomical differences with many gynaecological pathologies potentially mimicking more common diseases such as acute appendicitis. This symptom is very common in emergency departments (EDs), there is no clear literature providing a thorough and systematic approach that should be followed by ED physicians when facing RLQ abdominal pain in NPF While diagnostic tools such as abdominal computed tomography and/or magnetic resonance imaging can improve diagnostic accuracy [1, 2], the problem of unnecessary exposure to radiation and/or the lack of 24-hour availability remains a real issue. TVU is a helpful tool if performed by a physician who is well trained in TVU
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