Cyclical Lower Abdominal Pain Research Articles

Ultrasound features of neonate and paediatric female pelvis: Developmental change, physiologic and pathologic condition

The evaluation of the infant and pediatric pelvis requires the knowledge of the developmental changes occurring in the various stages of pediatric life. To be familiar with imaging findings of uterus and ovary diseases is helpful for diagnosis and preoperative evaluation. The uterus and ovaries undergo remarkable changes in size and appearance over the course of a lifetime. Ultrasonography (US) is the primary modality for the evaluation of the pediatric gynecologic organs. Variable physiologic and pathologic condition may arise from ovary including physiologic and functioning follicles, corpora lutea, hemorrhagic cysts, endometriomas, polycystic ovaries and ovarian tumors. For hydrometrocolpos, most cases present in adolescent period presenting with amenorrhea and cyclic lower abdominal pain. Hernia of uterus and ovary commonly occurs in infant. Herein, we present ultrasound imaging findings of morphologic change and various diseases involving female pelvis organ in infant and pediatric patients. It is helpful to be familiar with the spectrum of ultrasound image findings of the normal and abnormal female reproductive tract in infant and pediatric patients to avoid misinterpretation.

Use of amnion graft and surgicel in vaginoplasty for secondary vaginal atresia: A case report

Vaginal atresia can be congenital or acquired. The tissue is virgin in primary vaginal atresia or agenesis, so various methods have been used with successful outcomes. On the other hand, one can expect a lot of fibrosed tissue in secondary atresia. There is no elaborate literature on secondary vaginal atresia. There is also no standard treatment for both the types of vaginal atresia. The use of amnion graft and surgicel in vaginoplasty for secondary atresia is one of our experiences with best results. We report a case of a 22-year-old primipara who presented with dyspareunia and cyclical lower abdominal pain for the past 4 months. She had a history of traumatic vaginal delivery 3 months prior to presentation. On examination, she was diagnosed with secondary vaginal atresia. We managed her by vaginoplasty with amnion grafting and surgicel, followed by regular dilatation with soft vaginal mould for the next 6 weeks. Our patient is doing well with normal coital function on follow-up.

Ureteric Endometriosis: a 39 Years Old Lady Presented with Cyclical Lower Abdominal Pain

Abstract not available
 J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 98-101

Primary Amenorrhoea with Transverse Vaginal Septum Presented with Infected Pyometra of 24 Weeks Size

Transverse vaginal septum is a congenital anomaly of the female genital outflow tract. It mostly remains unrecognized till adolescence and manifests as primary amenorrhoea with cyclic lower abdominal pain in background of appropriate Tanner staging secondary sex characterstics. Diagnosis is done by clinical examination and imaging, usually Magnetic Resonance Imaging. Early surgical management by vaginal or abdominal approaches improves the outcome. A 16 years, adolescent with appropriate Tanner staging secondary sex characteristics presented to gynecology (OPD) of Kathmandu Model Hospital with complaints of primary amenorrhoea and palpable abdominal mass of 24 weeks size with cyclic lower abdominal pain. Ultrasound showed features suggestive of hematometra. Under spinal anaesthesia, drainage and excision of the transverse vaginal septum was done followed by placement of vaginal mould post-operatively. We present here a case of primary amenorrhoea with pyometra secondary to transverse vaginal septum.

Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps

Study ObjectiveTo demonstrate step-by-step the technique of hysteroscopic adhesiolysis (HA) by means of a blunt spreading technique using double-action forceps to dissect and restore the layer between the anterior and posterior uterine walls in a patient with severe intrauterine adhesions (IUAs), particularly in cases in which the endometrial lining is obscured on ultrasound imaging and the endometrial cavity is completely occluded on hysteroscopy. DesignA step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III). SettingA university-affiliated hospital. PatientA 36-year-old, gravida 3, para 1, abortus 2 woman presenting with amenorrhea for 5 months after surgical termination of a 53-day intrauterine pregnancy. She had no cyclic lower abdominal pain. Ultrasound revealed an obscure endometrial stripe and no obvious hematometra. Both the urine human chorionic gonadotropin test and the progesterone withdrawal test were negative. One month before admission, hysteroscopic adhesiolysis failed because the uterine cavity was inaccessible because of adhesions completely occluding the lower uterine cavity. Additionally, the uterine cavity could not be explored with a probe because the anatomic layer of the endometrial lining could not be easily identified by transabdominal ultrasound. InterventionHA using a blunt spreading dissection technique with double-action forceps to restore the uterine cavity followed by “ploughing” of the intrauterine scar tissue using cold scissors [1]. Measurements and Main ResultsAn intraoperative technique with commentary highlighting tips for a successful dissection. The uterine cavity was successfully restored using the blunt spreading dissection technique. There were no complications, including false uterine wall passage, uterine perforation, or fluid overload. Postoperative hysteroscopy at 1 month revealed an almost normal uterine cavity. ConclusionsHA using a blunt spreading dissection technique to restore the uterine cavity is a simple, effective, and safe hysteroscopic skill, especially when the endometrial stripe is obscured on ultrasound imaging and exploring the uterine cavity by means of a probe has failed. Furthermore, this technique may serve as an alternative to resectoscopic techniques because it uses cold forceps and scissors, which provide better protection for the endometrium.

Laparoscopic Uterovaginal Anastomosis for Cervical Agenesis: A Case Report

Study ObjectiveIsolated cervical agenesis occurs in 1 in 80 000 to 100 000 births. According to the American Fertility Society, cervical agenesis should be classified as a type Ib müllerian anomaly. According to ESHRE/ESGE classification, it is classified in class C4 category. Here we demonstrate the possibility of an innovative surgery for the management of cervical agenesis. DesignStepwise description of laparoscopic uterovaginal anastomosis (Canadian Task Force classification II-3). SettingVideo. PatientA 13-year-old girl. InterventionLaparoscopic uterovaginal anastomosis was performed. Informed consent was taken from the patient for use of video and images. Institutional review board has ruled that approval was not required for this study. Measurements and Main ResultsThis video demonstrates the management of a case of a 13-year-old girl with primary amenorrhea and cyclical lower abdominal pain for 5 months. After complete examination and investigation, a diagnosis of isolated cervical agenesis with hematomata and blind-ending vagina was made. An innovative technique was used to perform laparoscopic uterovaginal anastomosis. Later, a hysteroscopy was done that revealed patency of anastomoses. As a result, the patient is experiencing spontaneous regular menstruation for 48 months. The main steps of the procedure were as follows:1.Placement of uterine suspension sutures for manipulation and stabilization of the uterus.2.Infiltration of 10% vasopressin solution in the uterine fundus.3.Anteroposterior incision over the uterine fundus until the uterine cavity was reached and hematomata drained.4.Urinary bladder dissection to expose the vault of blind-ending vagina.5.An instrument was passed through the fundus to identify the lowermost pole of the uterine cavity and transverse incision made to open the uterine cavity.6.Transverse incision over the vaginal vault.7.Placement of a silastic Foley catheter as a stent between the vagina and uterine cavity.8.Uterovaginal anastomosis over the Foley catheter by placement of series of 2-0 Prolene (Ethicon, Somerville, NJ) sutures.9.Closure of uterine fundus with number 1 Vicryl (Ethicon).10.Distension of Foley bulb in uterine cavity with 3 mL normal saline.A follow-up hysteroscopy was performed at 9 weeks after surgery. It showed patent anastomosis and normal uterine cavity. After 48 months, a repeat hysteroscopy was done and a partial fibrotic septum noted. It was resected using electric energy. ConclusionUterovaginal anastomosis for isolated cervical agenesis is possible by a minimally invasive approach. It can be offered as a first-line management for such cases over hysterectomy and cervical canalization, which have high complication rates. The surgery should only be performed by a specialized team with required expertise in minimally invasive surgery.

Uterus didelphys with obstructed hemivagina and ipsilateral renal anomaly syndrome: A rare cause of cyclic abdominal pain in a young female

Obstructed hemivagina and ipsilateral renal anomaly syndrome is a rare group of urogenital anomalies in which unilateral genital anomaly is associated with ipsilateral renal anomaly. We describe imaging findings in a 14-year-old female patient who presented with cyclical lower abdominal pain.

A rare case of primary amenorrhea

Crytomenorrhea arises usually due to the imperforate hymen, sometimes due to vaginal septum, rarely due to cervical agenesis. Here, we present a case of primary amenorrhea resulting from cervical agenesis in a 38-year-old woman. She presented with primary amenorrhea and cyclic lower abdominal pain. She had undergone some surgery 5 years back, details of which were not available. On examination secondary sexual characters were normal, per abdomen there was an 18 weeks size firm abdominopelvic mass. Local vaginal examination showed a blind vaginal pouch. A clinical diagnosis of hematometra due to transverse vaginal septum was made. However, magnetic resonance imaging pelvis suggested hematometra with cervical stenosis. The patient was taken up for examination under anaesthesia (EUA) and exploratory laparotomy. On opening the abdomen uterus found to be enlarged with dense adhesions all around and signs of endometriosis. Extensive adhesiolysis revealed bilateral chocolate cysts of ovaries with hematosalpinges and peritubal adhesions. Hysterotomy and drainage of tarry contents were followed by an exploration of the uterine cavity. The lower pole ended blindly with no evidence of any cervix. Peroperative diagnosis of cervical agenesis leading to hematometra and endometriosis was made. A subtotal hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination confirmed ovarian endometriosis and adenomyosis of uterus. Though reconstructive surgery for cervical dysgenesis has been successful in some cases, hysterectomy is generally recommended for cervical agenesis.

Imperforate Hymen Presenting with Massive Hematometra and Hematocolpos: A Case Report

Background: Imperforate hymen is the commonest congenital anomaly that causes closure of the vagina. Ideally, diagnosis should be made early during fetal and neonatal examinations to prevent symptomatic presentations of its complications at puberty. Case report: We report a case of a 15-year-old girl who presented with delayed menarche, eight-month history of cyclic abdominal pain, and a three-week history of lower abdominal swelling. A doctor prescribed anthelmintic and analgesic drugs to her a month ago before she was verbally referred to ESUT Teaching Hospital, Enugu. The development of her secondary sexual characteristics was normal for her age. A 20 cm-sized suprapubic mass, and a bulging pinkishimperforate hymen were found on examination. Her transabdominal ultrasound revealed massive hematometra and hematocolpos. She had virginity-preserving hymenotomy and evacuation of about 1000 mls of accumulated coffee-colored menstrual blood. Conclusion: Clinicians should have high index of suspicion of imperforate hymen when assessing cases of delayed menarche with cyclic lower abdominal pain to prevent the consequences of its delayed treatment like massive hematometra and hematocolpos.

Complete cervical stenosis after conization: Timing for the minimally invasive reconstructive surgery

Among various long-term complications after conization, complete cervical stenosis is rare (<1%) but significant. This condition is typically associated with secondary amenorrhea, cyclical lower abdominal pain, and hematometra during menstrual periods. The risk of developing this condition is strongly associated with an estrogen-deficient state. Recently, we experienced a case of complete cervical stenosis after conization performed during lactation amenorrhea. Because our patient visited us during an intermenstrual asymptomatic period, we wondered when was the best time to perform minimally invasive reconstructive surgery. Until now, there has been no report concerning suitable timing for surgery for this condition. The clinical course of our case and clinical considerations associated with this rare complication are discussed.

Transvaginal Excision of Transverse Vaginal Septum in Children

Congenital anomalies of the female genital tract are often asymptomatic and therefore unrecognized. They usually present at adolescent with abdominal pain at the time of menarche. This is a report of two teen aged girls who presented to the University Hospital-Sharjah (UHS) complaining of recurrent attacks of cyclical lower abdominal pain which comes within the premenstrual periods and fades after menses. They were investigated and managed in other hospitals with no improvement. The two patients were diagnosed by trans-abdominal and trans-perineal pelvic U/S in addition to MRI studies which confirmed the diagnosis of didelphys uterus with an obstructing transverse vaginal septum leading to hematocolpos and hematometrocolpos in addition to the presence of an ipsilateral renal agenesis. Per-operative hysteroscopy was valuable in identification of the abnormal anatomy. The technique of transvaginal surgical excision of the septum in both cases with attempt to preserve the hymen in addition to the problems in diagnosis and management of these rare anomalies are discussed.

A Case of Postablation Tubal Sterilization Syndrome

Postablation tubal sterilization syndrome (PATSS) is a cause of severe, cyclic lower abdominal pain in women. There is scant literature available on PATSS for the emergency provider. Most of the evidence that exists on PATSS is presented in case report formats. A patient with PATSS is presented in this article. The purpose of this article is to increase awareness of PATSS as a diagnosis after acute abdominal processes have been excluded and to prevent recurrent emergency department visits. Early diagnosis of PATSS will prompt the emergency department provider to initiate gynecological referral necessary for definitive treatment.

Dysmenorrhoea

Dysmenorrhoea is a medical condition characterized by severe uterine pain during menstruation manifesting as cyclical lower abdominal pain. It is commonly classified into primary dysmenorrhoea in the absence of co-existent pathology and secondary dysmenorrhoea when there is an identifiable pathological condition. About 40–70% of women of reproductive age suffer with dysmenorrhoea along with its associated psychological, physical, behavioural and social distress. It is a leading cause of absenteeism. The exact pathophysiological processes are not fully understood but it probably reflects increased myometrial activity induced by an excessive production of prostaglandin causing ischaemia (uterine ‘angina’). History is critical in establishing the diagnosis of dysmenorrhoea and also in differentiating between primary and secondary dysmenorrhoea. Mainstay treatment is generally supportive providing symptomatic relief and more directive surgical treatment is reserved for specific secondary causes of dysmenorrhoea or for refractory cases. Therefore, patients with primary dysmenorrhoea may simply need reassurance and simple analgesics, while those with secondary dysmenorrhoea require investigation and treatment of the underlying organic problem. We present an overview of managing this condition.

Successful canalization of a noncommunicating uterine horn by horn-vaginal anastomosis: preliminary findings of a novel approach for an unclassified anomaly

Purpose The aim of this study was to present the preliminary results of a new technique for horn-vaginal anastomosis. Methods Horn-vaginal anastomosis without any dissection at the lower pole of the horn or vaginal apex at the site of anastomosis. This was followed by dilation and silicone stent retention for 4 months. Results The patient was a 14-year-old presenting with primary amenorrhea and severe recurrent cyclic lower abdominal pain. The total operative time was 115 minutes. No operative complications were reported. The patient developed stenosis of the tract after 2 successive menstrual periods (MP). The third period was retained. Transvaginal dilatation of the communication tract was successfully accomplished, and a silicon stent was left in place for 5 successive MP. The patient is now menstruating in a regular pattern for 15 successive MP, and an office hysteroscopic examination showed a patent tract with a normal hemicavity leading to a normal tubal ostia. Conclusions Communication between a well-developed noncommunicating uterine horn and vagina was accomplished with successful establishment of the menstrual outflow tract. Regular menstrual pattern was successfully reestablished for 15 consecutive menstrual periods.

Massive Hematocolpos Mimicking as an Ovarian Tumor: Atypical Presentation of Imperforate Hymen

This paper reports on an atypical presentation of imperforate hymen. A case of silent massive hematocolpos in a 11-year-old girl mimicking as a giant ovarian cyst is described. The diagnosis was made after examination under anesthesia. Successful surgery was then performed. We conclude that hematocolpos should always be included in the differential diagnosis of cystic pelvic pathology in perimenarcheal girls even in the absence of clinical symptom of cyclical lower abdominal pain.

Laparoscopic Ultrasonography for Uterovaginal Canalization of a Didelphic Uterus with Agenetic Cervix

Mullerian duct anomaly is often characterized by any of a number of disorders of the outflow tract and uterus. A 17-year-old woman suffered from cyclic lower abdominal pain for 3 years. Pelvic examination showed a small uterus with blind-ended vaginal canal about 3 cm in length. Three-dimensional pelvic ultrasonography showed a compact uterine corpus with fundal notch regarded as bicornuate uterus, and no evidence of uterine cervix. The same features were also proved by magnetic resonance imaging. Intraoperative ultrasonography showed a small uterine cavity, and uterovaginal canalization was performed. The patient had regular menses without further low abdominal pain after 6 months of follow-up. Uterovaginal canalization with the aid of intraoperative ultrasonography may be effective in managing the difficult didelphic uterus with an agenetic cervix and hypoplastic vagina.

Plastische Rekonstruktion der Gebärmutter nach traumatischer Trennung der Zervix vom Corpus uteri

Kasuistik eines heute 16-jährigen Mädchens, das im Alter von 11 Jahren durch Verkehrsunfall eine traumatische Trennung von Zervix und Corpus uteri erlitt. Mit der Menarche kam es zu zyklischen Schmerzen im Unterbauch. Bei der gynäkologischen Erstuntersuchung 27 Monate nach dem Ereignis fand sich eine nur 3 cm sondierbare Zervix mit tastbarer und sonographisch objektivierbarer Distanz zum Corpus uteri. Nach Uterusrekonstruktion mittels abdomino-vaginaler Zervix-Korpus-Anastomose setzten regelmäßige Menstruationen, bisher über 8 Zyklen ein. Es ist nur ein Fall dieser Art in der Literatur beschrieben worden, bei dem allerdings im Gegensatz zur eigenen Beobachtung der Uterus nicht erhalten wurde.

Hematometra as a Cause of Lumbar Radiculopathy

Low-back pain combined with a positive straight leg raising test (Lasègue's sign) is uncommon in children and adolescents. Reproductive tract (Mullerian) anomalies causing an accumulation of menstrual blood in the vagina, uterus, and fallopian tubes represent an unusual extraspinal cause of low-back pain. The accumulation of blood in these cavities is termed hematocolpos, hematometra, and hematosalpinx. Amenorrhea with cyclic lower abdominal pain and a presenting pelvic mass are the usual presenting features. In the current report, we describe a case of an adolescent with low-back pain, positive straight leg raising test, and signs of L5 radiculopathy that were attributable to hematometra secondary to congenital partial absence of a vagina. This appears to be the first report of this type of presentation.

Cervical occlusion due to adhesions following therapeutic abortion: an uncommon sequel to vacuum curettage.

Eleven women were referred with postabortal amenorrhoea and cyclical lower abdominal pain due to upper cervical occlusion by a thin band of fibrous adhesions. All had undergone first trimester termination of pregnancy by vacuum curettage. Associated intrauterine adhesions were found in 2 patients. Cervical adhesions were easily breached with a uterine sound and cervical dilators, and were then visualized with a hysteroscope. All women resumed normal menstrual cycles and suffered no sequelae. This unusual, but eminently treatable, complication of vacuum curettage should be more widely appreciated.