Evaluation Of Acute Pelvic Pain Research Articles

ROLE OF ULTRASONOGRAPHY IN EVALUATION OF ACUTE PELVIC PAIN IN FEMALES

Background: Pelvic pain in pregnant as well as non-pregnant females often represents a difcult challenge due to the variety of causes characterized by overlapping clinical symptoms, including gynaecological and non-gynaecological causes. Ultrasound (USG) is one of the best tools for the evaluating the female pelvis. It is very helpful in acute conditions to rule out different lower abdominal pathologies and is key to further management and appropriate treatment. Objectives: To assess the role of USG in acute pelvic pain & evaluate the common aetiologies of acute pelvic pain in females. This prospective observational study was conducted in the Department of Radi Material And Methods: o-diagnosis and Imaging in a tertiary care hospital in Jammu over a period of 6 months (May 2022 to October 2022). Female patients presenting with acute pelvic pain were included in our study. USG examination was performed using Samsung Sonoace R7 machine. Data obtained was compiled and analysed using standard statistical analysis. Results: In our study, the age range of the patients was 21-60 years and most common age group was 21-30 years. On USG, commonest cause of Acute Pelvic pain was ovarian cysts (48%). Ectopic pregnancy was seen in 16% cases while pelvic inammatory disease was seen in 10% cases. Uterine leiomyomas were the cause of acute pelvic pain in 8% of cases. Non-gynaecological causes included appendicular abscess, cystitis and ureteric calculus and were seen in 6% cases. In 12% cases, no diagnosis was made on USG. Conclusions: USG is a commonly used modality in evaluation of acute pelvic pain in females. It is very useful in emergency as it helps in quick evaluation and decision making for operative or medical treatment planning and can help in timely diagnosis without further imaging tests.

Laparoscopic Surgery in the Evaluation of Acute Pelvic Pain

Acute pelvic pain (APP) is non-specific with a 5% to 10% prevalence of visits per annum to emergency. The multiple organ systems within the pelvis, result in diagnostic error, with an estimated 45% of pre-menopausal women misdiagnosed. Unfortunately, diagnostic accuracy cannot always be ascertained with physical examination or imaging; however, direct visualisation of the pelvic cavity via laparoscopic surgery provides a more conclusive diagnostic approach. This letter aims to explore the various aetiologies of APP in women and the current modalities utilised in the diagnostic pathway. The primary aim of this letter is to propose laparoscopic surgery as a possible diagnostic modality to evaluate APP in women.

SONOGRAPHIC FINDINGS IN FEMALES OF REPRODUCTIVE AGE WITH ACUTE PELVIC PAIN

Background: Acute pelvic pain can result from the gynecological, urological systems and/or gastrointestinal. Ultrasound can be used as an initial imaging modality in the evaluation of acute pelvic pain. To determine sonographic findings in females of reproductive age coming with acute pelvic pain. Objective: To determine Sonographic findings in females of reproductive age with acute pelvic pain. Methodology: Toshiba Xario ultrasound machine with a standard gray scale and Doppler ultrasound convex probe of 3.5 MHz – 7.5 MHz or trans-vaginal probe of 5 MHz - 7.5MHz is used. Both transvaginal and trans-abdominal probes were used in this study. The study was conducted at Ultrasound University Clinic, Township, Lahore. Data of 163 patients was collected through convenient sampling. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: A total of 163 patients were examined in the study. The age incidence of the cases in this study varied between 15 years to 45 years. The mean age of the patients in the study was 29.8712 years. The uterine fibroid is most commonly involved in acute pelvic pain and is seen in 30.1% cases followed by simple ovarian cyst in 20.2% cases, hemorrhagic cyst in 14.1% cases. 8.6% cases with pelvic pain have no abnormal sonographic findings. Adenomyosis, PID and endometrial polyp in 4.3% each. Endometrial hyperplasia in 3.1%. Follicular cyst, simple adnexal cyst and complex adnexal cyst in 1.8% each, followed by ovarian endometrioma in 0.6% cases and dermoid cyst in 0.6%. In obstetric patients of acute pelvic pain; RPOCs are most common, constituting 1.8% of total acute pelvic pain, molar pregnancy in 1.2%, ectopic pregnancy in 0.6% patients, subchorionic bleed in 0.6% cases. Conclusion: Ultrasound is a very good modality for acute pelvic pain, as it can easily diagnose and characterize the causes of pelvic pain. The wide availability, radiation free and cost effectiveness makes it a first line investigation in acute pelvic pain. In the present study, the most common cause of pelvic pain is uterine fibroid. Key words: Ultrasound (US), Pelvic inflammatory disease (PID), acute pelvic pain, retained products of contraceptives (RPOCs), pouch of Douglas (POD). DOI: 10.7176/JHMN/71-14 Publication date: February 29 th 2020

How Can Pelvic MRI with Diffusion-Weighted Imaging Help My Pregnant Patient?

The purpose of this review is to explain how diffusion-weighted imaging (DWI) is used during magnetic resonance imaging (MRI) exams in pregnant patients for specific maternal indications, including evaluation of acute pelvic pain, adnexal masses, cancer diagnosis and staging, and morbidly adherent placenta. While ultrasound is often the appropriate initial imaging for evaluating a pregnant patient, MRI can be helpful when a pelvic ultrasound is indeterminate. MRI has advantages in that it does not use ionizing radiation and has shown no known deleterious effects to the fetus. The use of gadolinium-based contrast is controversial during pregnancy. DWI is a functional sequence performed during an MRI exam, which is valuable in the absence of gadolinium contrast, and can increase the visibility of inflammation, abscesses, and tumors. Case examples will be presented to demonstrate the utility and added value of DWI over conventional anatomic T1- and T2-weighted imaging in diagnosis of maternal disease in the pregnant patient's pelvis.

The role of ultrasound in the evaluation of acute pelvic pain in pregnancy and postpartum period: a review.

Acute pelvic pain in pregnant and postpartum patients presents diagnostic and therapeutic challenges. Ultrasound remains the primary imaging modality of choice for assessing pregnant and postpartum women. The purpose of this review is to help practitioners ensure a correct diagnosis of acute pelvic pain in pregnancy and the postpartum period. This review describes the various causes and highlights the sonographic features and characteristics of acute pelvic pain in pregnancy and the postpartum period. Evaluation of acute pelvic pain in pregnancy and the postpartum period is challenging. Knowledge of the clinical settings and sonographic features of acute pelvic pain in pregnancy and the postpartum period can lead to accurate diagnosis and appropriate management of the condition.

Imaging evaluation of acute pelvic pain in the emergency department

Imaging evaluation of acute pelvic pain in the emergency department

Ultrasonographic evaluation of acute pelvic pain in pregnant and postpartum period.

Acute pelvic pain in pregnant and postpartum patients presents diagnostic and therapeutic challenges. The interpretation ofimaging findings in these patients is influenced by the knowledge of the physiological changes that occur during the pregnantand postpartum period, as well as by the clinical history. Ultrasonography remains the primary imaging investigation of thepregnant and postpartum women. This article describes the causes and imaging features of acute pelvic pain in pregnant andpostpartum period and suggests characteristics to such diseases, focusing on the ultrasonography features that allow one toarrive at the corrective diagnosis. Knowledge of the clinical settings and imaging features of acute pelvic pain in pregnant andpostpartum period can lead to accurate diagnosis and appropriate management of the condition.

Unexpected Findings During Evaluation of Acute Pelvic Pain With Transvaginal Sonography.

Transvaginal sonography is the first-line imaging modality used to evaluate acute female pelvic pain in the emergency setting because of its accessibility, lack of ionizing radiation, and excellent ability to identify reproductive tract disorders. Although the intent of transvaginal sonography is to evaluate the reproductive organs, imaging of adjacent pelvic structures is an important part of every transvaginal sonographic examination. Gastrointestinal, urologic, and vascular disorders incidentally scanned on transvaginal sonography may explain the pain for which the examination is being performed. In such cases, transvaginal sonography may play an important role in the diagnostic process if the clinician is aware of the transvaginal sonographic appearance of these entities.

The Effect of a Clinical Practice Guideline for Acute Pelvic Pain on Length of Stay in the Emergency Department.

Length of stay (LOS) is a key measure of emergency department (ED) efficiency and a marker of overcrowding. The use of clinical practice guidelines (CPGs) has been shown to decrease the time spent in the ED. The objective of this study was to determine whether the utilization of a CPG for evaluation of acute pelvic pain in the ED would reduce patient LOS. This before-and-after study was conducted at a large urban Level II ED over the course of 2 years. A retrospective review of 134 electronic patient records: 67 charts prior to protocol implementation; 67 after implementation of a CPG for the evaluation of acute pelvic pain. Length of stay was based on the time from triage to discharge. The before-and-after protocol groups were compared using an independent-samples t test. Length of stay was actually increased in the protocol group (n = 67, M = 5:16, SD = 4:14 [hr:min]; p = 0.092). The use of diagnostic imaging was associated with longer LOS, varying with the specific imaging performed. Because of financial restructuring, the radiology unit reduced the availability of in-house sonography to 9:00 a.m.-5:00 p.m., Monday through Friday, which also possibly affected the LOS. Of significance was the willingness of the health care providers to utilize the CPG (86%). Time of day, availability of in-house ultrasound, and individual provider judgment influence ED LOS and subsequent imaging performed. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting LOS, reducing provider disparities, and ensuring patient safety.

Sonographic Evaluation of Acute Pelvic Pain

Sonographic Evaluation of Acute Pelvic Pain

Role of Ultrasound in the Evaluation of Acute Pelvic Pain in Nonpregnant Reproductive Age Patients

ABSTRACT In an emergency setting pelvic ultrasound is the tool of choice for the evaluation of the patients presenting with acute pelvic pain. It has a high sensitivity and specificity for detection of pelvic pathology, low cost, widespread availability and lack of ionizing radiation. This article presents a variety of case scenarios regarding the nonpregnant female of reproductive age presenting with acute pelvic and lower abdominal pain. By using illustrative images, the reader will be able to differentiate between the most common causes of abdominal and/or pelvic pain and identify typical B-mode and color Doppler ultrasound findings and CT images that require immediate treatment, while minimizing the performance of unnecessary additional imaging and invasive procedures. How to cite this article Zafar N, Kupesic Plavsic S. Role of Ultrasound in the Evaluation of Acute Pelvic Pain in Nonpregnant Reproductive Age Patients. Donald School J Ultrasound Obstet Gynecol 2012;6(2):207-217.

Diagnostic accuracy of ultrasound in suspected ovarian torsion

<em>Objective</em>. Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. <em>Methods</em>. A retrospective observational study was conducted at the Obstetrics/Gyneacology department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n=62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. <em>Results</em>. Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score >6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (P=0.039) and pain score (P=0.008). <em>Conclusion</em>. The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.

Imaging Evaluation of Acute Pelvic Pain in Reproductive Age Women

Imaging Evaluation of Acute Pelvic Pain in Reproductive Age Women

Validity of Ultrasound in Patients with Acute Pelvic Pain Related to Suspected Ovarian Torsion

Objective: Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. Methods: A retrospective observational study was conducted at the Ob/Gyn department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n = 62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. Results: Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score >6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (p = 0.039) and pain score (p = 0.008). Conclusion: The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.

Emergency Department Evaluation of Acute Pelvic Pain in the Adolescent Female

Adolescent females presenting to the emergency department (ED) with acute pelvic pain may have diagnoses with significant morbidity and in some cases, mortality. An adolescent female with a complaint of acute pelvic pain can create a challenging clinical situation for busy ED providers. Differentiating between acute and chronic pain, and determining gynecologic vs other origins is an important first step. A thorough knowledge of adolescent development and the legal requirements of confidential care are helpful in sorting through these complicated complaints. Assessing for sexual activity and risk taking, pregnancy, and other sexual health components is critical to a thorough assessment and accurate diagnostic plan. Using an organ-specific approach to the reproductive system, this article will focus on urgent and sometimes life-threatening gynecologic causes of acute pelvic pain in the adolescent female in the context of an ED visit.

US and CT Evaluation of Acute Pelvic Pain of Gynecologic Origin in Nonpregnant Premenopausal Patients

The interpretation of imaging findings in the premenopausal patient with acute pelvic pain is influenced by knowledge of the physiologic changes that occur in the pelvis as well as by the patient's clinical history. Although ultrasonography (US) is the modality of choice for initial imaging, gynecologic disease is detected or suspected with increasing frequency at computed tomography (CT) because of the increasing availability and use of this modality. As a result, the recognition of common features of gynecologic entities on both US and CT images is essential for prompt diagnosis and expeditious management. Categorizing lesions according to their anatomic location, physiologic or pathologic origin, and internal characteristics (cystic, solid, or mixed) allows efficient and accurate diagnosis.

Ultrasound Evaluation of Pelvic Pain

A rapid examination method for female subjects with acute pelvic pain was developed for potential clinic or emergency distinction of medical and surgical disorders. A 95% diagnostic accuracy was achieved in separating retrospectively 102 consecutive patients into "hospital" or "outpatient" categories. It is recommended that ultrasound be used routinely in the initial evaluation of acute pelvic pain. The procedure complements and may be considered an extension of the traditional physical examination.

Laparoscopy as an ambulatory procedure.

The experience of the Phoenix Surgicenter Arizona in performing laparoscopy as an outpatient procedure is summarized. Recognized contraindications to laparoscopy include abdominal peritonitis acute abdominal hemorrhage intolerance to necessary anesthesia and cardiac and respiratory disease. The laparoscopic procedure can be used on an outpatient basis for tubal coagulation evaluation of chronic pelvic pain therapy lysis of adhesions uterine suspension evaluation of acute pelvic pain evaluation of infertility and endocrine disorders evaluation of response to hormonal therapy lysis of adhesions uterine suspension evaluation of acute pelvic pain and pelvic masses and removal of intrauterine devices. Preoperative management and evaluation of patients record keeping procedures postoperative care and cost determination as practiced at the Surgicenter are described. No preoperative medication is given prior to anesthesia. The usual laparoscopic technique is practiced with the following modifications: 1) volume monitoring of carbon dioxide is not used 2) a Carboflator is used for establishing the pneumoperitoneum and 3) a Trendelenburg position of 15 degrees is used. In a series of 1264 laparoscopies there have been no major complications or subsequent laparotomy required. It is concluded that laparoscopy can be performed on an outpatient basis with safety economy and comfort.