scholarly journals Pyometra: An Atypical Cause of Abdominal Pain

2021 ◽  
Vol 9 ◽  
pp. 232470962110224
Author(s):  
Leonidas Walthall ◽  
Marc Heincelman
Keyword(s):  
Abdominal Pain ◽  
Vaginal Discharge ◽  
Elderly Women ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Laboratory Evaluation ◽  
Inpatient Service ◽  
Gynecologic Malignancy ◽  
Intravenous Contrast ◽  
Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

scholarly journals Pyometra

2019 ◽  
Vol 3 (1) ◽  
pp. 64-69
Author(s):  
Dimas Satria Yolanda
Keyword(s):  
Abdominal Pain ◽  
Vaginal Discharge ◽  
Elderly Women ◽  
Ultrasound Examination ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Postmenopausal Bleeding ◽  
The Masses ◽  
Mass Evacuation ◽  
Intraabdominal Tumor

Background : Pyometra is a rare condition with an incidence ranging from 0.01 - 0.5% among all gynecological patients.2 Pyometra is known to be rare in the general population and is more common in elderly women.3 In postmenopausal elderly patients, the incidence increases to 13.6% .4. The classic triometry of pyometra is postmenopausal bleeding, purulent vaginal discharge, and lower abdominal pain,Objective : Report the handling of pyometra casesCase Report : reportedly a 73-year-old woman came to the ER of RSUP Dr. M. Djamil on December 10, 2018 at 14.30, a referral from BMC Padang hospital with a diagnosis of abdominal pain susp. intraabdominal tumor. Ultrasound examination showed the uterus in normal size which was not in accordance with the picture of pyometra. Laparotomy with adhesionolysis and aspiration of pus in the patient was performed. This is appropriate for evacuating the pyometra mass in this case.Conclusion : In this case, to overcome the infection and evacuate the masses. The recommended antibiotics are broad-spectrum antibiotics, such as penicillin, piperacillin tazobactam, imipenem, meropenem, metronidazole, and vancomycin. Mass evacuation can be done by laparotomy or curettage accompanied by cervical dilatation.Keywords: Pyometra, pascamenoupose

scholarly journals Unusual Differential Disease Entity of Right Lower Abdominal Pain, Ileal Diverticulitis Perforation: A Report of Three Cases

2017 ◽  
Vol 102 (11-12) ◽  
pp. 530-535
Author(s):  
Pyong Wha Choi ◽  
Mee Joo
Keyword(s):  
Abdominal Pain ◽  
Clinical Manifestations ◽  
Lower Abdominal Pain ◽  
Disease Entity ◽  
Colonic Diverticulitis ◽  
Lower Quadrant ◽  
Ileal Perforation ◽  
Abdominal Symptoms ◽  
Right Lower Quadrant ◽  
Ileal Diverticulitis

Introduction: Small bowel diverticulum is a rare disease entity, and most cases are asymptomatic. However, diverticulitis can cause acute abdomen conditions like colonic diverticulitis. Depending on the location, various abdominal symptoms may ensue. Clinical manifestations of ileal diverticulitis may be similar to those of appendicitis and or colonic diverticulitis. Thus, making a diagnosis based on a physical examination alone may be challenging. Even though imaging techniques such as computed tomography (CT) may provide clues for a definite diagnosis, the majority of cases are confirmed through operation. Here, we present 3 cases of ileal diverticulitis perforation, which were not diagnosed preoperatively. Case presentation: A 71-year-old man, a 77-year-old woman, and a 78-year-old woman presented with abdominal pain. All 3 patients showed local peritoneal irritation signs in the right lower quadrant. Appendicitis or colonic diverticulitis was suspected, but CT scan results revealed free air and mesenteric fat infiltration around the terminal ileum, suggesting ileal perforation. During the operation in each case, terminal ileal perforation was confirmed, and ileocecal resection was performed. Subsequently, histologic examination revealed ileal diverticulitis perforation. Although the postoperative course was uneventful in the first and second patient, the third patient died of sepsis resulting from anastomosis leakage. Conclusion: These cases put forth unusual causes of right lower quadrant pain, which show physical findings similar to those of diverse inflammatory disease. Awareness of this disease is beneficial for making a differential diagnosis based on CT findings and eliciting prompt surgical management.

scholarly journals A Woman With Chronic Lower Abdominal Pain, Vaginal Discharge, and Infertility After a Stay in Mali

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Steven Van Den Broucke ◽  
Idzi Potters ◽  
Marjan Van Esbroeck ◽  
Lieselotte Cnops ◽  
Vasiliki Siozopoulou ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Vaginal Discharge ◽  
Lower Abdominal Pain

scholarly journals Accuracy of Five Different Diagnostic Techniques in Mild-to-Moderate Pelvic Inflammatory Disease

2002 ◽  
Vol 10 (4) ◽  
pp. 171-180 ◽  
Author(s):  
Hernando Gaitán ◽  
Edith Angel ◽  
Rodrigo Diaz ◽  
Arturo Parada ◽  
Lilia Sanchez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Clinical Diagnosis ◽  
Inflammatory Disease ◽  
Performance Test ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Diagnostic Methods ◽  
Cross Sectional

Objective:To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures.Study design:A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n= 31) was compared with a group (n= 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods.Results:All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity.Conclusions:Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.

scholarly journals Clinicomicrobiological spectrum of abnormal discharge from vagina in women in costal Andhra Pradesh

2020 ◽  
Vol 10 (1) ◽  
pp. 150
Author(s):  
Jyothi Singamsetty ◽  
G. Sravani
Keyword(s):  
Abdominal Pain ◽  
Bacterial Vaginosis ◽  
Vaginal Discharge ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Exclusion Criteria ◽  
History Of ◽  
Abnormal Vaginal Discharge ◽  
Trichomonas Vaginitis ◽  
Reproductive Age Group

Background: When there is change in colour, consistency, order and volume of discharge then it is called abnormal vaginal discharge and associated with vulvar pruritus, dyspareunia, dysuria and lower abdominal pain. There is variability in organism isolated and treatment used.Methods: Sexually active women in reproductive age group with complain of abnormal vaginal discharge were included in this study based in following inclusion and exclusion criteria. . A detailed history of patient was taken regarding nature of discharge, colour, smell along with dysuria, dyspareunia, itching of vulva and lower abdominal pain.Results: Out of 160 patients 88 patients have bacterial vaginosis. Trichomonas vaginitis was present in 7.5% patients. Candidiasis was present in 6.25% patients. Some patients were having more than one infection like Bacterial vaginosis and Trichomonas vaginitis was coexisting in 13.75%, Bacterial vaginosis + Candidiasis were present in 8.75% patients. Mixed infection was present in 8.75%.Conclusions: From present study we can conclude that vaginal discharge is more common in married women in young age. Patients commonly presented with curdy white discharge, pruritus vulva and lower abdominal pain. Erythema and excoriation in vulva were common presentation, followed by erythema of vagina. Nature of discharge was mucopurulent in most patients. Bacterial vaginosis was most common followed by Trichomonas vaginitis.

scholarly journals 715. A 79 year old Female with Bloody Diarrhea and Hypovolemic Shock: Keep the Differential Diagnosis Open

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S409-S409
Author(s):  
Sindhura Inkollu ◽  
Sindhuja Korem ◽  
sukrut Dwivedi ◽  
Ramy Osman ◽  
Arati Inamdar
Keyword(s):  
Abdominal Pain ◽  
New Jersey ◽  
Early Recognition ◽  
Regional Distribution ◽  
Hypovolemic Shock ◽  
Lower Abdominal Pain ◽  
Developed Countries ◽  
Bloody Diarrhea ◽  
Lower Quadrant ◽  
Intestinal Schistosomiasis

Abstract Background Schistosomiasis is considered one of the neglected tropical diseases which is rarely seen in USA. We are reporting herein a case of intestinal schistosomiasis presented as bloody diarrhea and hypovolemic shock at Monmouth Medical Center, New Jersey. Methods: Case Report A 79 year old female presented with bleeding into her colostomy bag and associated left lower abdominal pain for one day duration. She has a history of colon cancer diagnosed 25years ago, which was treated with chemotherapy and a left hemicolectomy with colostomy formation. On admission, her blood pressure was 78/51 mm Hg. She looked pale and her abdominal examination revealed tenderness in left lower quadrant. Laboratory findings showed hemoglobin of 5.3 g/dl. CT abdomen showed extensive colitis. She was resuscitated and treated with Piperacillin-Tazobactum for 6 days with minimal improvement. Stool for ova and parasites were negative. EGD was unremarkable with no evidence of acute bleeding. Colonoscopy showed severe ulcerative colitis in the distal 30cm of colon. Pathology revealed ischemic and necrotic tissue with numerous calcified schistosoma eggs in the colon (Figure 1). After furthering questioning, the patient mentioned that she travelled to South China 8months prior to presentation. Patient was then treated with Praziquental for one day for possible Schistosomiasis Japonicum, given the regional distribution. The patient showed marked clinical improvement and was discharged home later. Figure 1: Histopathology image showing calcified schistosoma eggs in colon Results Intestinal Schistosomiasis is a parasitic disease which peaks at age 15-20yrs, older patients usually have less parasitic burden. Symptoms include diarrhea, abdominal pain, dyspepsia and malnutrition. Heavily infected patients can have hemorrhagic diarrhea, obstruction and ischemic colitis. Definitive diagnosis requires egg identification. Treatment is relatively safe and effective, especially in the developed countries where the resistance to Praziquantel (PZQ) has not been reported yet. Conclusion Even though the worms that cause the disease are not found in USA, this case highlights the importance of recognizing Schistosomiasis especially in New Jersey, due to the high traveling immigrant population, as early recognition and treatment reduces morbidity and mortality. Disclosures All Authors: No reported disclosures

scholarly journals Non-haemorrhagic uterine rupture at 28 weeks of pregnancy following previous caesarean section: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alfred Lumala ◽  
Vicent Atwijukire
Keyword(s):  
Heart Rate ◽  
Abdominal Pain ◽  
Caesarean Section ◽  
Uterine Rupture ◽  
Fetal Heart Rate ◽  
Vaginal Bleeding ◽  
Vaginal Discharge ◽  
Fetal Heart ◽  
Lower Abdominal Pain ◽  
Previous Caesarean Section

Abstract Background There is need to put forward more symptoms and signs that could suggest a diagnosis of uterine rupture so that clinicians’ suspicion is increased; there is also need to put forward uncommon intraoperative findings in patients with uterine rupture to correlate with the signs and symptoms of patients. Case presentation A 33 year old Gravida 5 Para 4 + 0 with 2 previous caesarean section scars at 28 weeks of amenorrhoea, presented to hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine. On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labour and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios. Decision do deliver her by emergency caesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through and vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively. Conclusions There is need to suspect uterine rupture in pregnant women with previous caesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are haemodynamically stable and without vaginal bleeding and remote from term.

scholarly journals Acute appendiceal diverticulitis diagnosed in the postoperative context of appendectomy

2021 ◽  
Vol 8 (3) ◽  
pp. 1004
Author(s):  
Sofia M. Frade ◽  
Ana K. Andrade ◽  
João S. Pimentel ◽  
Luis M. Moniz ◽  
Helder J. Viegas
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Age Groups ◽  
Lower Abdominal Pain ◽  
Vermiform Appendix ◽  
Duration Of Symptoms ◽  
Lower Quadrant ◽  
Appendiceal Diverticulitis ◽  
And Gender ◽  
Histological Result

Acute appendiceal diverticulitis is a rare cause of acute abdomen that is commonly interpreted as acute appendicitis until definitive histological result. We herein present two cases of patients of distinct age groups and gender who presented to the emergency department with right lower quadrant abdominal pain. Laboratory and imaging studies led to the diagnosis of acute appendicitis. In both cases, intraoperative findings were compatible with the initial diagnosis and therefore appendectomy was performed. Later pathological exam showed diverticulitis of the vermiform appendix. Although appendiceal diverticulitis is associated with a higher risk of perforation and neoplasms, both patients had linear postoperative period, without complications or dysplastic findings. Despite its similarities to the acute appendicitis, appendiceal diverticulitis presents itself as a distinct entity and should be suspected in patients with right lower abdominal pain in older age and with longer duration of symptoms.

scholarly journals Mixed Mullerian Tumour (Carcinosarcoma) - A Rare Cervical Tumour

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 818-820
Author(s):  
Mst Atia Sultana ◽  
Kh Shahnewaj ◽  
Md Saiful Islam ◽  
Masuma Khatun ◽  
Nure Saba Rahman ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Vaginal Bleeding ◽  
Vaginal Discharge ◽  
Lower Abdominal Pain ◽  
Vaginal Examination ◽  
Lower Abdomen ◽  
Vaginal Canal

We report a 70 years old postmenopausal lady Mrs Johura Begum presented to us with the complaints of watery and foul smelling per vaginal discharge for 4-5 months, occasional per vaginal bleeding for 2-3 months lower abdominal pain for 15 days, fever for 7 days. On general examination she was restless, her temperature was 1020F and lower abdomen was tender. On per vaginal examination there were foul smelling discharge and a large ulcerated and necrossed mass in the vaginal canal that bleeds on touch. She was managed surgically. Now she is on chemotherapy and well.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 818-820

scholarly journals Ectopic lumbar kidney: a rare presentation

2018 ◽  
Vol 5 (10) ◽  
pp. 3410
Author(s):  
Ela Haider Rizvi ◽  
Kailash Charokar ◽  
Ajay Kumar Jain
Keyword(s):  
Abdominal Pain ◽  
Left Kidney ◽  
Lumbar Vertebrae ◽  
Lower Abdominal Pain ◽  
Symptomatic Therapy ◽  
Ectopic Kidney ◽  
Lower Abdomen ◽  
Rare Presentation ◽  
Lower Quadrant ◽  
The Right

Ectopic kidney is a rare developmental anomaly. Such kidneys may be asymptomatic or present with vague symptoms or remain unknown during the lifetime. Early detection and recognition of an ectopic kidney can prevent long-term complications. We report a 70-year-old lady with ectopic right kidney who presented with intermittent episodes of lower abdominal pain since one month 1 month. On clinical evaluation a tender lump was palpable in the right lower quadrant of the abdomen. Sonography revealed empty right renal fossa with normally present left kidney. A mass was detected in the right lower abdomen, with probability of ectopic kidney. Further, Multislice computed tomography with 3-D reconstruction demonstrated ectopic right kidney at the level of L4 to L5 lumbar vertebrae. Urine examination revealed pyuria. The patient was managed on empirical antibiotics for UTI with supportive and symptomatic therapy. On the next day, clinically the lump regressed significantly (Dietl's crises) in size, and the tenderness also reduced. The urine culture report grew Escherichia coli. Patients presenting with lower abdominal pain, and a palpable lump in the lower abdomen, one must include ectopic kidney in the differential diagnosis.

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