Cases reported "Abdominal Pain"

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11/21. Recurrent peritonitis with massive ascites as the initial manifestation of systemic lupus erythematosus: report of one case.

    Systemic lupus erythematosus (SLE) rarely presents with massive ascites secondary to severe peritonitis before the occurrence of major diagnostic features. We described a 13-year-old girl who developed four episodes of severe abdominal pain with massive ascites. During the first episode, the patient experienced deterioration with massive ascites over a 3-day period, after a 3-month history of intermittent abdominal pain. This episode resolved under conservative treatment. During the second episode, her acute abdominal findings mimicked appendicitis or gynecologic emergency. An exploratory laparotomy was initially planned, but not performed. thrombocytopenia postponed the surgical intervention and led to further investigation. Autoimmune studies confirmed SLE and prompted steroid therapy, which rapidly improved her painful ascites and spared an unnecessary operation. After improvement of peritonitis with ascites, and following discharge, other major clinical features of SLE ensued. The third episode of peritonitis with massive ascites responded well to steroid pulse therapy. The fourth episode of ascites was accompanied by intracranial hemorrhage that led to her death. To the best of our knowledge, this is the first case report of recurrent peritonitis with massive ascites as the initial and major manifestation of SLE in a pediatric patient.
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ranking = 1
keywords = gynecologic
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12/21. health seeking related to ovarian cancer.

    Critical review of general health-seeking models showed a need for expansion to include the early and atypical symptom period associated with ovarian cancer and the role of self and primary care in the diagnostic process. Data from family functioning research showed that in the self-care phase, the initial gastrointestinal symptoms were unrecognized as serious, given common sense labels, and self-managed. When primary care provider care was sought, misdiagnoses occurred three fourth of the time. Diagnostic delays occurred in these 2 phases of care. An expansion of a model of health seeking links personal and family risks and adds early symptom data may be obtained through monthly self-monitoring by women using a symptom checklist. Organization of risks and symptom information assists in interpretation of disparate streams of data and gives a recommended outcome: high personal risk level high family risk level high early and persistent symptoms presence = high need for a prompt gynecological evaluation. The restructured health-seeking process requires women be taught how to monitor their ovarian health. nurses and primary care providers need frequent continuing education updates and the health media need current and accurate information about this malignancy.
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ranking = 1
keywords = gynecologic
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13/21. Regular abdominal pain and fever in each menstruation onset: an unusual menses-associated familial Mediterrenean fever attacks and a favor result on colchicine treatment.

    We present a 38-year-old woman suffering from regular abdominal pain and fever only in each menstruation onset for 7 years. The clinical symptoms, along with inflammatory findings during painful attacks, the beneficial effect of colchicine and genetic mutation (M694 V and M680I) supported the diagnosis of familial mediterranean fever (FMF). A literature review indicated that FMF attacks occurring only during menstruation are rarely seen. This clinical picture may be confused with gynecological disorders especially in the people of Mediterranean origin.
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ranking = 1
keywords = gynecologic
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14/21. Diagnostic difficulties of pelvic splenosis: case report.

    We report the case of a 38-year-old woman who presented with chronic lower abdominal pain. Her past medical history included a splenectomy due to abdominal trauma. Ultrasound examination revealed four pelvic tumors which, upon laparotomy, were found to be the result of splenosis. Approximately 100 cases of splenosis have been reported but only a minority of them have been published in the gynecological literature. Our case indicates that those involved in pelvic scanning (even of asymptomatic women) and/or treating those complaining of lower abdominal pain or presenting with pelvic tumors should be aware of splenosis as a possible diagnosis.
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ranking = 1
keywords = gynecologic
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15/21. Can you find the source of her pain?

    BACKGROUND: The features of abdominal pain in this gravid patient mimicked more common diagnoses like preterm labor, chorioamnionitis, and appendicitis. CASE: A 40-year-old multipara presented at 30 weeks and 6 days with abdominal pain. The cause was not discovered until the time of cesarean delivery several days after admission. CONCLUSION: This common gynecologic problem can precipitate severe problems in a pregnant woman and should be considered part of the diagnosis in pregnant patients presenting with pain.
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ranking = 1
keywords = gynecologic
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16/21. Ovarian torsion in a 20-year-old patient.

    Ovarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage--an outcome of great importance in the population of reproductive age females.
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ranking = 1
keywords = gynecologic
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17/21. Toxic shock syndrome mimicking pelvic inflammatory disease presumably resulting from tattoo.

    The female patient with a variety of genital tract symptoms offers a distinct challenge to the gynecologist. We report a case that on initial examination was thought to be pelvic inflammatory disease (PID). After further evaluation, our patient was found to be suffering from toxic shock syndrome, which in many ways may resemble PID. This case demonstrates the importance of a careful and thorough evaluation of the gynecologic patient who has several nonspecific signs and symptoms.
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ranking = 1
keywords = gynecologic
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18/21. Nongynecologic causes of unexplained lower abdominal pain in adolescent girls.

    Unexplained lower abdominal pain in young women can present a challenge for even the most experienced clinicians. Although the cause is usually benign and self-limited, occasionally a serious underlying disorder exists. Clinicians should have an organized approach for diagnosis and management in an effort to avoid any unnecessary tests or referrals. The most important elements of the evaluation are thorough history, careful physical, and sequential follow-up as needed. Selective use of the laboratory and radiographic studies should be considered on an individual basis. This paper describes four disorders in adolescent girls that may present with pain in the lower abdominal region and closely resemble pathologic conditions within the gynecologic tract. Practitioners who provide services to young women should be aware of these entities so that the correct diagnosis is established as soon as possible and appropriate therapy initiated in a timely fashion.
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ranking = 5
keywords = gynecologic
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19/21. Coital injury presenting in a 13 year old as abdominal pain and vaginal bleeding.

    This 13-year-old girl presented with a four-day history of increasing lower abdominal pain associated with heavy vaginal bleeding which was now resolving. Her last normal menstrual period was 19 days before this incident, with a history of regular periods. Repeated questioning revealed a history of the patient engaging, for the first time, in consensual sexual intercourse one day prior to the onset of complaints. The abdominal examination revealed mild lower abdominal tenderness without rigidity or guarding. The pelvic examination failed to reveal any active bleeding, laceration, or findings suggestive of pelvic inflammatory disease. Routine laboratory studies revealed an elevated white cell count. As the patient's pain worsened over the next two to three hours, surgical and obstetric-gynecologic consultations were made, and both services advised overnight observation. Over the next 12 hours her abdominal examination revealed increased rigidity, and the patient was taken to the operating room with the a preoperative diagnosis of ruptured appendix. On exploratory laparotomy a hemoperitoneum was found, and approximately 600 ml of blood were suctioned from the peritoneal cavity. A 2-cm posterior vaginal wall laceration was subsequently repaired and a normal appendix removed.
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ranking = 1
keywords = gynecologic
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20/21. Incisional hernia after suprapubic catheterization.

    BACKGROUND: Suprapubic catheterization is a popular method of bladder drainage after gynecologic surgery. We report two cases of incisional hernia that developed after suprapubic catheterization. CASES: The first case involved a 64-year-old woman who underwent Burch urethropexy. Her suprapubic catheter was not removed until postoperative day 55 because of prolonged retention. She presented 1 month later with abdominal pain. In the second case, a 65-year-old woman had vesicovaginal fistula repair with suprapubic catheterization for 2 weeks after surgery. Five months later, she presented with abdominal pain. In both cases, examination revealed a hernia at the catheter exit site. CONCLUSION: Incisional hernia is a rare complication of suprapubic catheterization that should be considered in patients who present with abdominal discomfort some time after catheterization.
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ranking = 1
keywords = gynecologic
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