Cases reported "pelvic pain"

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11/180. Pelvic stress fracture: assessment and risk factors.

    OBJECTIVE: To discuss the case of a patient with a pelvic stress fracture and the differential considerations among patients presenting with hip and/or groin pain. FEATURES: A 42-year-old woman had hip pain after running. Initial radiograph of the pelvis was negative. Subsequent films showed a right inferior pubic ramus stress fracture. Stress fractures of the pelvis are relatively uncommon, accounting for only 1% to 2% of all stress fractures. INTERVENTION AND OUTCOME: Treatment included high-velocity, low-amplitude chiropractic manipulation, ultrasound, and stretching of the psoas and piriformis muscles. After 8 weeks, care was discontinued because the patient's hip pain had resolved. The pelvic fracture was left to heal with time. After 1 year, the patient still had delayed union of the fracture. CONCLUSION: When predisposing factors are present, such as osteoporosis and rheumatoid arthritis, pelvic stress fracture should be suspected in patients with groin or hip-area pain. However, because pelvic stress fractures are relatively rare, radiographic studies are often postponed, making diagnosis difficult. ( info)

12/180. A systematic history for the patient with chronic pelvic pain.

    Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached. ( info)

13/180. Anterior sacral meningocele as a pelvic complication of marfan syndrome.

    Anterior sacral meningocele (ASM) is well recognized in marfan syndrome as a consequence of dural ectasia. Two cases presenting as nongynaecological pelvic masses are described highlighting the clinical difficulty in diagnosis and the classical radiological findings. The classification of ASM and associated anomalies of the sacrum are reviewed. ( info)

14/180. Pelvic congestion syndrome caused by inferior vena cava reflux.

    We present a female patient who had pelvic congestion syndrome caused by inferior vena cava reflux associated with tricuspid regurgitation, but without other symptoms or signs related to her tricuspid regurgitation. Bladder pumping therapy was effective in improving her symptoms. ( info)

15/180. Laparoscopic myomectomy in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome.

    A 36-year-old woman had primary amenorrhea, pelvic pain, Mayer-Rokitansky-Kuster-Hauser syndrome, and an 8.5-cm, solid pelvic mass. The leiomyoma uteri was removed laparoscopically from the vestigial mullerian duct with secondary vaginopoiesis. The patient had a satisfactory clinical outcome. Finding of a leiomyoma in a patient with Rokitansky syndrome is rare. To our knowledge this is the first such case in which the myoma was removed by laparoscopy. ( info)

16/180. Unrecognized bladder perforation during operative laparoscopy.

    During operative laparoscopy in a 42-year-old woman, 12-mm trocar lacerations occurred through anterior and posterior walls of the bladder but were not recognized. This case demonstrates important issues related to predicting, avoiding, detecting, and treating bladder trauma associated with laparoscopic surgery. It also indicates that some classic warning signs of accidental cystotomy may be absent or delayed in appearance. ( info)

17/180. Computed tomography-guided pudendal nerve block. A new diagnostic approach to long-term anoperineal pain: a report of two cases.

    OBJECTIVE: To show the value of computed tomography (CT) in selectively blocking the pudendal nerve in patients with long-term anogenital pain of uncertain etiology. We report a technique to selectively block the pudendal nerve using CT guidance in 2 patients with long-term anogenital pain. CASE REPORT: In 1 patient, a competitive cyclist, the diagnosis of pudendal neuralgia was substantiated by blocking the nerve under CT. The procedure relieved the pain for approximately 24 hours. In the other patient, pudendal nerve block produced perineal analgesia but no pain relief. Superior hypogastric plexus block relieved the pain significantly for about 4 weeks on 2 separate occasions, suggesting sympathetically maintained pain. CONCLUSION: The use of CT to guide the procedure allowed precision in performing the procedure and in making a differential diagnosis. ( info)

18/180. Ovarian remnant syndrome: a case report and review of the literature.

    The ovarian remnant syndrome in an unusual complication of bilateral oophorectomy, usually presenting with pelvic mass and pain. A case of the syndrome is described in a 35-year-old woman with a history of abdominal hysterectomy and bilateral oophorectomy. We suggest that ovarian remnant syndrome should be considered in the differential diagnosis of chronic pelvic pain after recorded oophorectomy. ( info)

19/180. Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report.

    BACKGROUND: Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus. A multispecialty approach and alternative medicine are often effective. Recently, the FDA announced the use of acupuncture and acupressure as officially recognized modalities for treatment of chronic pain in oncology patients. CASE: Chronic pelvic pain in a 23 year-old primigravida at 27 weeks' gestation was incapacitating on narcotics. After organic causes were ruled out, acupuncture was employed successfully. Outpatient management for the duration of the pregnancy included acupuncture and narcotics for breakthrough pain while maintaining activities of daily living. Spontaneous vaginal delivery without complications at 38 5/7 weeks produced a 3,305-g female infant. The pain resolved immediately following delivery. CONCLUSION: This case demonstrates the benefit of combined allopathic with alternative forms of medicine. With the use of acupuncture, narcotic use was limited in this gravida while adding to her quality of life by allowing her to maintain normal activity. ( info)

20/180. Short course oral prednisolone therapy in chronic abacterial prostatitis and prostatodynia: case reports of three responders and one non-responder.

    OBJECTIVE: To report on a small group of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome treated with oral corticosteroids in order to suggest a hypothesis for a future randomised controlled trial. DESIGN: A retrospective, observational report. RESULTS: Three out of the four patients reported improvement in symptoms following steroid treatment. CONCLUSIONS: These reports suggest that there is scope for conducting a randomised, placebo controlled study to investigate the role of oral corticosteroids in patients with chronic abacterial prostatitis/chronic pelvic pain syndrome who have failed on conventional therapy. ( info)
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