Chronic pelvic pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Other gynecologic pathology that may present with symptoms of chronic discomfort include adnexal masses and uterine leiomyomata (fibroids). Vague lower abdominal discomfort and fullness and bladder or gastrointestinal symptoms may be related to leiomyomata or ovarian neoplasm. On examination, a pelvic mass is generally palpated, which is confirmed by ultrasound. A myomectomy or hysterectomy may be therapeutic for uterine myomata, especially if associated with abnormal bleeding or if uterine size is greater than 14 cm. An adnexal mass larger than 6 cm is concerning for malignancy and should be referred to a gynecologist. Solid or complex components and bilaterality are also more suspicious for malignancy, and a persistent mass should also be concerning for inflammatory mass, endometrioma or malignancy as functional cysts (follicles and corpus luteum cysts) usually resolve over four to eight weeks. One way of preventing functional cysts from recurring is ovulation suppression with hormonal contraception.
Benign and malignant ovarian masses
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
An adnexal mass may present either as a result of symptoms, which may be severe in the case of a cyst accident, or as an incidental finding when performing a pelvic examination or radiological investigation. Cyst accidents include torsion, haemorrhage and rupture. Pelvic pain radiating down the inner aspect of the leg is a common presenting symptom, and torsion classically presents as severe pain associated with vomiting. Although rupture of a small cyst may be asymptomatic with few associated signs, the abdomen of a patient experiencing a cyst accident is usually tender, with guarding and rigidity. Rupture of a large cyst may produce signs of peritonitis, particularly if the cyst contents are irritant (e.g. endometriotic cyst or dermoid cyst), and the patient may be shocked in cases of extensive rupture or continuing haemorrhage.
Acute abdomen in pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Pain is almost always the presenting symptom, but the nature of the pain is highly variable. The onset may be sudden or gradual. The character may be sharp and intermittent, or dull and constant. In about two-thirds of cases, the pain is unilateral in the lower abdomen. It may be generalized or, uncommonly, it may radiate to the back or flank. Nausea and/or vomiting are present in about half of the patients. Various urinary symptoms are less often reported (91,92). Abdominal tenderness is the most constant physical finding. Peritoneal signs are variably present. There may be adnexal tenderness or a mass. Leukocytosis may be present, but a normal white blood cell count does not rule out the diagnosis. Ultrasonographic imaging may aid in the identification and characterization of an adnexal mass. Color Doppler sonography may show absent arterial flow in the central ovarian parenchyma. Absent central ovarian venous flow may be a more sensitive finding in cases of adnexal torsion (93). Comparison with the uninvolved contralateral ovary may aid in sonographic diagnosis. Given the nonspecific clinical presentation, it is not surprising that the preoperative diagnosis is often erroneous (90,91).
The investigation of T-cell receptor subtypes in ovarian cancer: effects on survival and prognostic factors
Published in Journal of Obstetrics and Gynaecology, 2021
Sultan Özkan, Nur Selvi Gunel, Duygu Aygünes, Levent Akman, Nuri Yildirim, Aslı Teti̇k Vardarli, Aydın Özsaran, Coşan Terek
This study included 47 patients with the diagnosis of adnexal mass who were admitted to The Department of Obstetrics and Gynecology, Ege University Hospital between March 2011 and November 2012. After the preoperative work-up including physical examination, abdominal ultrasonography, chest X-ray and blood chemistry, they were scheduled for surgery. After the operation, they were divided into two groups according to their pathology as being benign or malignant. Twenty-four of them were malignant and 23 of them were benign cases. The exclusion criteria were the borderline tumours and the patients who underwent neoadjuvant chemotherapy. The study was approved by The Ethics Committee of Clinical Research in Ege University (February 23 2011; 10-11.1/55). All patients signed informed consent after explaining the study and the trial was conducted in accordance with the Helsinki II Declaration.
Diagnostic work-up in paediatric and adolescent patients with adnexal masses: an evidence-based approach
Published in Journal of Obstetrics and Gynaecology, 2021
Milan Terzic, Agnese Maria Chiara Rapisarda, Luigi Della Corte, Rahul Manchanda, Gulzhanat Aimagambetova, Melanie Norton, Simone Garzon, Gaetano Riemma, Cara Robinson King, Benito Chiofalo, Antonio Cianci
According to aetiological factors, functional cysts, benign pathologies, benign neoplasms, or malignant neoplasms define ovarian masses. The failure of involution of follicles may lead to the development of functional cysts in the prepubertal adolescent. Abnormal gonadotropin stimulation of the ovary by the immature hypothalamic-pituitary axis is a common cause of prepubertal cysts (Pienkowski et al. 2004). Although rare, endometriomas represent a possible cause of adnexal mass in prepuberal and adolescent patients (Gordts et al. 2015), which require adequate management and regular follow-up to avoid adverse effects on fertility and quality of life. Extensive surgery with full excision is often related to endometriosis as well (Baggio et al. 2015; Laganà, La Rosa, Rapisarda, Valenti, et al. 2017; Mama 2018; Raffaelli et al. 2018).
Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management
Published in Journal of Obstetrics and Gynaecology, 2019
Padmasree Resapu, Sirisha Rao Gundabattula, Vijaya Bharathi Bayyarapu, Manjula Pochiraju, Kameswari Surampudi, Shashikala Dasari
This was a retrospective study of women with abdominal pain who either underwent surgery for suspected adnexal torsion or were found to have torsion intraoperatively. Women with the ultrasound features of torsion but which was not confirmed by surgery and the asymptomatic patients with incidental operative finding of torsion during surgery performed for other reasons were excluded. Preoperatively, adnexal torsion was diagnosed based on clinical suspicion with or without sonographic concordance. Classically, this presents as acute-onset abdominal pain, nausea and vomiting with or without an adnexal mass. The sonographic features suggestive of torsion include: enlarged, oedematous and displaced ovary, ovarian mass (sometimes tender), multiple small peripheral follicles, hyperechoic rings around the antral follicles (follicular rings), decreased or no blood supply to the ovary and whirlpool sign in the ovarian vessels (Sibal 2012; Laufer 2015).
Related Knowledge Centers
- Ectopic Pregnancy
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- Endometrioma