Emergent gynecological operations: A report of 105 cases

Abstract

Objectives: To evaluate the clinical characteristics of patients that hospitalized with acute abdominopelvic pain (AAP) and underwent emergent gynecological operations in obstetrics and gynecology clinics. Methods: This retrospective study was performed at Dicle University Hospital, Department of Obstetrics and Gynecology, from June 2006 to May 2009. The data were collected from hospital records and patients charts. The age, gravidy, parity, last menstrual period, physical examination findings, initial complaints, operation diagnosis, preoperative and postoperative hematocrit values, the type of the operation that performed and the amount of blood products transfusions were investigated. Results: During the study period, a total of 105 patients were operated due to characteristic clinical sign and symptoms of acute abdomen. The initial complaints were abdominopelvic pain in 62 patients (59.0%) and abdomino-pelvic pain with vaginal bleeding in 43 patients (41.0%). Of all cases; 60 (57.1%) women had ruptured ectopic pregnancy, 29 (27.6%) had corpus hemorrhagic cyst rupture. Only 68 (64.76%) of the cases were subjected to laparotomy under emergency conditions, while 37 (35.2%) of them were subjected to laparoscopy. Fifty five (52.4%) women needed blood products transfusion. Conclusion: The initial evaluation of abdominopelvic pain related to gynecologic causes should include taking a careful history, performing abdominopelvic examination, pregnancy test, laboratory studies and color Doppler ultrasound. Although the patients can be followed conservatively, they may need an emergent surgery for life saving.

Keywords

• Acute abdomen, emergent gynecologic surgery, clinical characteristics, causes.

Acil jinekolojik operasyonlar: 105 olgunun değerlendirilmesi

Abstract

Amaç: Kadın Doğum Kliniğinde akut abdominopelvik ağrı nedeniyle acil olarak opere edilen hastaların klinik özelliklerini değerlendirilmesi. Yöntemler: Bu retrospektif çalışma Dicle Üniversitesi Tıp Fakültesi Obstetrik ve Jinekoloji Kliniğinde yapılmıştır. Akut abdominopelvik ağrı nedeniyle Haziran 2006-Mayıs 2009 tarihleri arasında opere edilen 105 hasta geriye dönüşlü olarak değerlendirilmiştir. Hastalar operasyon tanısı, yaş, gravida, parite, son adet tarihi, geliş şikayeti, fizik muayene bulguları, operasyon öncesi ve sonrası hematokrit seviyeleri, transfüze edilen kan ürünleri miktarı ve yapılan operasyon şekli açısından değerlendirildi. Hasta bilgileri hastane kayıtlarından elde edildi. Bulgular: Belirtilen süre içerisinde 105 hastanın akut jinekolojik nedenlerle opere edildiği saptandı. Geliş şikayeti 62 (59.0%) hastada abdominopelvik ağrı iken, 43 (41.0%). hastada ağrıya eşlik eden vaginal kanama şikayeti mevcuttu. Altmış (57.1%) hasta rüptüre ektopik gebelik nedeniyle ve 29 (27.6%) hastanın rüptüre over kisti nedeniyle opere edildiği saptandı. Acil koşullar nedeniyle 68 (64.8%) hastada laparatomi ile 37 (35.2%)\'sinde ise laparaskopi ile opere edildiği saptandı. Elli beş (52.4%) hastaya kan transfüzyonu yapılmış olduğu görüldü. Sonuç: Jinekolojik nedenli akut abdominopelvik ağrının başlangıç değerlendirilmesi; dikkatli alınmış anamnez, abdominopelvik fizik muayene bulguları, gebelik testi, laboratuvar bulguları ve renkli Doppler ultrasonografi ile incelemeyi içermelidir. Hastalar konservatif olarak takip edilmekle birlikte, hayat kurtarıcı acil cerrahi girişim gerekebilir.

Keywords

• Akut abdomen, acil jinekolojik cerrahi, klinik özellikler, nedenler

References

1. Kamin RA, Nowicki TA, Courtney DS, Powers RD. Pearls and pitfalls in the emergency department evaluation of ab- dominal pain. Emerg Med Clin North Am 2003;21:61-72
2. Jermy K, Bourne The role of ultrasound in the management of the acute gynaecological abdomen. Rev Gynaecol Pract 2004; 4:224-9.
3. Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician 2008;77:971-8.
4. Tarraza HM,Moore RD . Gynecological causes of the acute abdomen and the acute abdomen in pregnancy. Surg Clin North Am 1997;77:1371-94.
5. Ramphal SR, Moodley J. Emergency gynaecology. Best Pract Res Clin Obstet Gynaecol 2006;20:729-50.
6. Damario MA, Rock JA. Ectopic pregnancy. In Rock JA, Jones HW eds, Te Linde’s Operative Gynecology, Ninth edition. Lippincott Williams &Wilkins. 2003;507-33
7. McWilliams GD, Hill MJ, Dietrich CS 3rd. Gynecologic emergencies. Obstet Gynecol Clin North Am 2007;34:599- 616.
8. Hammond R. Gynaecological causes of abdominal pain. Women’s Health Medicine 2006;3:124-7.

9. Ramphal SR. Emergency gynaecology. Best Pract Res Clin Obstet Gynaecol 2006;20:729-50.
10. Yao M, Tulandi T. Current status of surgical and non- surgical management of ectopic pregnancy. Fertil Steril 1997;67:421-33.
11. Albayam F, Hamper UM. Ovarian and adnexal torsion: spec- trum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20:1083-9.
12. Nagel TC, Sebastian J, Malo JW. Oophoropexy to prevent sequential or recurrent torsion. J Am Assoc Gynecol Lap- arosc 1997;4:495-8.