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Differenzialdiagnose des akuten Abdomens in der Gynäkologie

Differential diagnosis of the acute abdomen in gynecology

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Versorgung von Notfällen bildet eine der häufigsten Aufgaben unseres Fachgebietes. Eine besondere Herausforderung ist dabei die Abklärung, Erkennung und zeitgerechte Versorgung eines akuten Abdomens. Ein akutes Abdomen wird definiert als ein unterhalb des Nabels auftretender, nichttraumaassoziierter Schmerz mit einer Dauer von maximal 5 Tagen. Dieser Zustand ist durch Bauchschmerzen, Abwehrspannung und ggf. Begleitsymptome (Übelkeit, Erbrechen, Miktions- oder Defäkationsbeschwerden, Fieber etc.) charakterisiert. Das akute Abdomen, der typischerweise „brettharte Bauch“, stellt einen absoluten Notfall dar, der lebensbedrohlich sein kann. Im Beitrag werden die wesentlichen diagnostischen Schritte, insbesondere entscheidende „Kleinigkeiten“ zu diesen sowie die möglichen Krankheitsbilder dargestellt und diskutiert.

Abstract

The care in emergency situations is one of the most frequent duties in the field of gynecology and obstetrics. A particular challenge is the clarification, detection and timely care of an acute abdomen. An acute abdomen is defined as non-trauma-associated pain that occurs below the navel and lasts for a maximum of 5 days. This condition is characterized by abdominal pain, muscular tension and possibly accompanying symptoms (nausea, vomiting, micturition or defecation problems, fever, etc.). The acute abdomen, which is typically a belly as hard as a board, is an absolute emergency that can be life-threatening. In this article the essential diagnostic steps, in particular the decisive small details of these as well as the possible clinical symptoms are presented and discussed.

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Literatur

  1. Arora D (2005) Acute abdomen in gynaecological practice. Med J Armed Forces India 61(1):66–70. https://doi.org/10.1016/S0377-1237(05)80124-8

    Article  PubMed  PubMed Central  Google Scholar 

  2. Haque M, Kamal F, Chowdhury S, Uzzaman M, Aziz I (2014) Non obstetric causes and presentation of acute abdomen among the pregnant women. J Family Reprod Health 8(3):117–122

    PubMed  PubMed Central  Google Scholar 

  3. Jiang X, Shi M, Sui M et al (2019) Clinical value of early laparoscopic therapy in the management of tubo-ovarian or pelvic abscess. Exp Ther Med 18(2):1115–1122. https://doi.org/10.3892/etm.2019.7699

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lankisch PG, Mahlke R, Lübbers H (2009) Das akute Abdomen aus internistischer Sicht. Dtsch Arztebl 02:46a–47

    Google Scholar 

  5. Lee R, Dupuis C, Chen B, Smith A, Kim YH (2018) Diagnosing ectopic pregnancy in the emergency setting. Ultrasonography 37(1):78–87. https://doi.org/10.14366/usg.17044

    Article  PubMed  Google Scholar 

  6. Menon S, Colins J, Barnhart KT (2007) Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review. Fertil Steril 87(3):481–484. https://doi.org/10.1016/j.fertnstert.2006.10.007

    Article  CAS  PubMed  Google Scholar 

  7. Mol F, van Mello NM, Strandell A, Strandell K, Jurkovic D, Ross J, Barnhart KT, Yalcinkaya TM, Verhoeve HR, Graziosi GCM, Koks CAM, Klinte I, Hogström L, Janssen ICAH, Kragt H, Hoek A, Trimbos-Kemper TCM, Broekmans FJM, Willemsen WNP, Ankum WM, Mol BW, van Wely M, van der Veen F, Hajenius PJ, European Surgery in Ectopic Pregnancy (ESEP) study group (2014) Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet 383(9927):1483–1489. https://doi.org/10.1016/S0140-6736(14)60123-9

    Article  PubMed  Google Scholar 

  8. Panelli DM, Phillips CH, Brady PC (2015) Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract 1:15. https://doi.org/10.1186/s40738-015-0008-z

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rottenstreich A et al (2016) Pregnancy and non-pregnancy related ovarian vein thrombosis: clinical course and outcome. Thromb Res 146:84–88. https://doi.org/10.1016/j.thromres.2016.09.001

    Article  CAS  PubMed  Google Scholar 

  10. Sahin C, Taylan E, Akdemir A, Ozgurel B, Taskıran D, Ergenoglu AM (2016) The impact of salpingectomy and single-dose systemic methotrexate treatments on ovarian reserve in ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol 205:150–152. https://doi.org/10.1016/j.ejogrb.2016.08.028

    Article  CAS  PubMed  Google Scholar 

  11. Schmidt P, Skelly CL, Raines DA (2021) Placental abruption. In: StatPearls. StatPearls Publishing, Treasure Island

    Google Scholar 

  12. Timor-Tritsch IE, Monteagudo A, Rebarber A, Goldstein SR, Tsymbal T (2003) Transrectal scanning: an alternative when transvaginal scanning is not feasible. Ultrasound Obstet Gynecol. https://doi.org/10.1002/uog.110

    Article  PubMed  Google Scholar 

  13. Yuk JS, Yang SW, Lee MH, Kyung MS (2021) Incidence of adnexal torsion in the republic of Korea: a nationwide serial cross-sectional study (2009–2018). J Pers Med 11(8):743. https://doi.org/10.3390/jpm11080743

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zannoni L, Del Forno S, Coppola F, Papadopoulos D, Valerio D, Golfieri R, Caprara G, Paradisi R, Seracchioli R (2017) Comparison of transvaginal sonography and computed tomography-colonography with contrast media and urographic phase for diagnosing deep infiltrating endometriosis of the posterior compartment of the pelvis: a pilot study. Jpn J Radiol 35(9):546–554. https://doi.org/10.1007/s11604-017-0665-4

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten, Klinikverbund Allgäu gGmbH, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland

    Bálint Balogh, Maria-Rita Anwander, Bettina Unseld, Philipp Guttenberg & Ricardo Felberbaum

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  1. Bálint Balogh
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  2. Maria-Rita Anwander
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  3. Bettina Unseld
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  4. Philipp Guttenberg
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  5. Ricardo Felberbaum
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Correspondence to Bálint Balogh.

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Interessenkonflikt

B. Balogh, M.-R. Anwander, B. Unseld, P. Guttenberg und R. Felberbaum geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wolfgang Janni, Ulm

Ricardo Felberbaum, Kempten

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Balogh, B., Anwander, MR., Unseld, B. et al. Differenzialdiagnose des akuten Abdomens in der Gynäkologie. Gynäkologe 55, 238–245 (2022). https://doi.org/10.1007/s00129-022-04922-9

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