Abstract
Gynecological emergencies must be considered in the differential diagnosis of a woman presenting with lower abdominal pain to the general surgeon. Recognition and awareness of gynecological emergencies are essential as a general surgeon, to ensure patients are investigated appropriately and managed in a timely manner. This chapter provides an overview of gynecological conditions such as adnexal torsion, ectopic pregnancy, ovarian cysts, and pelvic inflammatory disease with the aim of improving the knowledge, recognition, and subsequent management of patients presenting to the acute general surgery take with gynecological pathology. It will also discuss when the laparoscopic approach is appropriate.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009;52:2–20.
Karam AR, Birjawi GA, Sidani CA, Haddad MC. Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast. Clin Imaging. 2007;31:77–86.
McCartan DP, Fleming FJ, Grace PA. The management of right iliac fossa pain—is timing everything? Surgeon. 2010;8:211–7.
Wilson MSJ, Powell-Bowns M, Robertson AG, et al. Results of a national multicenter audit assessment of gynecologic history in surgical patients. Int J Gynecol Obstet. 2017;139:197–201.
Ramphal SR, Moodley J. Emergency gynaecology. Best Pract Res Clin Obstet Gynaecol. 2006;20:729–50.
Ness RB, Smith KJ, Chang C-CH, Schisterman EF, Bass DC. Prediction of pelvic inflammatory disease among young, single, sexually active women. Sex Transm Dis. 2006;33:137–42.
Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018;29:108–14.
Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. https://reference.medscape.com/medline/abstract/22030186. Accessed 15 Apr 2021.
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372:2039–48.
Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009;23:667–78.
Livengood CH. Tubo-ovarian abscess. Contemp Ob-Gyn. 1999;44:108.
Augustin G, Prutki M. Pelvic inflammatory disease. Cham: Springer; 2018. p. 199–206.
DeWitt J, Reining A, Allsworth JE, Peipert JF. Tuboovarian abscesses: is size associated with duration of Hospitalization & Complications? Obstet Gynecol Int. 2010;2010:1–5.
Jiang X, Shi M, Sui M, Wang T, Yang H, Zhou H, Zhao K. Clinical value of early laparoscopic therapy in the management of tubo-ovarian or pelvic abscess. Exp Ther Med. 2019;18:1115–22.
Topçu HO, Kokanali K, Güzel AI, Tokmak A, Erkilinç S, Ümit C, Doʇanay M. Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess. J Obstet Gynaecol (Lahore). 2015;35:699–702.
Akselim B, Karaşin SS, Demirci A, Üstünyurt E. Can antibiotic treatment failure in tubo-ovarian abscess be predictable? Eur J Obstet Gynecol Reprod Biol. 2021;258:253–7.
Kinay T, Unlubilgin E, Cirik DA, Kayikcioglu F, Akgul MA, Dolen I. The value of ultrasonographic tubo-ovarian abscess morphology in predicting whether patients will require surgical treatment. Int J Gynecol Obstet. 2016;135:77–81.
Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64:681–9.
Theofanakis CP, Kyriakidis AV. Fitz-Hugh-Curtis syndrome. https://doi.org/10.1007/s10397-010-0642-8.
Lopez-Zeno JA, Keith LG, Berger GS. The Fitz-Hugh-Curtis syndrome revisited. Changing perspectives after half a century. J Reprod Med. 1985;30:567–82.
Banerjee B, Rennison A, Boyes BE. Sonographic features in a case of Fitz-Hugh-Curtis syndrome masquerading as malignancy. Br J Radiol. 1992;65:342–4.
Gaskins AJ, Missmer SA, Rich-Edwards JW, Williams PL, Souter I, Chavarro JE. Demographic, lifestyle, and reproductive risk factors for ectopic pregnancy. Fertil Steril. 2018;110:1328–37.
Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plan Reprod Heal Care. 2011;37:231–40.
Goyaux N, Leke R, Keita N, Thonneau P. Ectopic pregnancy in African developing countries. Acta Obstet Gynecol Scand. 2003;82:305–12.
Leke RJ, Goyaux N, Matsuda T, Thonneau PF. Ectopic pregnancy in Africa: a population-based study. Obstet Gynecol. 2004;103:692–7.
Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril. 2006;86:36–43.
Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65:1093–9.
Walker JJ. Ectopic pregnancy. Clin Obstet Gynecol. 2007;50:89–99.
Tay JI. Regular review: ectopic pregnancy. BMJ. 2000;320:916–9.
Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Hamid MA, Northern K, Schmidt J, Kharwadkar A. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28:10–7.
Ahmed AA, Tom BDM, Calabrese P. Ectopic pregnancy diagnosis and the pseudo-sac. Fertil Steril. 2004;81:1225–8.
Levine D. Ectopic pregnancy. Radiology. 2007;245:385–97.
Mukul LV, Teal SB. Current Management of Ectopic Pregnancy. Obstet Gynecol Clin N Am. 2007;34:403–19.
Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173:905–12.
Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ. Diagnosis and management of ectopic pregnancy. BJOG Int J Obstet Gynaecol. 2016;123:e15–55.
National Institute for Health and Clinical Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE Guideline CG154. 2012:1–34.
San Lazaro Campillo IS, Meaney S, O’Donoghue K, Corcoran P. Ectopic pregnancy hospitalisations: a national population-based study of rates, management and outcomes. Eur J Obstet Gynecol Reprod Biol. 2018;231:174–9.
Lundorff P, Thorburn J, Hahlin M, Källfelt B, Lindblom B. Laparoscopic surgery in ectopic pregnancy: a randomized trial versus laparotomy. Acta Obstet Gynecol Scand. 1991;70:343–8.
Gray DT, Thorburn J, Lundorff P, Strandell A, Lindblom B. A cost-effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy. Lancet. 1995;345:1139–43.
Boyd CA, Riall TS. Unexpected gynecologic findings during abdominal surgery. Curr Probl Surg. 2012;49:195–251.
Lee YR. CT imaging findings of ruptured ovarian endometriotic cysts: emphasis on the differential diagnosis with ruptured ovarian functional cysts. Korean J Radiol. 2011;12:59–65.
Choi NJ, Rha SE, Jung SE, Choi BG, Oh SN, Byun JY, Kim MR. Ruptured endometrial cysts as a rare cause of acute pelvic pain: can we differentiate them from ruptured corpus luteal cysts on CT scan? J Comput Assist Tomogr. 2011;35:454–8.
Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009;23:711–24.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol. 2016;128:e210–26.
Evangelinakis N, Grammatikakis I, Salamalekis G, Tziortzioti V, Samaras C, Chrelias C, Kassanos D. Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study. Clin Exp Obstet Gynecol. 2009;36:254–5.
Savasi I, Lacy JA, Gerstle JT, Stephens D, Kives S, Allen L. Management of Ovarian Dermoid Cysts in the pediatric and adolescent population. J Pediatr Adolesc Gynecol. 2009;22:360–4.
Rogers EM, Allen L, Kives S. The recurrence rate of ovarian dermoid cysts in pediatric and adolescent girls. J Pediatr Adolesc Gynecol. 2014;27:222–6.
Royal College of Obstretician and Gynaecologist. The management of ovarian cysts in postmenopausal women. 2016.
Balci O, Icen MS, Mahmoud AS, Capar M, Colakoglu MC. Management and outcomes of adnexal torsion: a 5-year experience. Arch Gynecol Obstet. 2011;284:643–6.
Adnexal torsion in adolescents: ACOG Committee Opinion No, 783. Obstet Gynecol. 2019;134:E56–E63.
Valsky DV, Esh-Broder E, Cohen SM, Lipschuetz M, Yagel S. Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion. Ultrasound Obstet Gynecol. 2010;36:630–4.
Kives S, Gascon S, Dubuc É, Van Eyk N. No. 341-diagnosis and management of adnexal torsion in children, adolescents, and adults. J Obstet Gynaecol Canada. 2017;39:82–90.
Adeyemi-Fowode O, McCracken KA, Todd NJ. Adnexal torsion. J Pediatr Adolesc Gynecol. 2018;31:333–8.
Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. 2001;38:156–9.
Lo LM, Chang SD, Horng SG, Yang TY, Lee CL, Liang CC. Laparoscopy versus laparotomy for surgical intervention of ovarian torsion. J Obstet Gynaecol Res. 2008;34:1020–5.
Asfour V, Varma R, Menon P. Clinical risk factors for ovarian torsion. J Obstet Gynaecol (Lahore). 2015;35:721–5.
Graziano A, Monte GL, Engl B, Marci R. Recurrent ovarian torsion in a pregnancy complicated by ovarian hyperstimulation syndrome. J Minim Invasive Gynecol. 2014;21(5):723–4.
Ginath S, Shalev A, Keidar R, et al. Differences between adnexal torsion in pregnant and nonpregnant women. J Minim Invasive Gynecol. 2012;19:708.
Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25:51–9.
Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004;39:750–3.
Appelbaum H, Abraham C, Choi-Rosen J, Ackerman M. Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol. 2013;26:167–70.
Karaman E, Beger B, Çetin O, Melek M, Karaman Y. Ovarian torsion in the normal ovary: a diagnostic challenge in postmenarchal adolescent girls in the emergency department. Med Sci Monit. 2017;23:1312–6.
Rey-Bellet Gasser C, Gehri M, Joseph J-M, Pauchard J-Y. Is it ovarian torsion? A systematic literature review and evaluation of prediction signs. Pediatr Emerg Care. 2016;32:256–61.
Poonai N, Poonai C, Lim R, Lynch T. Pediatric ovarian torsion: case series and review of the literature. Can J Surg. 2013;56:103–8.
Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006;49(3):459–63.
Tsafrir Z, Azem F, Hasson J, et al. Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center. J Minim Invasive Gynecol. 2012;19:29–33.
Bronstein ME, Pandya S, Snyder CW, Shi Q, Muensterer OJ. A meta-analysis of b-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 2015;25:82–6.
Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 2014;21:179–87.
Wilkinson C, Sanderson A. Adnexal torsion—a multimodality imaging review. Clin Radiol. 2012;67:476–83.
Piper H, Oltmann S, Xu L, et al. Ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Pediatr Surg. 2012;47:2071–6.
Göçmen A, Karaca M, Sari A. Conservative laparoscopic approach to adnexal torsion. Arch Gynecol Obstet. 2008;277:535–8.
Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, Moscovici J, Guitard J, Pienkowski C, Vaysse P. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44:1759–65.
Wang JH, Wu DH, Jin H, Wu YZ. Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls. Eur J Pediatr Surg. 2010;20:298–301.
Fuchs N, Smorgick N, Tovbin Y, Ben Ami I, Maymon R, Halperin R, Pansky M. Oophoropexy to prevent adnexal torsion: how, when, and for whom? J Minim Invasive Gynecol. 2010;17:205–8.
Comeau IM, Hubner N, Kives SL, Allen LM. Rates and technique for Oophoropexy in pediatric ovarian torsion: a single-institution case series. J Pediatr Adolesc Gynecol. 2017;30:418–21.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kilkenny, J.L., Wilson, M.S.J. (2023). Gynecological Emergencies. In: Coccolini, F., Podda, M., Lim, R.B., Chiarugi, M. (eds) Mini-invasive Approach in Acute Care Surgery. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-39001-2_22
Download citation
DOI: https://doi.org/10.1007/978-3-031-39001-2_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-39000-5
Online ISBN: 978-3-031-39001-2
eBook Packages: MedicineMedicine (R0)