Acute Pelvic Pain in Premenapausal Women, Children and Infants: Evidence-Based Emergency Imaging

  • Aine Marie Kelly
  • Jennifer L. Cullmann
  • Stefan Puig
  • Kimberly E. Applegate
Chapter
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)

Abstract

Acute lower abdominal and pelvic pain in premenopausal women has a wide range of etiologies including gastrointestinal, urological, obstetrical, and gynecological causes. Specifically, in younger patients, it is difficult to localize the pain during both history and physical examination, making it a diagnostic challenge. Life- and/or fertility-threatening conditions are the first to be considered until they can be confidentially excluded. History, physical examination, and laboratory testing narrow the differential diagnosis and guide the physician to choose the proper imaging test. Ultrasound is the recommended initial imaging tool for pregnant and nonpregnant women and girls presenting with acute pelvic pain and in which a gynecological etiology is suspected.

Keywords

Acute pelvic pain Ectopic pregnancy Pelvic inflammatory disease Ruptured ovarian cyst Adnexal/ovarian torsion Endometriosis Ultrasound Evidence-based imaging Emergency imaging 

References

  1. 1.
    Carrico CW, Fenton LZ, Taylor GA, et al. Am J Roentgenol. 1999;172:513–6.CrossRefGoogle Scholar
  2. 2.
    Hollman AS, MacDonald S. Genital emergencies. In: Carty H, editor. Emergency pediatric radiology. Berlin: Springer; 1999. p. 217–32.Google Scholar
  3. 3.
    Klein MD, Rabbani AB, Rood KD, et al. J Pediatr Surg. 2001;36:1375–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Puig S, Hormann M, Rebhandl W, et al. Radiology. 2003;226:101–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Kruszka PS, Kruszka SJ. Am Fam Physician. 2010;82:141–7.PubMedGoogle Scholar
  6. 6.
    Andreotti RF, Lee SI, Dejesus Allison SO, et al. Ultrasound Q. 2011;27:205–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Bhosale PR, Javitt MC, Atri M, et al. Ultrasound Q. 2016;32:108–15.PubMedCrossRefGoogle Scholar
  8. 8.
    Vandermeer FQ, Wong-You-Cheong JJ. Clin Obstet Gynecol. 2009;52:2–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Perera DS, Prabhakar HB. Clin Obstet Gynecol. 2015;58:28–46.PubMedCrossRefGoogle Scholar
  10. 10.
    Westrom L, Bengtsson LP, Mardh PA. Br Med J (Clin Res Ed). 1981;282(6257):15–8.CrossRefGoogle Scholar
  11. 11.
    Brunham RC, Gottlieb SL, Paavonen J. N Engl J Med. 2015;372:2039–48.PubMedCrossRefGoogle Scholar
  12. 12.
    Ross JD, Pelvic BMJ. Clin Evid. 2008;2008:1606.Google Scholar
  13. 13.
    Soper DE. Obstet Gynecol. 2010;116:419–28.PubMedCrossRefGoogle Scholar
  14. 14.
    Lis R, Rowhani-Rahbar A, Manhart LE. Clin Infect Dis. 2015;61:418–26.PubMedCrossRefGoogle Scholar
  15. 15.
    CDC. 2015 Sexually transmitted diseases treatment guidelines – pelvic inflammatory disease. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention; 2015.Google Scholar
  16. 16.
    Workowski KA, Bolan GA, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.PubMedGoogle Scholar
  17. 17.
    Chang HC, Bhatt S, Dogra VS. Radiographics. 2008;28:1355–68.PubMedCrossRefGoogle Scholar
  18. 18.
    Ngo AV, Otjen JP, Parisi MT, et al. Pediatr Radiol. 2015;45:1845–55.PubMedCrossRefGoogle Scholar
  19. 19.
    Albayram F, Hamper UM. J Ultrasound Med. 2001;20:1083–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Breech LL, Hillard PJ. Curr Opin Obstet Gynecol. 2005;17:483–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Pomeranz AJ, Sabnis S. Pediatr Emerg Care. 2004;20:172–4.PubMedCrossRefGoogle Scholar
  22. 22.
    McWilliams GD, Hill MJ, Dietrich CS III. Surg Clin North Am. 2008;88:265–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Chamie LP, Blasbalg R, Pereira RM, et al. Radiographics. 2011;31:E77–100.PubMedCrossRefGoogle Scholar
  24. 24.
    Dupuis CS, Kim YH. Ultrasonography. 2015;34:258–67.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Hsu AL, Khachikyan I, Stratton P. Clin Obstet Gynecol. 2010;53:413–9.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Hudelist G, Fritzer N, Thomas A, et al. Hum Reprod. 2012;27:3412–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Husby GK, Haugen RS, Moen MH. Acta Obstet Gynecol Scand. 2003;82:649–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Simoens S, Hummelshoj L, D’Hooghe T. Hum Reprod Update. 2007;13:395–404.PubMedCrossRefGoogle Scholar
  29. 29.
    Bhuiya FA, Pitts SR, McCaig LF. Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief. 2010;43:1–8.Google Scholar
  30. 30.
    Bouquier J, Huchon C, Panel P, et al. Sex Transm Dis. 2014;41:525–31.PubMedCrossRefGoogle Scholar
  31. 31.
    RCOG. Why mothers die 1997–1999. The fifth report of the Confidential enqiries into maternal deaths in the United Kingdom. London: RCOG Press.Google Scholar
  32. 32.
    Kaakaji Y, Nghiem HV, Nodell C, et al. AJR. 2000;174:641–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Menon S, Sammel MD, Vichnin M, et al. J Pediatr Adolesc Gynecol. 2007;20:181–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Zane SB, Kieke BA Jr, Kendrick JS, et al. Matern Child Health J. 2002;6(4):227–36.PubMedCrossRefGoogle Scholar
  35. 35.
    Curtis KM, Hillis SD, Kieke BA Jr, et al. Obstet Gynecol. 1998;91:1007–12.PubMedGoogle Scholar
  36. 36.
    Goyal M, Hersh A, Luan X, et al. J Adolesc Health. 2013;53:249–52.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Anteby SO, Schenker JG, Polishuk WZ. Ann Surg. 1975;181:484–6.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Gaitan H, Angel E, Sanchez J, et al. Int J Gynaecol Obstet. 2002;76:149–58.PubMedCrossRefGoogle Scholar
  39. 39.
    Haggerty CL, Peipert JF, Weitzen S, et al. Sex Transm Dis. 2005;32:293–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Kontoravdis A, Chryssikopoulos A, Hassiakos D, et al. Int J Gynaecol Obstet. 1996;52:243–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Morino M, Pellegrino L, Castagna E, et al. Ann Surg. 2006;244:881–6.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Black AY, Jamieson MA. Curr Opin Obstet Gynecol. 2002;14:467–74.PubMedCrossRefGoogle Scholar
  43. 43.
    CDC. 2015 Sexually transmitted diseases treatment guidelines: pelvic inflammatory disease. http://www.cdc.gov/std/tg2015/pid.htm.
  44. 44.
    Eskenazi B, Warner ML. Obstet Gynecol Clin North Am. 1997;24:235–58.PubMedCrossRefGoogle Scholar
  45. 45.
    Low N, McCarthy A, Macleod J, et al. Health Technol Assess. 2007;11:iii–iv, ix–xii, 1–165.Google Scholar
  46. 46.
    Hata K, Hata T, Senoh D, et al. Br J Obstet Gynaecol. 1990;97:163–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Stark JE, Siegel MJ. AJR. 1994;163:1479–82.PubMedCrossRefGoogle Scholar
  48. 48.
    Burnett LS. Surg Clin North Am. 1988;68:385–98.PubMedCrossRefGoogle Scholar
  49. 49.
    Hibbard LT. Am J Obstet Gynecol. 1985;152:456–61.PubMedCrossRefGoogle Scholar
  50. 50.
    Houry D, Abbott JT. Ann Emerg Med. 2001;38:156–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Mordehai J, Mares AJ, Barki Y, et al. J Pediatr Surg. 1991;26:1195–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Cass DL. Semin Pediatr Surg. 2005;14:86–92.PubMedCrossRefGoogle Scholar
  53. 53.
    Ozkan S, Murk W, Arici A. Ann N Y Acad Sci. 2008;1127:92–100.PubMedCrossRefGoogle Scholar
  54. 54.
    Laufer MR, Goitein L, Bush M, et al. J Pediatr Adolesc Gynecol. 1997;10(4):199–202.PubMedCrossRefGoogle Scholar
  55. 55.
    Matalliotakis IM, Cakmak H, Fragouli YG, et al. Arch Gynecol Obstet. 2008;277(5):389–93.PubMedCrossRefGoogle Scholar
  56. 56.
    Reese KA, Reddy S, Rock JA. J Pediatr Adolesc Gynecol. 1996;9(3):125–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Trent M, Ellen JM, Frick KD. Sex Transm Dis. 2011;38(4):326–8.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Washington AE, Katz P. JAMA. 1991;266(18):2565–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Rein DB, Kassler WJ, Irwin KL, Rabiee L. Obstet Gynecol. 2000;95(3):397–402.PubMedGoogle Scholar
  60. 60.
    Yeh JM, Hook EW III, Goldie SJ. Sex Transm Dis. 2003;30(5):369–78.PubMedCrossRefGoogle Scholar
  61. 61.
    CDC. Pelvic inflammatory disease (PID) – CDC Factsheet. http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm.
  62. 62.
    Soliman AM, Yang H, Du EX, et al. Hum Reprod. 2016;31:712–22.PubMedCrossRefGoogle Scholar
  63. 63.
    Gao X, Outley J, Botteman M, et al. Fertil Steril. 2006;86:1561–72.PubMedCrossRefGoogle Scholar
  64. 64.
    Ebner F, Varga D, Sorg F, et al. Arch Gynecol Obstet. 2015;291:493–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Ballard K, Lowton K, Wright J. Fertil Steril. 2006;86:1296–301.PubMedCrossRefGoogle Scholar
  66. 66.
    Schenken RS. Fertil Steril. 2006;86:1305–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Crochet JR, Bastian LA, Chireau MV. JAMA. 2013;309:1722–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Lehnert BE, Gross JA, Linnau KF, et al. Emerg Radiol. 2012;19:293–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Torkzad MR, Bremme K, Hellgren M, et al. Thromb Res. 2010;126:107–12.PubMedCrossRefGoogle Scholar
  70. 70.
    Ulusan S, Koc Z, Tokmak N. J Clin Ultrasound. 2007;35:256–61.PubMedCrossRefGoogle Scholar
  71. 71.
    White WM, Johnson EB, Zite NB, et al. J Urol. 2013;189:931–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Lameris W, van Randen A, van Es HW, et al. BMJ. 2009;338:b2431.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Lourenco AP, Swenson D, Tubbs RJ, et al. Emerg Radiol. 2014;21:179–87.PubMedCrossRefGoogle Scholar
  74. 74.
    Nur Azurah AG, Zainol ZW, Zainuddin AA, et al. World J Pediatr. 2015;11:35–40.PubMedCrossRefGoogle Scholar
  75. 75.
    Revzin MV, Mathur M, Dave HB, et al. Radiographics. 2016;36:1579–96.PubMedCrossRefGoogle Scholar
  76. 76.
    Borrelli PT, Butler SA, Docherty SM, et al. Clin Chem. 2003;49:2045–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Braffman BH, Coleman BG, Ramchandani P, et al. Radiology. 1994;190:797–802.PubMedCrossRefGoogle Scholar
  78. 78.
    Buckley RG, King KJ, Disney JD, et al. Acad Emerg Med. 1998;5:951–60.PubMedCrossRefGoogle Scholar
  79. 79.
    Gracia CR, Barnhart KT. Obstet Gynecol. 2001;97:464–70.PubMedGoogle Scholar
  80. 80.
    Mol BW, van Der Veen F, Bossuyt PM. Hum Reprod. 1999;14:2855–62.PubMedCrossRefGoogle Scholar
  81. 81.
    Barnhart KT, Fay CA, Suescum M, et al. Obstet Gynecol. 2011;117:299–306.PubMedCrossRefGoogle Scholar
  82. 82.
    Takahashi A, Takahama J, Marugami N, et al. Abdom Imaging. 2013;38:844–50.PubMedCrossRefGoogle Scholar
  83. 83.
    Romosan G, Bjartling C, Skoog L, et al. Hum Reprod. 2013;28:1569–79.PubMedCrossRefGoogle Scholar
  84. 84.
    Si MJ, Gui S, Fan Q, et al. Eur Radiol. 2016;26:1971–80.PubMedCrossRefGoogle Scholar
  85. 85.
    Horrow MM. Ultrasound Q. 2004;20:171–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Bazot M, Malzy P, Cortez A, et al. Ultrasound Obstet Gynecol. 2007;30:994–1001.PubMedCrossRefGoogle Scholar
  87. 87.
    Bulas DI, Ahlstrom PA, Sivit CJ, et al. Radiology. 1992;183:435–9.PubMedCrossRefGoogle Scholar
  88. 88.
    Varras M, Polyzos D, Perouli E, et al. Clin Exp Obstet Gynecol. 2003;30:117–21.PubMedGoogle Scholar
  89. 89.
    Li W, Zhang Y, Cui Y, et al. Abdom Imaging. 2013;38:193–200.PubMedCrossRefGoogle Scholar
  90. 90.
    Ueda H, Togashi K, Kataoka ML, et al. Magn Reson Med Sci. 2002;1:207–15.PubMedCrossRefGoogle Scholar
  91. 91.
    Sam JW, Jacobs JE, Birnbaum BA. Radiographics. 2002;22:1327–34.PubMedCrossRefGoogle Scholar
  92. 92.
    Lee MH, Moon MH, Sung CK, et al. Abdom Imaging. 2014;39:1350–5.PubMedCrossRefGoogle Scholar
  93. 93.
    Jung SI, Kim YJ, Park HS, et al. J Obstet Gynaecol Res. 2011;37:228–35.PubMedCrossRefGoogle Scholar
  94. 94.
    Levine D, Brown DL, Andreotti RF, et al. Radiology. 2010;256:943–54.PubMedCrossRefGoogle Scholar
  95. 95.
    Patel MD, Feldstein VA, Filly RA. J Ultrasound Med. 2005;24:607–14.PubMedCrossRefGoogle Scholar
  96. 96.
    Chiou SY, Lev-Toaff AS, Masuda E, et al. J Ultrasound Med. 2007;26:1289–301.PubMedCrossRefGoogle Scholar
  97. 97.
    Harris RD, Javitt MC, Glanc P, et al. Ultrasound Q. 2013;29:79–86.PubMedCrossRefGoogle Scholar
  98. 98.
    Brown DL, Doubilet PM, Miller FH, et al. Radiology. 1998;208:103–10.PubMedCrossRefGoogle Scholar
  99. 99.
    Littman ED, Rydfors J, Milki AA. Hum Reprod. 2003;18:1641–2.PubMedCrossRefGoogle Scholar
  100. 100.
    Servaes S, Zurakowski D, Laufer MR, et al. Pediatr Radiol. 2007;37(5):446–51.PubMedCrossRefGoogle Scholar
  101. 101.
    Shadinger LL, Andreotti RF, Kurian RL. J Ultrasound Med. 2008;27:7–13.PubMedCrossRefGoogle Scholar
  102. 102.
    Lee EJ, Kwon HC, Joo HJ, et al. J Ultrasound Med. 1998;17:83–9.PubMedCrossRefGoogle Scholar
  103. 103.
    Vijayaraghavan SB. J Ultrasound Med. 2004;23(12):1643–1649; quiz 1650–1.Google Scholar
  104. 104.
    Graif M, Itzchak Y. Am J Roentgenol. 1988;150(3):647–9.CrossRefGoogle Scholar
  105. 105.
    Albayram F, Hamper UM. J Ultrasound Med. 2001;20:1083–9.PubMedCrossRefGoogle Scholar
  106. 106.
    Wilkinson C, Sanderson A. Clin Radiol. 2012;67:476–83.PubMedCrossRefGoogle Scholar
  107. 107.
    Nisenblat V, Prentice L, Bossuyt PM, et al. Cochrane Database Syst Rev. 2016;7:CD012281.PubMedGoogle Scholar
  108. 108.
    Nisenblat V, Bossuyt PM, Farquhar C, et al. Cochrane Database Syst Rev. 2016;2:CD009591.PubMedGoogle Scholar
  109. 109.
    Bazot M, Lafont C, Rouzier R, et al. Fertil Steril. 2009;92:1825–33.PubMedCrossRefGoogle Scholar
  110. 110.
    Bailez MM. Semin Pediatr Surg. 2007;16:278–87.PubMedCrossRefGoogle Scholar
  111. 111.
    Rock JA, Schlaff WD. Fertil Steril. 1985;43:681–92.PubMedCrossRefGoogle Scholar
  112. 112.
    Garel L, Dubois J, Grignon A, et al. Radiographics. 2001;21:1393–407.PubMedCrossRefGoogle Scholar
  113. 113.
    Behr SC, Courtier JL, Qayyum A. Radiographics. 2012;32:E233–50.PubMedCrossRefGoogle Scholar
  114. 114.
    Mashiach R, Melamed N, Gilad N, et al. Ultrasound Med. 2011;30:1205–10.CrossRefGoogle Scholar
  115. 115.
    Molander P, Sjoberg J, Paavonen J, et al. Ultrasound Obstet Gynecol. 2001;17:233–8.PubMedCrossRefGoogle Scholar
  116. 116.
    Alcazar JL, Guerriero S, Laparte C, et al. Maturitas. 2011;68:182–8.PubMedCrossRefGoogle Scholar
  117. 117.
    Nizar K, Deutsch M, Filmer S, et al. J Clin Ultrasound. 2009;37:436–9.PubMedCrossRefGoogle Scholar
  118. 118.
    Potter AW, Chandrasekhar CA. Radiographics. 2008;28:1645–59.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Aine Marie Kelly
    • 1
  • Jennifer L. Cullmann
    • 2
  • Stefan Puig
    • 2
    • 3
  • Kimberly E. Applegate
    • 4
  1. 1.Department of Radiology, Division of Cardio-Thoracic RadiologyMichigan MedicineAnn ArborUSA
  2. 2.Department of Diagnostic, Interventional, and Pediatric Radiology, InselspitalUniversity Hospital Bern, University of BernBernSwitzerland
  3. 3.Department of Radiology and NeuroradiologyKlinik im Park, Hirslanden AGZurichSwitzerland
  4. 4.Department of RadiologyUniversity of Kentucky Children’s HospitalLexingtonUSA

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