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

Aine Marie Kelly, Jennifer L. Cullmann, Stefan Puig, Kimberly E. Applegate
In: Evidence-Based Imaging · 2018 · pp. 415–434 · doi:10.1007/978-3-319-67066-9_27 · W2795066102
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Acute pelvic pain in premenopausal women, children, and infants requires careful consideration of various etiologies, with ultrasound recommended for suspected gynecological causes.

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This chapter reviews causes and emergency imaging strategies for acute lower abdominal and pelvic pain in premenopausal women and in children and infants, emphasizing that diagnostic localization is often difficult in younger patients and that life- or fertility-threatening conditions must be considered until excluded. Using a high-level evidence-based approach, it describes how history, physical examination, and laboratory testing narrow the differential diagnosis and guide selection of imaging, recommending ultrasound as the initial imaging modality for pregnant and nonpregnant patients when a gynecological etiology is suspected. A major limitation is that the work is a narrative evidence-based guidance chapter rather than a single primary study, and it does not provide quantitative diagnostic performance measures in the provided text. Relevance to endometriosis: endometriosis is not explicitly discussed in the provided excerpt, though the chapter’s focus on emergency evaluation of acute gynecologic pelvic pain is applicable to diagnostic contexts where endometriosis can be considered.

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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. Similar content being viewed by others

References

Carrico CW, Fenton LZ, Taylor GA, et al. Am J Roentgenol. 1999;172:513–6. Hollman AS, MacDonald S. Genital emergencies. In: Carty H, editor. Emergency pediatric radiology. Berlin: Springer; 1999. p. 217–32. Klein MD, Rabbani AB, Rood KD, et al. J Pediatr Surg. 2001;36:1375–80. Puig S, Hormann M, Rebhandl W, et al. Radiology. 2003;226:101–4. Kruszka PS, Kruszka SJ. Am Fam Physician. 2010;82:141–7. Andreotti RF, Lee SI, Dejesus Allison SO, et al. Ultrasound Q. 2011;27:205–10. Bhosale PR, Javitt MC, Atri M, et al. Ultrasound Q. 2016;32:108–15. Vandermeer FQ, Wong-You-Cheong JJ. Clin Obstet Gynecol. 2009;52:2–20. Perera DS, Prabhakar HB. Clin Obstet Gynecol. 2015;58:28–46. Westrom L, Bengtsson LP, Mardh PA. Br Med J (Clin Res Ed). 1981;282(6257):15–8. Brunham RC, Gottlieb SL, Paavonen J. N Engl J Med. 2015;372:2039–48. Ross JD, Pelvic BMJ. Clin Evid. 2008;2008:1606. Soper DE. Obstet Gynecol. 2010;116:419–28. Lis R, Rowhani-Rahbar A, Manhart LE. Clin Infect Dis. 2015;61:418–26. 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. Workowski KA, Bolan GA, Centers for Disease C, Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137. Chang HC, Bhatt S, Dogra VS. Radiographics. 2008;28:1355–68. Ngo AV, Otjen JP, Parisi MT, et al. Pediatr Radiol. 2015;45:1845–55. Albayram F, Hamper UM. J Ultrasound Med. 2001;20:1083–9. Breech LL, Hillard PJ. Curr Opin Obstet Gynecol. 2005;17:483–9. Pomeranz AJ, Sabnis S. Pediatr Emerg Care. 2004;20:172–4. McWilliams GD, Hill MJ, Dietrich CS III. Surg Clin North Am. 2008;88:265–83. Chamie LP, Blasbalg R, Pereira RM, et al. Radiographics. 2011;31:E77–100. Dupuis CS, Kim YH. Ultrasonography. 2015;34:258–67. Hsu AL, Khachikyan I, Stratton P. Clin Obstet Gynecol. 2010;53:413–9. Hudelist G, Fritzer N, Thomas A, et al. Hum Reprod. 2012;27:3412–6. Husby GK, Haugen RS, Moen MH. Acta Obstet Gynecol Scand. 2003;82:649–53. Simoens S, Hummelshoj L, D’Hooghe T. Hum Reprod Update. 2007;13:395–404. 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. Bouquier J, Huchon C, Panel P, et al. Sex Transm Dis. 2014;41:525–31. RCOG. Why mothers die 1997–1999. The fifth report of the Confidential enqiries into maternal deaths in the United Kingdom. London: RCOG Press. Kaakaji Y, Nghiem HV, Nodell C, et al. AJR. 2000;174:641–9. Menon S, Sammel MD, Vichnin M, et al. J Pediatr Adolesc Gynecol. 2007;20:181–5. Zane SB, Kieke BA Jr, Kendrick JS, et al. Matern Child Health J. 2002;6(4):227–36. Curtis KM, Hillis SD, Kieke BA Jr, et al. Obstet Gynecol. 1998;91:1007–12. Goyal M, Hersh A, Luan X, et al. J Adolesc Health. 2013;53:249–52. Anteby SO, Schenker JG, Polishuk WZ. Ann Surg. 1975;181:484–6. Gaitan H, Angel E, Sanchez J, et al. Int J Gynaecol Obstet. 2002;76:149–58. Haggerty CL, Peipert JF, Weitzen S, et al. Sex Transm Dis. 2005;32:293–9. Kontoravdis A, Chryssikopoulos A, Hassiakos D, et al. Int J Gynaecol Obstet. 1996;52:243–8. Morino M, Pellegrino L, Castagna E, et al. Ann Surg. 2006;244:881–6. Black AY, Jamieson MA. Curr Opin Obstet Gynecol. 2002;14:467–74. CDC. 2015 Sexually transmitted diseases treatment guidelines: pelvic inflammatory disease. http://www.cdc.gov/std/tg2015/pid.htm. Eskenazi B, Warner ML. Obstet Gynecol Clin North Am. 1997;24:235–58. Low N, McCarthy A, Macleod J, et al. Health Technol Assess. 2007;11:iii–iv, ix–xii, 1–165. Hata K, Hata T, Senoh D, et al. Br J Obstet Gynaecol. 1990;97:163–6. Stark JE, Siegel MJ. AJR. 1994;163:1479–82. Burnett LS. Surg Clin North Am. 1988;68:385–98. Hibbard LT. Am J Obstet Gynecol. 1985;152:456–61. Houry D, Abbott JT. Ann Emerg Med. 2001;38:156–9. Mordehai J, Mares AJ, Barki Y, et al. J Pediatr Surg. 1991;26:1195–9. Cass DL. Semin Pediatr Surg. 2005;14:86–92. Ozkan S, Murk W, Arici A. Ann N Y Acad Sci. 2008;1127:92–100. Laufer MR, Goitein L, Bush M, et al. J Pediatr Adolesc Gynecol. 1997;10(4):199–202. Matalliotakis IM, Cakmak H, Fragouli YG, et al. Arch Gynecol Obstet. 2008;277(5):389–93. Reese KA, Reddy S, Rock JA. J Pediatr Adolesc Gynecol. 1996;9(3):125–8. Trent M, Ellen JM, Frick KD. Sex Transm Dis. 2011;38(4):326–8. Washington AE, Katz P. JAMA. 1991;266(18):2565–9. Rein DB, Kassler WJ, Irwin KL, Rabiee L. Obstet Gynecol. 2000;95(3):397–402. Yeh JM, Hook EW III, Goldie SJ. Sex Transm Dis. 2003;30(5):369–78. CDC. Pelvic inflammatory disease (PID) – CDC Factsheet. http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm. Soliman AM, Yang H, Du EX, et al. Hum Reprod. 2016;31:712–22. Gao X, Outley J, Botteman M, et al. Fertil Steril. 2006;86:1561–72. Ebner F, Varga D, Sorg F, et al. Arch Gynecol Obstet. 2015;291:493–8. Ballard K, Lowton K, Wright J. Fertil Steril. 2006;86:1296–301. Schenken RS. Fertil Steril. 2006;86:1305–6. Crochet JR, Bastian LA, Chireau MV. JAMA. 2013;309:1722–9. Lehnert BE, Gross JA, Linnau KF, et al. Emerg Radiol. 2012;19:293–9. Torkzad MR, Bremme K, Hellgren M, et al. Thromb Res. 2010;126:107–12. Ulusan S, Koc Z, Tokmak N. J Clin Ultrasound. 2007;35:256–61. White WM, Johnson EB, Zite NB, et al. J Urol. 2013;189:931–4. Lameris W, van Randen A, van Es HW, et al. BMJ. 2009;338:b2431. Lourenco AP, Swenson D, Tubbs RJ, et al. Emerg Radiol. 2014;21:179–87. Nur Azurah AG, Zainol ZW, Zainuddin AA, et al. World J Pediatr. 2015;11:35–40. Revzin MV, Mathur M, Dave HB, et al. Radiographics. 2016;36:1579–96. Borrelli PT, Butler SA, Docherty SM, et al. Clin Chem. 2003;49:2045–9. Braffman BH, Coleman BG, Ramchandani P, et al. Radiology. 1994;190:797–802. Buckley RG, King KJ, Disney JD, et al. Acad Emerg Med. 1998;5:951–60. Gracia CR, Barnhart KT. Obstet Gynecol. 2001;97:464–70. Mol BW, van Der Veen F, Bossuyt PM. Hum Reprod. 1999;14:2855–62. Barnhart KT, Fay CA, Suescum M, et al. Obstet Gynecol. 2011;117:299–306. Takahashi A, Takahama J, Marugami N, et al. Abdom Imaging. 2013;38:844–50. Romosan G, Bjartling C, Skoog L, et al. Hum Reprod. 2013;28:1569–79. Si MJ, Gui S, Fan Q, et al. Eur Radiol. 2016;26:1971–80. Horrow MM. Ultrasound Q. 2004;20:171–9. Bazot M, Malzy P, Cortez A, et al. Ultrasound Obstet Gynecol. 2007;30:994–1001. Bulas DI, Ahlstrom PA, Sivit CJ, et al. Radiology. 1992;183:435–9. Varras M, Polyzos D, Perouli E, et al. Clin Exp Obstet Gynecol. 2003;30:117–21. Li W, Zhang Y, Cui Y, et al. Abdom Imaging. 2013;38:193–200. Ueda H, Togashi K, Kataoka ML, et al. Magn Reson Med Sci. 2002;1:207–15. Sam JW, Jacobs JE, Birnbaum BA. Radiographics. 2002;22:1327–34. Lee MH, Moon MH, Sung CK, et al. Abdom Imaging. 2014;39:1350–5. Jung SI, Kim YJ, Park HS, et al. J Obstet Gynaecol Res. 2011;37:228–35. Levine D, Brown DL, Andreotti RF, et al. Radiology. 2010;256:943–54. Patel MD, Feldstein VA, Filly RA. J Ultrasound Med. 2005;24:607–14. Chiou SY, Lev-Toaff AS, Masuda E, et al. J Ultrasound Med. 2007;26:1289–301. Harris RD, Javitt MC, Glanc P, et al. Ultrasound Q. 2013;29:79–86. Brown DL, Doubilet PM, Miller FH, et al. Radiology. 1998;208:103–10. Littman ED, Rydfors J, Milki AA. Hum Reprod. 2003;18:1641–2. Servaes S, Zurakowski D, Laufer MR, et al. Pediatr Radiol. 2007;37(5):446–51. Shadinger LL, Andreotti RF, Kurian RL. J Ultrasound Med. 2008;27:7–13. Lee EJ, Kwon HC, Joo HJ, et al. J Ultrasound Med. 1998;17:83–9. Vijayaraghavan SB. J Ultrasound Med. 2004;23(12):1643–1649; quiz 1650–1. Graif M, Itzchak Y. Am J Roentgenol. 1988;150(3):647–9. Albayram F, Hamper UM. J Ultrasound Med. 2001;20:1083–9. Wilkinson C, Sanderson A. Clin Radiol. 2012;67:476–83. Nisenblat V, Prentice L, Bossuyt PM, et al. Cochrane Database Syst Rev. 2016;7:CD012281. Nisenblat V, Bossuyt PM, Farquhar C, et al. Cochrane Database Syst Rev. 2016;2:CD009591. Bazot M, Lafont C, Rouzier R, et al. Fertil Steril. 2009;92:1825–33. Bailez MM. Semin Pediatr Surg. 2007;16:278–87. Rock JA, Schlaff WD. Fertil Steril. 1985;43:681–92. Garel L, Dubois J, Grignon A, et al. Radiographics. 2001;21:1393–407. Behr SC, Courtier JL, Qayyum A. Radiographics. 2012;32:E233–50. Mashiach R, Melamed N, Gilad N, et al. Ultrasound Med. 2011;30:1205–10. Molander P, Sjoberg J, Paavonen J, et al. Ultrasound Obstet Gynecol. 2001;17:233–8. Alcazar JL, Guerriero S, Laparte C, et al. Maturitas. 2011;68:182–8. Nizar K, Deutsch M, Filmer S, et al. J Clin Ultrasound. 2009;37:436–9. Potter AW, Chandrasekhar CA. Radiographics. 2008;28:1645–59. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2018 Springer International Publishing AG, part of Springer Nature About this chapter Cite this chapter Kelly, A.M., Cullmann, J.L., Puig, S., Applegate, K.E. (2018). Acute Pelvic Pain in Premenapausal Women, Children and Infants: Evidence-Based Emergency Imaging. In: Kelly, A., Cronin, P., Puig, S., Applegate, K. (eds) Evidence-Based Emergency Imaging. Evidence-Based Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-67066-9_27 Download citation DOI: https://doi.org/10.1007/978-3-319-67066-9_27 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-67064-5 Online ISBN: 978-3-319-67066-9 eBook Packages: MedicineMedicine (R0)

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