Clinical presentation and general symptoms
All manifestations of abdomen acutum gynaecologicum share similar symptomatology. The main sign is a suddenly occurring severe lower abdominal pain amidst complete well-being, which may spread throughout the abdominal cavity and lead to fainting.
Additional clinical manifestations:
- Dyspeptic disorders in the form of nausea and vomiting.
- Impaired peristalsis and intestinal transit: delayed passage of gas and stool (diarrhea is more common in children).
- Presence of peritoneal irritation signs.
Etiological groups of pathologies
Causes of dangerous conditions in gynecology are divided into three main groups:
- Acute intra-abdominal hemorrhages — include disrupted ectopic pregnancy (entry of ovum elements and blood into the abdominal cavity) and ovarian apoplexy.
- Circulatory disorders in organs — torsion of an ovarian tumor or mass pedicle, as well as torsion and necrosis of a myomatous node.
- Acute inflammatory processes — inflammation of internal genital organs proceeding with peritoneal involvement and the development of peritonitis.
Ectopic pregnancy and its danger
Ectopic pregnancy represents the development of a fertilized egg outside the uterine cavity. Over the past decade, the frequency of this pathology has increased 2–3 times, with developed countries showing a rate of 12–14 per a given number of observations.
The danger of the condition lies in the lack of conditions for prolongation, causing the pregnancy to terminate in early stages. This causes massive intra-abdominal hemorrhage and the clinical picture of an "acute abdomen". Without emergency diagnostics and care, the pathology can lead to maternal mortality.
Localization of ectopic pregnancy
According to the site of implantation of the ovum, the following forms are distinguished:
- Tubal pregnancy (the vast majority of cases, 98.5–99%): ampullary (60–95%), isthmic (15%), interstitial or intramural (1–3%).
- Rare forms: ovarian (0.1–0.7%), in a rudimentary uterine horn (0.5%), abdominal (0.3–0.4%), cervical (0.01%).
- Casuistic cases: multiple and bilateral tubal pregnancy, heterotopic (combination of intrauterine and ectopic), as well as implantation in the stump of a removed tube.
Briefly: answers to topical questions
Which acute surgical diseases must be differentiated from gynecological "acute abdomen"?
In the differential diagnosis of gynecological "acute abdomen", the following acute surgical conditions are considered:
- Acute appendicitis — differentiated from ruptured ectopic pregnancy and other conditions.
- Acute cholecystitis — differentiated from acute appendicitis, pancreatitis, urolithiasis, perforated gastric and duodenal ulcers, pneumonia, and pleurisy.
- Acute pancreatitis.
- Perforated gastric and duodenal ulcers.
What instrumental research methods are used for the emergency diagnosis of gynecological "acute abdomen"?
The following instrumental methods are used to diagnose gynecological "acute abdomen":
- Pelvic ultrasound — allows detection of indirect and absolute signs of ectopic pregnancy, accumulation of blood in the rectouterine pouch, and inflammatory masses.
- Culdocentesis (posterior colpocentesis) — used to aspirate fluid from the pouch of Douglas; performing it under ultrasound guidance increases safety and accuracy.
- Laparoscopy — the most informative diagnostic method for acute adnexitis, allowing evaluation of the severity and extent of the inflammatory process and selection of treatment tactics.
Which purulent-inflammatory diseases of the uterine appendages can lead to the development of peritonitis?
Complications of acute adnexitis upon perforation or rupture of purulent tubo-ovarian masses can lead to the development of peritonitis.
- Pyosalpinx — purulent inflammation of the fallopian tube.
- Pyoovar — purulent inflammation of the ovary.
- Tubo-ovarian abscess — forms as a result of purulent melting of contacting walls of the pyoovar and pyosalpinx.
The spread of infection from these foci first causes pelvioperitonitis, which may subsequently progress to generalized peritonitis.
CBC: Hemorrhage (or Circulation), Inflammation, Torsion — the three pillars of the gynecological "acute abdomen".
Class and exam questions
What is included in the concept of "acute abdomen" in gynecology?
This is a collective term for acutely occurring pathological processes in the abdominal cavity of various origins that require immediate hospitalization, accurate diagnostics, and emergency care.
What are the main symptoms of the development of this condition?
Sudden intense lower abdominal pain (the patient can name the exact hour of its onset), which may cause fainting. Nausea, vomiting, delayed stool and gas passage, and peritoneal irritation signs are also observed.
Into what groups are the causes of gynecological "acute abdomen" divided?
Three groups are distinguished: acute intra-abdominal hemorrhages (ectopic pregnancy, ovarian apoplexy), organ circulatory disorders (torsion of tumors and myomatous nodes), and acute inflammation with peritoneal involvement.
What percentage of ectopic pregnancies are accounted for by the tubal form?
Tubal pregnancy accounts for 98.5% to 99% of all ectopic pregnancy cases.
What else to study on this topic
- Detailed analysis of ampullary, isthmic, and interstitial forms of tubal pregnancy
- Clinical differences between ovarian apoplexy and disrupted ectopic pregnancy
- Diagnosis of ovarian tumor pedicle torsion and myomatous node necrosis
- Peritoneal irritation signs in gynecological pathologies
- Rare and casuistic forms of ectopic pregnancy (cervical, abdominal, heterotopic)
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