Acute abdomen with adnexal masses in the reproductive age group: diagnosis and management

Authors

  • Anuradha D. Murki Department of Obstetrics and Gynecology, Kamineni Academy of Medical Sciences and Research Centre LB Nagar, Hyderabad, Telangana, India
  • Vasundhara Kamineni Department of Obstetrics and Gynecology, Kamineni Academy of Medical Sciences and Research Centre LB Nagar, Hyderabad, Telangana, India
  • Sowmya R. Velagapudi Department of Obstetrics and Gynecology, Kamineni Academy of Medical Sciences and Research Centre LB Nagar, Hyderabad, Telangana, India
  • Ashok K. Deshpande Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre LB Nagar, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20202308

Keywords:

Adnexa, Ectopic pregnancy, Reproductive age

Abstract

Background: Women with adnexal masses can present with acute symptoms such as abdominal pain, nausea and vomiting. As there is insufficient evidence on the frequency, presentation and management of adnexal masses we conducted this study to evaluate the clinical profile, surgical findings and histopathology of adnexal masses in women presenting with acute abdomen and needing surgical intervention.

Methods: In this prospective observational study, history, examination, investigations and ultrasound of abdomen and pelvis were evaluated in women presenting with acute abdomen with adnexal mass and needing surgical intervention. Diagnosis was confirmed from the operative findings and histopathology. Etiology and its correlation with clinical symptoms and signs and radiological diagnosis formed the primary objective of the study.

Results: Of the 79 patients enrolled in the study, the mean age was 30.82±6.69 years. Younger women were likely to have ectopic pregnancy while older women (>35 years) other tubal pathologies. Pain abdomen (n=70) and nausea (n=53), bleeding per vagina(n=33), menstrual irregularities (n=18), fever (n=10) abdominal distension (n=10) and dysuria (4) were the common symptoms. Etiology of the adnexal mass was ectopic pregnancy (57%), ovarian mass (34%), tubal mass (7.5%), tube and ovary (2.5%) in 46, 25, 6 and 2 patients respectively. 61% (n=48) of the women underwent laparoscopic management. Women with ruptured ectopic pregnancy were more likely to have abdominal distension, pallor, hypotension, cervical motion tenderness and need for blood transfusions.

Conclusions: In women from reproductive age group with adnexal mass and needing surgery, ectopic pregnancies and benign ovarian tumours were the common etiologies. Urine pregnancy test and ultrasound are useful tests to differentiate ectopic from ovarian and tubal pathology.

References

Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016;93:676-81.

Russell DJ. The female pelvic mass: Diagnosis and management. Med Clin North Am. 1995;79:1481-93.

Al-Shukri M, Mathew M, Al-Ghafri W, Al-Kalbani M, Al-Kharusi L, Gowri V. A clinicopathological study of women with adnexal masses presenting with acute symptoms. Ann Med Health Sci Res. 2014;4:286-8.

Bhagde AD, Jani SK, Patel MS, Shah SR. An analytical study of 50 women presenting with an adnexal mass. Int J Reprod Contracept Obstet Gynecol. 2016;6(1):262.

Mohan S, Thomas M, Raman J. Adnexal torsion: clinical, radiological and pathological characteristics in a tertiary care centre in Southern India. Int J Reprod Contracept Obstet Gynecol. 2014;3:70-708.

Shrivastava M, Parashar H, Modi JN. A clinical study of ectopic pregnancy in a tertiary care centre in Central India. Int J Reprod Contracept Obstet Gynecol. 2017;6:2485-90.

Tamilarasi V, Adaikkappan, Kumari L. A Study on accuracy of ultrasound imaging in diagnosing adnexal masses presenting with acute symptoms by clinicopathological correlation. JMCSR. 2018;6:1191-7.

Chowdhury RN. A study of 158 cases of ectopic pregnancy. J Obste Gynaecol India. 1968;364-369.

Baretta A, Sallum LF, Sarian LO, Bastos JFB, Derchain S. Strict criteria for selection of laparoscopy for women with adnexal mass. JSLS. 2014;18:2014-5.

Serur E, Emeney PL, Byrne DW. Laparoscopic management of adnexal masses. JSLS. 2001;5:143-51.

Huang C, Hong MK, Chu TY, Ding DC. A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015. Peer J. 2018;6:e5995..

Koo YJ, Kim HJ, Lim KT, Lee IH, Lee KH, Shim JU, et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy. Aust N Z J Obstet Gynaecol. 2012;52:34-8.

Downloads

Published

2020-05-27

Issue

Section

Original Research Articles