Adnexal torsion in post-menopausal women: an even more challenging diagnosis / Torsión anexial en postmenopausia: un diagnostico aún más desafiante

Adnexal torsion is usually diagnosed in pre-menopausal women and is less common in post-menopausal patients. Symptoms are nonspecific and the risk of torsion in post-menopausal women presenting with an adnexal mass is often undervalued. Because the clinical presentation of adnexal torsion can mimic other causes of abdominal pain, the diagnosis is often delayed, and post-menopausal women are taken to surgery later than pre-menopausal ones. We report a case of adnexal torsion in a post-menopausal woman presenting with pain and an adnexal mass (AU)

La torsión anexial se diagnostica más frequentemente en mujeres premenopáusicas. Los síntomas son inespecíficos y el riesgo de torsión en las mujeres postmenopáusicas que se presentan con una masa anexial es a menudo infravalorado. Debido a que la presentación clínica puede simular otras causas de dolor abdominal, el diagnóstico a menudo se retrasa y las mujeres postmenopáusicas son llevadas a cirugía más tarde que las premenopáusicas. Presentamos un caso de torsión anexial en una mujer postmenopáusica que presenta dolor y una masa anexia (AU)

Ruptured ectopic pregnancy presenting 3 years after supracervical hysterectomy.

An ectopic pregnancy after a hysterectomy is a rare event, with about 40 reported cases since it was first identified by Wendeler in 1895. There are even fewer cases reported of an ectopic pregnancy occurring years after a hysterectomy has been performed. This case illustrates the sonographic and computed tomographic (CT) findings in the setting of abdominal pain in a woman of childbearing age and highlights the need to obtain a urine pregnancy test as part of the workup for abdominal pain in women, even if a history of a hysterectomy has been given. Many providers may automatically exclude an ectopic pregnancy as a possibility in the aforementioned clinical scenario if the patient has a history of a hysterectomy. Such automatic exclusion may result in life-threatening consequences.

[The Allen-Masters syndrome]. / Ein Beitrag zum Allen-Masters-Syndrom.

In cases where women suffer from chronic troubles in the abdominal region (genital apparatus) it is often difficult to diagnose the causes thereof. The knowledge even of seldom clinical pictures can be useful for considerations of differential diagnosis. On the basis of a case report on a traumatic insufficiency of the uterine supporting apparatus (known as Allen-Masters-Syndrom) the possible causes that may have led to this trouble are being discussed.

Chronic pelvic disease of unknown origin.

PIP: Obscure, chronically recurring pains in the lower abdomen and back are common symptoms in the office of the gynecologist or practitioner. Often the cause has never been found. Many are functional or psychosomatic disturbances. There is no objective measurement of the quality or amount of pain. Common diagnoses have been chronic adnexitis, chronic appendicitis, retroflexion of the uterus, or adhesions. Too often surgical operations have been of little benefit. When consultations with other specialists have not helped, laparoscopy is indicated. Endometriosis is a common finding. Cauteriziation of this lesion at laparoscopy is better than hormone therapy. Adhesions may be severed with relief of symptoms. Varicose enlargement of ovarian veins is sometimes seen. Laparotomy may be indicated for conditions not readily treated by laparoscopy. However, indications for surgery should be carefully considered to avoid iatrogenic damage in an already apprehensive patient. Tranquilizers and small doses of cortisone may be adequate. In about 80% of patients complaining of chronic lower abdominal pain, organic disorders may be found by laparoscopy. The procedure should be recommended more frequently.^ieng