"Acute Abdomen in Woman of Childbearing Age: Appendicitis or Pelvic Inflammatory Disease? A Systematic Review"

Abstract

Acute abdomen is a clinical presentation that requires emergency surgical treatment in many cases, rapid diagnosis is oftentimes essential. The diagnoses associated with an acute abdomen vary according to age and gender [1], and it is more difficult in young women, in which it is necessary to distinguish between gynecological and non-gynecological diseases (Table 1).Non-gynecological causes include appendicitis, which remains one of the main causes of acute abdomen in childbearing women. The diagnosis of acute appendicitis is essentially clinical. Appendicitis can initially present with periumbilical pain that migrates to the right ARTICLE INFO ABSTRACTAcute abdomen in women of childbearing age is a clinical presentation that requires emergency surgical treatment in many cases and rapid diagnosis is oftentimes essential. Most are the causes of acute abdomen: gynecological (ectopic pregnancy, ovarian torsion, ovarian cysts, endometriosis, pelvic inflammatory disease) and non-gynecological (appendicitis, Crohn's disease, Meckel's diverticulitis, sigmoid diverticulitis, perforated peptic ulcer, viral gastroenteritis, hernias, urological disease). Appendicitis and pelvic inflammatory disease (PID) are two of the most common causes of abdominal pain in women of childbearing age. This article is a systematic review of literature of the differential diagnosis between appendicitis and PID. The diagnosis is clinical, laboratory and radiological. When the sign and symptoms and the biochemical markers are nonspecific abdominal ultrasound (US) is the first radiological test that is performed, but the computer tomography (CT) remains the best specific and sensible exam for the differential diagnosis. Nuclear Magnetic Resonance is performed when CT is contraindicated. Other test like transvaginal ultrasound is a relatively simple and inexpensive diagnostic test that could easily complement the classic abdominal US and be part of the routine diagnostic protocol of women with acute abdominal pain. Therefore, a careful management of the patient starting from the clinical examination and passing through the laboratory and radiological characteristics is necessary.

About a New Palpation Sign in the Diagnosis of Acute Appendicitis in Children and Women of Childbearing Age

“…Its advantage is the absence of radiation exposure and excellent specificity and sensitivity in the diagnosis of acute appendicitis or PID. However, it should be reserved for specific population groups (pregnant women, children) [34]. MRI has sensitivity and specificity for diagnosis of appendicitis of 95% and 89%, respectively.…”

“…Second-level laboratory tests may be useful in patients with nonspecific abdominal symptoms. Among them, cervical smear to diagnose genital infections (such as Neisseria gonorrhea or Chlamydia trachomatis) is certainly important, which would support the diagnosis of PID [34]. Rapid tests for the detection of these microorganisms are available.…”