Unexpected Gynecologic Findings During Abdominal Surgery

Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy

“…1), and free or clotted fluid in the pelvis/abdomen, in case of TP rupture. The ''tubal ring sign'' appears as peritrophoblastic ringshaped flow by Color Doppler examination [1]. US diagnosis of EP should be based upon the visualization of an adnexal mass rather than the absence of an intrauterine gestational sac.…”

“…In few cases, the EP may coexist with an intrauterine pregnancy (heterotopic pregnancy). TVS has been shown to be superior to TAS when EP is suspected [1,3].…”

“…US diagnosis of EP should be based upon the visualization of an adnexal mass rather than the absence of an intrauterine gestational sac. When serum beta-hCG concentrations are below the discriminatory zone-the range of beta-hCG above which a gestational sac can be visualized consistently by TVS (1,000-2,000 IU/L)-and no intrauterine (IUP) or extrauterine pregnancy is seen, the pregnancy is defined unknown localization (PUL) [1,8,9]. PUL may result in spontaneous miscarriage, possible EP, or IP, according to beta-HCG trend [8].…”

“…However, the diagnosis is often not that simple, especially when the pain is minimal, the patient is hemodynamically stable, and ultrasound (US) examination shows no obvious ectopic implantation of pregnancy or adnexal/pelvic mass. The differential diagnosis of abdominal/pelvic pain is broad and includes primarily gastrointestinal and urogenital disorders, as acute appendicitis, acute cholecystitis, diverticulitis, bowel obstruction, perforated ulcers, pyelonephritis, and neoplastic processes [1]. Generally, TAS should be the sonographic technique for initial evaluation of the female pelvis, followed by TVS if indicated (gynecologic diseases), and when TAS is not conclusive.…”

“…Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders-as pelvic inflammatory disease (PID), acute salpingitis, tubo-ovarian abscess (TOA), and pyosalpinx-complications involving the uterine fibroids-including degenerative changes, process of expulsion of a submucous pedunculated myoma, torsion of a pedunculated subserous myoma, and acute vaginal or intra-peritoneal hemorrhage-endometriosis, and spontaneous uterine rupture are possible acute complications [1,2]. Classically, the patient comes to the observation because of acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis.…”