Sardar Ali, Syed Tahir Ahmad Shah.
Gynaecological Emergencies.
Professional Med J Jan ;14(1):43-8.

Objectives: To highlight the various gynaecological problems presenting as acute surgical abdomen and their management. Design. Prospective Study. Setting: District Headquarters Hospital Kasur. Period: Two years from January 2001 to December 2002. Materials & Methods: A total of 44 patients presenting with acute surgical abdomen but having some gynaecological problems included. The females above 12 years of age and admitted through emergency. Clinical assessment and routine laboratory investigations were performed in all the patients. More specific investigations were performed where required. All the patients were resusscitated and operative treatment; where required; was performed under general anesthesia at the earliest possible time. The surgical procedure was tailored according to the circumstances. Further management, conservative or post operative care was done in surgical ward Results: Pelvic Inflammatory Disease (PID) which is the inflamation of upper genital tract with its complications like pelvic cellulitis and pelvic peritonitis was the most common (40.9%) emergency. The age group between 16 to 30 years was the commonest having gynaecological problems. There was a clear predilection of married than unmarried females facing these problems. Because of lack of experience and limited diagnotistic facilities erroneous diagnosis was made to some extent in almost all the cases. 55.55% of patients suffering from PID were treated successfully by conservative means. Surgical procedure was performed in all the patients (100%) suffering from ruptured ectopic pregnancy, perforated uterus and torsion of ovarian cyst and pedunculated subserosal fibroid. Wound infection and delayed wound healing were among the most common postoperative complications. Mortality occurred in ectopic pregnancy (16.66%) and PID (5.55%). Conclusion: The different gynaecological problems are commonly encountered in general surgical practice. The surgeons often fall in this un-wary trap because of (1) close resemblance of clinical features (2) less exposure to gynaecological problems (3) non availability of more sophisticated diagnostic tools in emergency.

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