Gynecological emergencies

Abstract

The famous English writer and physician W.Somerset Maugham (1874-1965) wrote: "...woman is an animal that micturates once a day, defecates once a week, menstruates once a month,parturates once a year and copulates whenever she has the opportunity...". One could not have written such a "sexist" and politically incorrect statement today, but if one could one might have added to it some comment about "lower abdominal pain"... As a practicing general surgeon you are unlikely ever to deliver a baby but you are likely to face a gynecological problem that you should know how to handle. Acute abdominal pain is very common in women during their reproductive years. Such pain is commonly "gynecological"in origin but is equally likely to be "surgical". Your gynecological colleagues are generally "nice," but typically possess a vision limited by the boundaries of the bony pelvis (> Fig. 31.1) (Figure presented). Consequently, they are often reluctant to diagnose any acute condition as "gynecological" unless you have ruled out acute appendicitis. Occasionally you operate for what you think is acute appendicitis and the findings are "gynecological".You should know how to deal with this. Another situation, which provides you with the pleasure of interacting with gynecologists-obstetricians, is the pregnant patient.As you know, pregnancy itself may be the cause of abdominal pain while at the same time it may modify the presentation of common surgical disorders,making diagnosis difficult. It may also pose considerable challenges in the injured patient. © Springer-Verlag Berlin Heidelberg 2005.