Page 53 - World Journal of Laparoscopic Surgery

LETTER TO THE EDITOR
Laparoscopy: A See- and -treat Modality for Lower

Abdominal Pain in Females

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Amina Kuraishy , Noor Afshan Sabzposh , Afzal Anees 3
AbstrAct
Background: In females, lower abdominal pain (LAP) is a common presenting complaint that has a diverse etiology. It can involve reproductive,
gastrointestinal, genitourinary, and musculoskeletal systems; therefore, accurate diagnosis is a clinical challenge. Laparoscopy has become the
gold standard for the diagnosis and management of LAP.
Aims and objectives: To diagnose the cause of LAP with laparoscopy and to correlate it with clinical examination and ultrasound.
Materials and methods: A prospective study was conducted from December 2012 to January 2015 in JNMCH, Aligarh. Laparoscopy was performed
on 84 patients with complaints of LAP (acute, subacute, or chronic). Data were statistically analyzed on the basis of the epidemiology, clinical
features, ultrasound findings, and laparoscopic findings. Correlation of clinical, ultrasound, and laparoscopic finding was done.
Results: With laparoscopy, diagnosis was established in 94.1% (n = 79) of patients. The most common cause of LAP was pelvic inflammatory
disease (PID) present in 20.2% (n = 17) of patients followed by endometriosis in 17.9% (n = 15), ectopic pregnancy in 15.5% (n = 13), ovarian
cyst in 15.5% (n = 13), genital TB in 7.1% (n = 6), etc. Therapeutic laparoscopy was performed in 82.1% (n = 69) of women, which included
adhesiolysis, cystectomy, cystotomy, salpingectomy, salpingostomy fulguration of endometriotic lesions, ovarian drilling, myomectomy, and
salpingo-ophorectomy.
Conclusion: Laparoscopy can be used as the first-line interventional investigation for LAP. Besides diagnosis, it also has a therapeutic role.
Therefore, it can be considered as a “see and treat” modality.
Keywords: Adhesiolysis, Laparoscopic, Ultrasound.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1389

IntroductIon
1,2 Department of Obstetrics and Gynecology, Jawaharlal Nehru
In females, lower abdominal pain (LAP) is a very common presenting Medical College and Hospital, Aligarh, Uttar Pradesh, India
complaint in both the outpatient and emergency department. It 3 Department of Surgery, Jawaharlal Nehru Medical College and
can be acute, subacute, and chronic in nature. Acute LAP is intense Hospital, Aligarh, India
and characterized by sudden onset, sharp rise, and short course. To Corresponding Author: Amina Kuraishy, Department of Obstetrics and
consider a pain as acute pelvic pain, different authors have defined Gynecology, Jawaharlal Nehru Medical College and Hospital, Aligarh,
different durations. Some authors have defined it as the pain lasting Uttar Pradesh, India, Phone: +91 7417593780, e-mail: aminakur234@
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for less than 7 days while others have defined it as the pain lasting gmail.com
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for less than 3 months. The gynecological causes of acute pelvic How to cite this article: Kuraishy A, Sabzposh NA, Anees A.
pain are pelvic inflammatory disease (PID), ectopic pregnancy, Laparoscopy: A See- and -treat Modality for Lower Abdominal Pain in
adnexal torsion, ruptured ovarian cyst, and adhesions. Subacute Females. World J Lap Surg 2020;13(1):51–54.
pelvic pain is the pain that does not clearly fit either in acute or Source of support: Nil

chronic category and requires consideration of differential diagnosis Conflict of interest: None
for both acute and chronic pain. Chronic pelvic pain is defined as
intermittent or constant pain in the lower abdomen or the pelvis
of at least 6 months’ duration, not associated with menstruation, MAterIAls And Methods
intercourse, or pregnancy. It is severe enough to cause functional
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disability or may require medical or surgical intervention. The The prospective study was conducted on 84 patients from
causes of chronic pelvic pain are chronic PID, endometriosis, and December 2012 to January 2015 after getting approval from
adhesions. 4 the ethical committee. Women with complaints of LAP—acute,
The etiology is of LAP is diverse. It can be reproductive, subacute, and chronic—were included in the study. Patients with
gastrointestinal, genitourinary, or musculoskeletal. Hence, accurate abdominal trauma, gynecological malignancy, cardiopulmonary
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diagnosis of the underlying cause presents a clinical challenge. disease, and peritonitis were excluded from the study.
In many cases, the cause of LAP remains obscure despite thorough A detailed clinical history was taken regarding site, duration,
examination, lab investigations, and noninvasive imaging like pain, nature, and radiation of pain; aggravating and relieving
ultrasonography (USG), CT, and MRI. Laparoscopy has been factors; and associated complaints like dyspareunia, dysmenorrhea,
increasingly recognized as a key in solving the diagnostic dilemma. discharge per vaginam, gastrointestinal, and urological complaints.
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Not only that, treatment may also be provided in the same sitting. Menstrual history, obstetric history, and past history were also taken.
Therefore, the present study was conducted to assess the role of All women underwent a thorough general, systemic, and
laparoscopy for diagnosis and management of LAP. gynecological examination. Routine investigations were carried

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