Principais causas ginecológicas de dor pélvica aguda em mulheres / Main gynecological causes of acute pelvic pain in women

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)

The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)

Imaging description of extragenital müllerian adenosarcoma: A case report / Descrição da imagem do adenosarcoma mülleriano extragenital: relato de caso

Abstract Müllerian adenosarcoma is a very rare gynecological disease, comprising 5% of uterine sarcomas. Extragenital localizations are even rarer.We report a very interesting case of a 27-year-old woman complaining of pelvic pain, with a subsequent diagnosis of extragenital Müllerian adenosarcoma. This is the first case reported in the literature with a complete and wide imaging description. Even if rare, Müllerian adenosarcoma should be hypothesized in case of young female patients presenting with suspicious pelvic mass.

Resumo O adenosarcoma Mülleriano é uma doença ginecológica muito rara, compreendendo 5% dos sarcomas uterinos. Localizações extragenitais são ainda mais raras. Relatamos um caso muito interessante de uma mulher de 27 anos queixando-se de dor pélvica com diagnóstico subsequente de adenosarcoma Mülleriano extragenital. Este é o primeiro caso relatado na literatura com uma descrição completa e ampla de imagem. Mesmo que raro, o adenosarcoma Mülleriano deve ser hipotetizado no caso de pacientes jovens do sexo feminino com massa pélvica suspeita.

Dolor pélvico crónico secundario a síndrome de congestión pélvica: resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales / Embolization of insufficient pelvic veins for pelvic congestion syndrome: analysis of 17 cases

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.

Riñones pélvicos y embarazo / Pelvic Kidneys and Pregnancy

Las anomalías congénitas del riñón pueden ser variadas. Dentro de las anomalías de posición, una de las más frecuentes es la ectopia renal y la localización más frecuente es en la cavidad pélvica (riñón pélvico). Se presenta el caso de una paciente en su tercera década de vida que acude a consulta de nefrología por dolor lumbar inespecífico, se decide realizar ultrasonido renal, no encontrándose los riñones en su posición habitual. Después de tener los resultados normales de una hemoquímica sanguínea se somete a un urograma descendente donde se pueden apreciar los riñones en una posición pélvica. Unos meses después la paciente acude nuevamente a consulta remitida por obstetricia por embarazo deseado de 9 semanas. Se conversa con la paciente de los principales riesgos y se decide continuar con la gestación haciendo recomendaciones generales y un seguimiento estrecho para lograr llevar a término el embarazo. La evolución de la paciente fue favorable y hoy disfruta de su maternidad a pesar de tener una anomalía congénita renal que no es infrecuente y que se detecta muchas veces de forma casual y que en este caso los riñones compartieron el espacio pélvico con una gestación que llegó a feliz término(AU)

Congenital kidney abnormalities can be varied. Within the positional abnormalities, one of the most frequent is the renal ectopia and the most frequent location is in the pelvic cavity (pelvic kidney). We present the case of a patient in her third decade of life who went to a nephrology clinic for nonspecific low back pain. It was decided to perform renal ultrasound, not finding the kidneys in their usual position. After having normal results of a blood chemistry, it is subjected to a downward urogram where the kidneys could be seen in a pelvic position. Few months later this patient returned to a consultation referred by obstetrics for a nine-week desired pregnancy. The main risks are discussed and the patient decided to continue her pregnancy. General recommendations are given to the patient and a close follow-up is the option to follow in order to achieve this pregnancy. The evolution was favorable and now this patient enjoys her motherhood despite having a renal congenital anomaly that is not uncommon and it is often detected by chance. In this case, kidneys shared the pelvic space with a gestation that arrived to a happy ending(AU)