Pelvik Ağrıya Yaklaşım
Özet
Pelvik ağrı, göbek altı bölgesinden kaynaklanan ve süresine göre akut veya kronik olarak sınıflandırılan, jinekolojik, ürolojik, gastrointestinal ve kas-iskelet sistemi kaynaklı birçok farklı nedenden oluşabilen klinik bir durumdur. Akut vakalarda ektopik gebelik, yumurtalık torsiyonu ve apandisit gibi acil müdahale gerektiren hayati riskler öncelikle dışlanırken; kronik vakalarda endometriozis ve irritabl bağırsak sendromu gibi multidisipliner yaklaşım gerektiren süreçler öne çıkar. Tanı aşamasında fizik muayene ile birlikte ultrason, bilgisayarlı tomografi ve laboratuvar testleri gibi yöntemler kullanılarak nedene yönelik medikal veya cerrahi tedavi planlanır.
Pelvic pain is a clinical condition originating below the umbilicus, classified as acute or chronic based on duration, and caused by various gynecological, urological, gastrointestinal, or musculoskeletal issues. In acute cases, life-threatening conditions such as ectopic pregnancy, ovarian torsion, and appendicitis are prioritized for exclusion, while chronic cases focus on conditions like endometriosis and irritable bowel syndrome that require a multidisciplinary approach. Diagnosis involves physical examination alongside imaging methods like ultrasound and CT scans, followed by medical or surgical treatment tailored to the specific underlying cause.
Referanslar
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1.
Wiesenfeld HC, Meyn LA, Darville T, et al. A Randomized Controlled Trial of Ceftriaxone and Doxycycline, With or Without Metronidazole, for the Treatment of Acute Pelvic Inflammatory Disease. Clin Infect Dis 2021; 72:1181.
Ross J, Guaschino S, Cusini M, Jensen J. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2018; 29:108.
Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23:667.
Wexner SD, Talamini MA. EAES/SAGES consensus conference on acute diverticulitis: a paradigm shift in the management of acute diverticulitis. Surg Endosc 2019; 33:2724.
Francis NK, Sylla P, Abou-Khalil M, et al. EAES and SAGES 2018 consensus conference on acutediverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc 2019; 33:2726.
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52:e103.
Frokiaer J, Zeidel M. Urinary Tract Obstruction. In: Brenner and Rector's The Kidney, 9, Elsevier, New York 2011.
Fall M, Baranowski AP, Elneil S, et al. EAU guidelines on chronic pelvic pain. Eur Urol 2010; 57:35.
Zondervan KT, Yudkin PL, Vessey MP, et al. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 1999; 106:1149.
International working group of AAGL, ESGE, ESHRE and WES, Tomassetti C, Johnson NP, et al. An International Terminology for Endometriosis, 2021. J Minim Invasive Gynecol 2021; 28:1849.
Giudice LC. Clinical practice. Endometriosis. NEngl J Med 2010; 362:2389.
Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update 2001; 7:567.
Fall M, Baranowski AP, Elneil S, et al. EAU guidelines on chronic pelvic pain. Eur Urol 2010; 57:35.
van den Beukel BA, de Ree R, van Leuven S, etal. Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Hum Reprod Update 2017; 23:276.
Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol 2016;23:164.
Centers for Disease Control and Prevention. Morbidity and mortality weekly report. Prevalence of pelvic inflammatory disease in sexually experienced women of reproductive age - United States, 2013-2014. https://www.cdc.gov/mmwr/volumes/66/wr/mm6603a3.htm (Accessed on January 31, 2018).
Williams RE, Hartmann KE, Sandler RS, et al. Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain. Am J Obstet Gynecol 2005; 192:761.
Kruszka PS, Kruszka SJ. Evaluation of acute pelvic pain in women. Am Fam Physician 2010; 82:141.
Robertson JJ, Long B, Koyfman A. Myths in the Evaluation and Management of Ovarian Torsion. J Emerg Med 2017; 52:449.
Ellaithy M, Asiri M, Rateb A, et al. Prediction of recurrent ectopic pregnancy: A five-year follow-up cohort study. Eur J Obstet Gynecol ReprodBiol 2018; 225:70.
