Gynecological emergencies under the guise of surgical pathology

Introduction. One of the actual problems of urgent gynecology is diseases included in the symptom complex “acute abdomen”, because today there are no algorithms for examining this cohort of patients of reproductive age, and existing clinical guidelines explain only part of the diagnostic standards of individual groups.

Aim. To improve diagnostic criteria and optimize tactics for managing patients with the symptom complex acute abdomen in order to preserve reproductive function.

Materials and methods. A retrospective analysis of 785 emergency laparoscopic surgeries performed from 2017 to 2020 was carried out at one of the clinical sites of the Department of Obstetrics and Gynecology, Faculty of Medicine, RNIMU named after N.I. Pirogov. A comparison of preand postoperative diagnoses, an analysis of diagnostic algorithms, and treatment outcomes of patients with suspected acute abdomen were carried out. The role of laparoscopy as a highly informative method of differential diagnosis in the presence of the symptom complex acute abdomen is shown.

Results. Based on the conducted retrospective analysis, an algorithm for managing female patients of reproductive age with the symptom complex acute abdomen was developed: at the first stage, it includes a diagnostic search with a decision on the need for emergency surgical treatment, mandatory joint examination by a surgeon and an obstetrician-gynecologist. At the second stage, in case of choosing a conservative management tactic, patients need to undergo extended clinical and laboratory diagnostics, determine the effectiveness of the therapy, and, if necessary, set indications for delayed surgical treatment.

Conclusions. Thus, only improving the quality of differential diagnostics, including instrumental research methods, will help avoid unnecessary surgical aggression, which will ultimately lead to the preservation and implementation of reproductive function in female patients of reproductive age.

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