POUZDANOST GINEKOLOŠKOG PREGLEDA U DIFERENCIJALNOJ DIJAGNOSTICI UPALE CRVULJKA ŽENA REPRODUKTIVNE DOBI

Abstract

The aim of the study was to examine the differential-diagnostical reliability of gynaecological examination in women of reproductive age who have shown clinical symptoms of acute abdomen in the lower right quadrant, with a dilemma whether this was due to acute appendicitis or acute gynaecological disease. Patients and methods. During the 15-year period (from 1988 to 2003), there were 530 women of reproductive age who underwent surgery for suspected acute appendicitis at County Hospital in Požega. Case histories, intraoperative findings, pathohistological findings, as well as consultative gynaecological findings were analysed retrospectively. For statistical analysis .2 test was used, with measuring confidence intervals at the level of 95% (p<0.05). Results. Out of 530 women of reproductive age included in the study, 159 of them were referred to a gynaecological examination (group A) and 371 of them were not (group B). In the group A (n=159), 34 (21.4%) women were diagnosed with a gynaecological disease intraoperatively even though the previous palpatory gynaecological findings were normal. In the group B (n=371), 22 (5.9%) patients were diagnosed with a gynaecological disease intraoperatively but these patients were not referred to a gynaecologist at all. Among all the women at 34 was diagnosed an ovarian cyst, at 12 a tubo-ovarian abscess, at 9 a pelvic inflammatory disease and at 1 an ovarian torsion. A significant (p<0.05, .2=26.516; odds ratio=4.31; CI 95%=2.43–7.65) unreliability of bimanual gynae-cological examination was found in diagnosing an acute gynaecological pathology in female patients who were referred to a consultation by a surgeon. Conclusion. The results of this study suggest a significant unreliability of bimanual gynaeco-logical examination in differential diagnosis of acute abdomen in women of reproductive age. Clinical work should, at any rate, include other diagnostical methods (US; CT; laparoscopy, MRI), aiming at a more precise diagnosis, which would then lead to the application of a more adequate therapy.Cilj rada bio je istražiti diferencijalno dijagnostičku pouzdanost ginekološkog pregleda kod žena reproduk- tivne dobi koje imaju kliničku sliku akutnog abdomena desnog donjeg kvadranta uz postojanje dileme radi li se o akutnoj upali crvuljka ili akutnoj ginekološkoj bolesti. Bolesnici i metode. U 15 godišnjem razdoblju (od 1988. do 2003. godine) u Općoj županijskoj bolnici Požega operirano je 530 žena reproduktivne dobi zbog sumnje na akutni apendicitis. Retro-spektivno su analizirane povijesti bolesti, intraoperacijski nalaz, patohistološki nalaz, te konzilijarni ginekološki nalaz. Statistička analiza učinjena je .2 testom uz mjerenje intervala pouzdanosti na razini od 95% (p<0,05). Rezultati. Od 530 žena reproduktivne dobi uključenih u studiju, 159 je bilo upućeno na ginekološki pregled (skupina A), a 371 nije (skupina B). U skupini A (N=159) intraoperacijski je kod 34 žene nađena ginekološka bolest iako je prethodni palpatorni ginekološki nalaz bio uredan. U skupini B (N=371) intraoperacijski je kod 22 bolesnice nađena ginekološka bolest, ali te bolesnice nisu bile upućene ginekologu. Od svih 530 žena u 34 nađena je rupturirana ovarijalna cista, tubo-ovarijalni absces u 12 bolesnica, u 9 upalni proces u maloj zdjelici i torzija ovarija u 1 bolesnice. Nađena je značajna (p<0,05, .2=26,516; odds ratio=4,31, CI 95%=2,43–7,65) nepouzdanost bimanualnog ginekološkog pregleda radi utvrđivanja akutne ginekološke patologije kod pacijentica upućenih na konzultaciju kirurga. Zaključak. Rezultati ovog rada upućuju na značajnu nepouz-danost bimanuelnog ginekološkog pregleda u diferencijalnoj dijagnostici akutnog abdomena kod žena reproduktivne dobi. Svakako treba u kliničkom radu uključiti druge dijagnostičke metode (UZV, CT, laparoskopija, MRI) zbog postavljanja sigurnije dijagnoze, pa time i primjenjivanja adekvatnije terapije