# Surgical Treatment in Gynecological Emergency: The Experience of a Tertiary Hospital

## Authors

- Simten Genc ([ORCID](https://orcid.org/0000-0003-4446-4467)) — Department of Obstetrics & Gynaecology, Okmeydanı Training & Research Hospital, Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
- Yagmur Olmez Ozkan ([ORCID](https://orcid.org/0000-0003-0568-9575)) — Department of Obstetrics & Gynaecology, Okmeydanı Training & Research Hospital, Cemil Taşçıoğlu City Hospital, Istanbul, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 8, Issue 1 (2022), pages 5–17
- **Article type:** Original Article
- **Published online:** 2022-03-09
- **DOI:** [10.5455/umj.20220123023926](https://doi.org/10.5455/umj.20220123023926)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=14145
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/14145.pdf

## Abstract

Introduction: Gynecological emergencies are conditions that are frequently encountered every day and can account for high morbidity and mortality rates. Ectopic pregnancy, tuboovarian abscess, ruptured ovarian cysts, and adnexal torsion are common gynecological diseases that require an emergency surgical approach. Materials and Methods: Our retrospective study was conducted by examining the records of patients between the ages of 18-55 who applied to Prof. Dr. Cemil Taşçıoğlu City Hospital emergency department between January 1, 2017, and December 31, 2020. A total of 464 patients who were treated surgically with laparotomy or laparoscopic approaches were included in our study. Results: The mean age of all patients was 32.28±8.25 years. 79.74% of the patients were under the age of 40, and our patients were operated on for ruptured ectopic pregnancy (50.64%), ruptured ovarian cyst (20.25%), ovarian torsion (12.71%), and tuboovarian abscess (16.37%), while 23.49% of the patients required blood transfusions. The mean initial β-hCG concentration was 3346 mIU/ml in ectopic pregnancy. The hospital stay was observed to be significantly longer in cases with tuboovarian abscesses. Salpingectomy was the most common surgical operation performed in all cases. Conclusion: Gynecological emergencies have an important place in admissions to the emergency departments. Early diagnosis and treatment both reduce the morbidity and mortality of the patients and are important for preserving their fertility status in the later stages of their lives.

## Keywords

Adnexal torsion; ectopic pregnancy; gynecological emergency; ruptured ovarian cysts; tubo-ovarian abscess

## How to cite

Genc S, Ozkan YO. Surgical Treatment in Gynecological Emergency: The Experience of a Tertiary Hospital. Ulutas Med J. 2022;8(1):5-17. doi:10.5455/umj.20220123023926

## References

1. Pokharel HP, Dahal P, Rai R, Budhathoki S. Surgical emergencies in obstetrics and gynecology in a tertiary care hospital. JNMA J Nepal Med Assoc. 2013; 52(189): 213-6 16 77 Surgical Treatment in Gynecological Emergency Genc et al. https://doi.org/10.31729/jnma.550
2. Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis, and management of tubal and nontubal ectopic pregnancies: a review. Fertil Res Pract. 2015;15;1-15 https://doi.org/10.1186/s40738-015-0008-z
3. Poonam, Uprety D, Banerjee B. Ectopic pregnancy - two years review from BPKIHS, Nepal. Kathmandu Univ Med J (KUMJ). 2005;3(4):365-9
4. Akselim B, Karaşin SS, Demirci A, Üstünyurt E. Can antibiotic treatment failure in tubo-ovarian abscess be predictable? Eur J Obstet Gynecol Reprod Biol. 2021;258: 253-257 https://doi.org/10.1016/j.ejogrb.2021.01.011
5. Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):711-724 https://doi.org/10.1016/j.bpobgyn.2009.02.001
6. Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG. 2021;128(1):37-44 https://doi.org/10.1111/1471-0528.16371
7. Beuran M, Negoi I, Hostiuc S, Catena F, Sartelli M, Negoi RI, et al. Laparoscopic Approach has Benefits in Gynecological Emergencies - Even for Massive Hemo peritoneum. Chirurgia (Bucur). 2016;111(1):48-53
8. Alouini S, Mesnard L, Coly S, Dolique M, Lemaire B. Urgences gynécologiques: nature et degré de gravité. J Gynecol Obstet Biol Reprod. 2012;41(1):48-54 https://doi.org/10.1016/j.jgyn.2011.08.004
9. Acharya I, Thapa S. Surgical Emergencies among Gynecological Surgeries in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2020;58(232):1052-1055 https://doi.org/10.31729/jnma.5888
10. Knoepp US, Mazza MB, Chong ST, Wasnik AP. MR Imaging of Pelvic Emergencies in Women. Magn Reson Imaging Clin N Am. 2017;25(3):503-519 https://doi.org/10.1016/j.mric.2017.03.009
11. Szadok P, Kubiaczyk F, Bajorek A, Suchocki S. Ovarian ectopic pregnancy. Ginekol Pol. 2019;90(12):728 https://doi.org/10.5603/gp.2019.0125
12. Maheux-Lacroix S, Li F, Bujold E, Nesbitt-Hawes E, Deans R, Abbott J. Cesarean Scar Pregnancies: A Systematic Review of Treatment Options. J Minim Invasive Gynecol. 2017;24(6):915-925 https://doi.org/10.1016/j.jmig.2017.05.019
13. Seak CJ, Goh ZNL, Wong AC, Seak JC, Seak CK. Unilateral live twin tubal ectopic pregnancy presenting at 12 weeks of gestation: A case report. Medicine. 2019;98(38):e17229 https://doi.org/10.1097/md.0000000000017229
14. Ramalho I, Ferreira I, Marques JP, Carvalho MJ, Lobo A, Rebelo T, et al. Live birth after treatment of a spontaneous ovarian heterotopic pregnancy: A case report. Case Rep Women Health. 2019;10(24):e00144 https://doi.org/10.1016/j.crwh.2019.e00144
15. Awori MN, Jani PG. Surgical implications of abdominal pain in patients presenting to the Kenyatta National Hospital casualty department with abdominal pain. East Afr Med J. 2005;82(6):307-310 https://doi.org/10.4314/eamj.v82i6.9302
16. Pradhan P, Thapamagar SB, Maskey S. A profile of ectopic pregnancy at Nepal medical college teaching hospital. Nepal Med Coll J. 2006;8(4):238-42
17. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population- based study in France. Am J Epidemiol. 2003;157(3):185-194 https://doi.org/10.1093/aje/kwf190
18. Elito J Jr, Ferreira DF, Araujo Júnior E, Stavale JN, Camano L. Values of beta-human chorionic gonadotrofin as a risk factor for tubal pregnancy rupture evaluated by histopathology. J Matern Fetal Neonatal Med. 2014;27(6):637-639
19. Helmy S, Bader Y, Pablik E, Tiringer D, Pils S, Laml T, et al. Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2014; 179:175-180 https://doi.org/10.1016/j.ejogrb.2014.05.033
20. Turgut EN, Celik E, Celik S, Arikan DC, Altuntas H, Leblebici C, et al. Could serum β-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies? Arch Gynecol Obstet. 2013;287(2):323-8 https://doi.org/10.1007/s00404-012-2566-1
21. Ozcan MCH, Wilson JR, Frishman GN. A Systematic Review and Meta -analysis of Surgical Treatment of Ectopic Pregnancy with Salpingectomy versus Salpingostomy. J Minim Invasive Gynecol. 2021;28(3):656-667 https://doi.org/10.1016/j.jmig.2020.10.014
22. Abdelazim IA, AbuFaza M, Bekmukhambetov Y, Zhurabekova G, Shikanova S. Postmenopausal adnexal torsion: case report. Prz Menopauzalny. 2020;19(1):49-51
23. Huchon C, Staraci S, Fauconnier A. Adnexal torsion: a predictive score for pre-operative diagnosis. Hum Reprod. 2010;25(9):2276-2280 https://doi.org/10.1093/humrep/deq173
24. Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol. 2006;49(3):459-463
25. Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod. 2003;18(12): 2599-2602 https://doi.org/10.1093/humrep/deg498
26. Fiaschetti V, Ricci A, Scarano AL, Liberto V, Citraro D, Arduini S, et al. Hemoperitoneum from corpus luteal cyst rupture: a practical approach in emergency room. Case Rep Emerg Med. 2014:252657 https://doi.org/10.1155/2014/252657
27. Kim JH, Lee SM, Lee JH, Jo YR, Moon MH, Shin J, et al. Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women. PLoS One. 2014;9(3):e91171 https://doi.org/10.1371/journal.pone.0091171
28. Teng SW, Tseng JY, Chang CK, Li CT, Chen YJ, Wang PH. Comparison of laparoscopy and laparotomy in managing hemodynamically stable patients with ruptured corpus luteum with hemoperitoneum. J Am Assoc Gynecol Laparosc. 2003;10(4):474-477 https://doi.org/10.1016/s1074-3804(05)60147-8
29. Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):667-678 https://doi.org/10.1016/j.bpobgyn.2009.01.010
30. Zhu S, Ballard E, Khalil A, Baartz D, Amoako A, Tanaka K. Impact of early surgical management on tubo-ovarian abscesses. J Obstet Gynaecol. 2021;41(7):1097 -1101 https://doi.org/10.1080/01443615.2020.1821620