Managing acute lower abdominal pain in women of childbearing age

Gaitán HG, Reveiz L, Farquhar C

Published Online:

January 19, 2011

Acute lower abdominal pain is a common occurrence amongst women of childbearing age and frequently results in referral to hospital. Possible diagnoses include ovulation pain, ovarian cysts, pelvic infection, ectopic pregnancy and appendicitis. Many women end up having their appendices removed unnecessarily. In this review of randomised controlled trials laparoscopy was found to be superior to both open appendicectomy alone and a wait and see strategy as there were more specific diagnoses made before discharge, shorter hospital stays and an earlier return to work (when compared to open appendicectomy only). There was no evidence of an increase in adverse events with any of the strategies. The rate of normal appendices being removed was reduced with the laparoscopic approach compared to open appendicectomy but was greater when a laparoscopic approach was compared with a wait and see strategy.

Abstract (click to read)

Background:

Acute lower abdominal pain is common and making a diagnosis is particularly challenging in premenopausal woman as ovulation and menstruation symptoms overlap with the symptoms of appendicitis and pelvic infection. A management strategy involving early laparoscopy could potentially provide a more accurate diagnosis, earlier treatment and reduced risk of complications.

Objectives:

To evaluate the effectiveness and harms of laparoscopy for the management of acute lower abdominal pain in women of childbearing age.

Search strategy:

The Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, LILACS and CINHAL were searched (to April 2010).

Selection criteria:

Randomised controlled trials (RCTs) that included women of childbearing age who presented with acute lower abdominal pain, nonspecific lower abdominal pain or suspected appendicitis were included.

Data collection and analysis:

Data from studies that met the inclusion criteria were independently extracted by two authors and the risk of bias assessed.

Main results:

Laparoscopy was compared with open appendicectomy in eight RCTs. Laparoscopy was associated with an increased rate of specific diagnoses (7 RCTs, 561 participants; OR 4.10, 95% CI 2.50 to 6.71; I2 18%) but there was no evidence of reduced rate for any adverse event (8 RCTs, 623 participants; OR 0.46, 95% CI 0.19 to 1.10; I2 0%).

Laparoscopic diagnosis versus a 'wait and see' strategy was investigated in four RCTs. There was a significant difference favouring laparoscopy in the rate of specific diagnoses (4 RCTs, 395 participants; OR 6.07, 95% CI 1.85 to 29.88; I2 79%) but there was no evidence of a difference in the rates of adverse events (OR 0.87, 95% CI 0.45 to 1.67; I2 0%).

Authors' conclusions:

The advantages of laparoscopy in women with nonspecific abdominal pain and suspected appendicitis include a higher rate of specific diagnoses being made and a lower rate of removal of normal appendices compared to open appendicectomy only. Hospital stays were shorter. There was no evidence of an increase in adverse events with any of the strategies.

This record should be cited as:

Gaitán HG, Reveiz L, Farquhar C. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007683. DOI: 10.1002/14651858.CD007683.pub2

Assessed as up to date:

April 30, 2010

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gastroenterology > Non-neoplastic disease of the small & large bowel > Abdominal pain

Gastroenterology > Non-neoplastic disease of the small & large bowel > Appendiceal diseases

Gynaecology > Pelvic pain > Other causes

Gynaecology > Subfertility > Female: other

Methodological & diagnostic > Diagnostic test accuracy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Managing acute lower abdominal pain in women of childbearing age

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