ABDOMINOPELVIC LUMP

Pelvic and lower abdominal masses need differentiation as regard their origin (ovary, cervix, uterus) or from other organs (bowel, retroperitoneal tissues). This may occur at any age and are of different consistency (solid, cystic). However, some tumors are common in a particular age group. These masses need to be diagnosed by clinical evaluation. Different investigations should be done as too often they have confusing presentation.

Full Bladder: It is an axiom that prior to gynecologic examination, bladder must be kept empty. Not only full bladder may be confused with some abdominopelvic pathology but empty bladder ensures better evaluation of pelvic findings on bimanual examination.

COMMON CAUSES OF LOWER ABDOMINAL LUMP: -

TODDLERS (< 5 YEARS): OVARIAN TUMOR

• Mucocolpos
• Full bladder

5 years of age to puberty: -           

• Ovarian tumor
• Full bladder
• Hematocolpos

CHILDBEARING PERIOD: -

• Pregnancy
• Full bladder
• Ovarian tumor
• Fibroid
• Adenomyosis
• Chocolate cyst
• TO mass
• Pelvic hematocele
• Pelvic abscess
• Encysted peritonitis
• Pseudocyesis

POSTMENOPAUSAL: -

• Ovarian tumor
• Pyometra
• Sarcoma uterus

FEATURES OF A FULL BLADDER: -

• Strictly suprapubic, may even reach up to the umbilicus.
• Cystic or tense cystic.
• Margins—ill-defined.
• Tendency of urge for micturition on pressure.
• Disappears after catheterization.

Pregnancy: Pregnancy with a uterine size of 16–18 weeks is most confusing. The confusion is accentuated with a history of oligomenorrhea, conception occurring during lactational amenorrhea or illegal pregnancy.

In fact, amenorrhea during childbearing period with a lump in the lower abdomen should be provisionally diagnosed as pregnancy unless proved otherwise.

OVARIAN TUMOR: -

Features are:

• Slow growing (takes months to grow).
• Menstrual history—unaffected.
• Feel—cystic, tense cystic or solid.
• Margins—well-defined but lower pole may not be reached.
• Ascites—may be present.
• Internal examination reveals:
• The swelling is separated from the uterus.
•  

FIBROID: -

Features are:

• Slow growing (takes years to grow).
• Menstrual history—menorrhagia.
• Feel—firm, may be cystic in cystic degeneration.
• Surface—nodular.
• Pregnancy features—absent.
• Internal examination reveals:
• Swelling is uterine in origin.
• Cervix—feels firm.
•  

ADENOMYOSIS

• Usually associated with parous woman.
• Menorrhagia with increasing dysmenorrhea— congestive and persists even after the period.
• Lump—rarely more than 14–16 weeks.
• Uniform with well-defined margins.
• Soft and tender.
• PV examination reveals:
• Swelling is uterine.
• Cervix-firm, uterus-tender.
• Associated pelvic endometriosis may be present.
•  

ENCYSTED PERITONITIS: -

• History of Koch’s infection.
• Amenorrhea of longer duration may be present.
• Swelling—ill-defined margins.
• Feel—cystic.

INTERNAL EXAMINATION REVEALS: -

• Uterus is separated from the cystic mass.
• X-ray chest—A lesion may be found.
• Mantoux test—may be positive.
•  

PSEUDOCYESIS: -

• Usually present in women having problem of infertility or approaching menopause with an intense desire to have a baby.
• History of amenorrhea.
• Abdominal examination reveals absence of positive signs of pregnancy.
• EUA — uterus of normal size.
• Sonography — empty uterus, absence of fetal echo.

HOMOEOPATHIC MANAGEMENT OF ABDOMINOPELVIC LUMPS: -

Homoeopathic medicine's strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. When ABDOMINOPELVIC Lumps are concerned there are many effective medicines available in homoeopathy, but the selection depends upon the individuality of the patients, considering mental and physical symptoms.

Apis Mel: - There is Soreness and stinging pain with Ovaritis. The ovaries are numb or congested with suppressed menses. Menses painful with scanty discharge of slimy blood with or Ovarian pain with numbness down the thighs.

Colocynthis:- Used when there is round, small Cystic tumors in Ovaries or broad ligament. There is boring pain in ovary. The patient must bend double with great restlessness. The menses are painful.

Aurum mur natronatum:- A specific remedy. Ovaries indurated. Enlarged uterus,uterus fills up whole pelvis.

Kali bromatum:- There is ovarian Neuralgia with great nervous uneasiness from ungratified sexual desire. Aversion to sex.

Lachesis: - For left sided complaints. There is pain in the ovary which is better from a discharge from the uterus. The pain of left ovary extends to the right ones. There is Uterine and ovarian pain,all relieve by the flow.

Lycopodium: - Effective for right side complaints. There is cutting pain from right ovary to left. Menses of clots. The woman complaints of flatulence and weak digestion. There is special craving for hot food and drinks and sweets