Acute Pelvic Pain

Acute pelvic pain, defined as the sudden onset of lower abdominal or pelvic pain lasting less than 3 months [1], is a common urgent clinical presentation. Women frequently present to the emergency department after hours. More than one third of women of reproductive age experience nonmenstrual pelvic pain [2]. Acute pelvic pain can pose a diagnostic challenge because the clinical history, symptoms, and physical examination findings are often nonspecific, and the clinical presentations of the underlying gynecologic, obstetric, urologic, and gastrointestinal conditions often vary widely and can frequently overlap. Although some of the common conditions, such as ruptured or hemorrhagic ovarian cysts, are self-limiting, it is imperative that urgent conditions that may necessitate intervention or surgery, such as ovarian torsion, pelvic inflammatory disease (PID), and appendicitis, be considered when a premenopausal woman has acute pelvic pain. The American College of Radiology Appropriateness Criteria list pelvic sonography as the preferred first-line imaging modality in the evaluation of acute pelvic pain in pregnant women and nonpregnant women of reproductive age when an obstetric or gynecologic condition is suspected and in the initial assessment of a suspected nongynecologic condition in a pregnant patient [3]. This can be attributed to its ready availability, cost-effectiveness, noninvasive nature, and lack of ionizing radiation. Sonography can also prove helpful in the assessment of suspected gastrointestinal or urinary tract abnormalities in a nonpregnant woman; however, CT is typically the preferred first-line imaging modality for those patients [3].