MANAGEMENT OF WOMEN PRESENTING TO THE ACCIDENT AND EMERGENCY DEPARTMENT WITH LOWER ABDOMINAL-PAIN

The diagnosis and management of lower abdominal pain is difficult, par ticularly for the inexperienced accident and emergency (AandE) or surg ical trainee. In women, potential gynaecological causes may further co nfuse the picture. We analysed the incidence, spectrum of presentation and immediate management of 322 women presenting consecutively to an inner city AandE department over a L-month period with lower abdominal pain. A standard questionnaire relating to history, examination, imme diate investigations and preliminary diagnosis was completed by the at tending AandE doctor. The cause of abdominal pain, according to the Aa ndE doctor's diagnosis, was gynaecological in 61%, gastroenterological in 23%, urological in 7% and non-specific in 9% of cases. Of the wome n, 39% (124/322) were referred to a duty specialist, of whom 86% (107/ 124) required admission for investigation and/or treatment. Women init ially diagnosed as having pain of gynaecological origin formed the lar gest group of patients to be referred. In 69% (67/97) of these cases, the AandE doctor's initial. diagnosis was confirmed by the gynaecologi st. This study shows that pain of gynaecological origin was the larges t single cause of lower abdominal pain in women presenting to our Aand E department and that, in the majority of cases, these women needed to be referred to the duty gynaecologist for immediate treatment. Althou gh overall diagnostic accuracy rate was relatively high, the managemen t of potentially life-threatening gynaecological conditions such as ec topic pregnancy was poor. These results emphasise the need to improve in-service gynaecological training in AandE departments.