Jinekolojik Kaynaklı Pelvik Ağrılar (II); Pelvik İnflamatuar Hastalık, Endometriozis ve Fitz–Hugh–Curtis Sendromu
Özet
Jinekolojik kaynaklı pelvik ağrılar, kadınlarda hem akut hem de kronik başvuruların en önemli nedenlerinden biridir ve altta yatan patolojiye bağlı olarak ciddi morbiditeye yol açabilir. Bu bölümde, pelvik ağrının başlıca jinekolojik nedenlerinden olan Pelvik İnflamatuar Hastalık (PID), endometriozis ve Fitz–Hugh–Curtis sendromu ele alınmaktadır. PID, üst genital sistemin enfeksiyöz inflamasyonu olup sıklıkla Neisseria gonorrhoeae, Chlamydia trachomatis ve diğer mikroorganizmalarla ilişkilidir. Klinik olarak alt karın ağrısı, servikal ve adneksiyel hassasiyet ile karakterizedir ve erken tedavi edilmediğinde infertilite, ektopik gebelik ve kronik pelvik ağrı gibi ciddi komplikasyonlara yol açabilir. Fitz–Hugh–Curtis sendromu ise PID’nin ekstrapelvik bir komplikasyonu olup karaciğer kapsülünün (Glisson kapsülü) inflamasyonu ile seyreder ve sağ üst kadran ağrısı ile kendini gösterir. Endometriozis ise endometriyal benzeri dokunun uterin kavite dışında yerleşmesi ile karakterize, kronik, inflamatuar ve östrojene bağımlı bir hastalıktır. En sık kronik pelvik ağrı ve infertilite ile ilişkilidir. Tanı ve tedavi süreci çoğu zaman multidisipliner yaklaşım gerektirir. Bu bölümde söz konusu hastalıkların epidemiyolojisi, patofizyolojisi, klinik özellikleri, tanı yaklaşımları ve güncel tedavi seçenekleri ayrıntılı olarak incelenerek pelvik ağrının ayırıcı tanısında klinisyene rehberlik edilmesi amaçlanmıştır.
Gynecologic causes of pelvic pain represent one of the leading reasons for both acute and chronic presentations in women and may result in substantial morbidity depending on the underlying pathology. This chapter focuses on three major gynecologic conditions associated with pelvic pain: Pelvic Inflammatory Disease (PID), endometriosis, and Fitz–Hugh–Curtis syndrome. PID is an infectious inflammatory disorder of the upper female genital tract, most commonly associated with Neisseria gonorrhoeae, Chlamydia trachomatis, and polymicrobial flora. It typically presents with lower abdominal pain accompanied by cervical motion tenderness and adnexal tenderness. Delayed diagnosis or inadequate treatment may lead to serious long-term complications, including infertility, ectopic pregnancy, and chronic pelvic pain. Fitz–Hugh–Curtis syndrome is an extrapelvic manifestation of PID characterized by inflammation of the hepatic capsule (Glisson’s capsule). Clinically, it presents with right upper quadrant pain and may mimic hepatobiliary pathology, which can complicate the diagnostic process. Endometriosis is a chronic, estrogen-dependent inflammatory condition defined by the presence of endometrial-like tissue outside the uterine cavity. It is strongly associated with chronic pelvic pain and infertility. The diagnostic and therapeutic management of endometriosis often requires a multidisciplinary approach. This chapter reviews the epidemiology, pathophysiological mechanisms, clinical features, diagnostic strategies, and contemporary treatment options of these conditions, aiming to provide clinicians with a structured framework for the differential diagnosis of gynecologic pelvic pain.
Referanslar
Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 2011;38(1):85-viii. doi:10.1016/j.ogc.2011.02.005
Taira T, Broussard N, Bugg C. Pelvic inflammatory disease: diagnosis and treatment in the emergency department. Emerg Med Pract. 2022;24(12):1-24.
Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4(2):235-247. doi:10.1586/14787210.4.2.235
Mitchell CM, Anyalechi GE, et. al. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. J Infect Dis. 2021;224(12 Suppl 2):S29-S35. doi:10.1093/infdis/jiab067
Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224(3):251-257. doi:10.1016/j.ajog.2020.10.019
Soper DE. Pelvic inflammatory disease. Obstet Gynecol. 2010;116(2 Pt 1):419-428. doi:10.1097/AOG.0b013e3181e92c54
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100(6):357-364.
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039-2048. doi:10.1056/NEJMra1411426
Revzin MV, Mathur M, Dave HB, et al. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics. 2016;36(5):1579-1596. doi:10.1148/rg.2016150202
Beigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am. 2003;30(4):777-793. doi:10.1016/s0889-8545(03)00088-3
Bugg CW, Taira T. Pelvic Inflammatory Disease: Diagnosis And Treatment In The Emergency Department. Emerg Med Pract. 2016;18(12):1-24.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Published 2021 Jul 23. doi:10.15585/mmwr.rr7004a1.
Basit H, Pop A, Malik A, et al. Fitz-Hugh-Curtis Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 3, 2023.
Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004;71(3):233-239. doi:10.3949/ccjm.71.3.233
Ris HW. Perihepatitis (Fitz-Hugh--Curtis syndrome). A review and case presentation. J Adolesc Health Care. 1984;5(4):272-276. doi:10.1016/s0197-0070(84)80131-x
Theofanakis, C.P., Kyriakidis, A.V. Fitz-Hugh–Curtis syndrome. Gynecol Surg 8, 129–134 (2011). https://doi.org/10.1007/s10397-010-0642-8
As-Sanie S, Mackenzie SC, Morrison L, et al. Endometriosis: A Review. JAMA. 2025;334(1):64-78. doi:10.1001/jama.2025.2975
Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002
Chapron C, Marcellin L, Borghese B, et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-682. doi:10.1038/s41574-019-0245-z
Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021;22(19):10554. Published 2021 Sep 29. doi:10.3390/ijms221910554
Berkkanoglu M, Arici A. Immunology and endometriosis. Am J Reprod Immunol. 2003;50(1):48-59. doi:10.1034/j.1600-0897.2003.00042.x
Leyland N, Casper R, Laberge P, et al. Endometriosis: Diagnosis and Management. Journal of Endometriosis. 2018;2(3):107-134. doi:10.1177/228402651000200303
Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363-E371. doi:10.1503/cmaj.220637
Spaczynski RZ, Duleba AJ. Diagnosis of endometriosis. Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326
Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018;131(3):557-571. doi:10.1097/AOG.0000000000002469
Referanslar
Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am. 2011;38(1):85-viii. doi:10.1016/j.ogc.2011.02.005
Taira T, Broussard N, Bugg C. Pelvic inflammatory disease: diagnosis and treatment in the emergency department. Emerg Med Pract. 2022;24(12):1-24.
Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4(2):235-247. doi:10.1586/14787210.4.2.235
Mitchell CM, Anyalechi GE, et. al. Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. J Infect Dis. 2021;224(12 Suppl 2):S29-S35. doi:10.1093/infdis/jiab067
Ravel J, Moreno I, Simón C. Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. Am J Obstet Gynecol. 2021;224(3):251-257. doi:10.1016/j.ajog.2020.10.019
Soper DE. Pelvic inflammatory disease. Obstet Gynecol. 2010;116(2 Pt 1):419-428. doi:10.1097/AOG.0b013e3181e92c54
Curry A, Williams T, Penny ML. Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. Am Fam Physician. 2019;100(6):357-364.
Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039-2048. doi:10.1056/NEJMra1411426
Revzin MV, Mathur M, Dave HB, et al. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics. 2016;36(5):1579-1596. doi:10.1148/rg.2016150202
Beigi RH, Wiesenfeld HC. Pelvic inflammatory disease: new diagnostic criteria and treatment. Obstet Gynecol Clin North Am. 2003;30(4):777-793. doi:10.1016/s0889-8545(03)00088-3
Bugg CW, Taira T. Pelvic Inflammatory Disease: Diagnosis And Treatment In The Emergency Department. Emerg Med Pract. 2016;18(12):1-24.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. Published 2021 Jul 23. doi:10.15585/mmwr.rr7004a1.
Basit H, Pop A, Malik A, et al. Fitz-Hugh-Curtis Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 3, 2023.
Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. 2004;71(3):233-239. doi:10.3949/ccjm.71.3.233
Ris HW. Perihepatitis (Fitz-Hugh--Curtis syndrome). A review and case presentation. J Adolesc Health Care. 1984;5(4):272-276. doi:10.1016/s0197-0070(84)80131-x
Theofanakis, C.P., Kyriakidis, A.V. Fitz-Hugh–Curtis syndrome. Gynecol Surg 8, 129–134 (2011). https://doi.org/10.1007/s10397-010-0642-8
As-Sanie S, Mackenzie SC, Morrison L, et al. Endometriosis: A Review. JAMA. 2025;334(1):64-78. doi:10.1001/jama.2025.2975
Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012;39(4):535-549. doi:10.1016/j.ogc.2012.10.002
Chapron C, Marcellin L, Borghese B, et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-682. doi:10.1038/s41574-019-0245-z
Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021;22(19):10554. Published 2021 Sep 29. doi:10.3390/ijms221910554
Berkkanoglu M, Arici A. Immunology and endometriosis. Am J Reprod Immunol. 2003;50(1):48-59. doi:10.1034/j.1600-0897.2003.00042.x
Leyland N, Casper R, Laberge P, et al. Endometriosis: Diagnosis and Management. Journal of Endometriosis. 2018;2(3):107-134. doi:10.1177/228402651000200303
Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363-E371. doi:10.1503/cmaj.220637
Spaczynski RZ, Duleba AJ. Diagnosis of endometriosis. Semin Reprod Med. 2003;21(2):193-208. doi:10.1055/s-2003-41326
Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018;131(3):557-571. doi:10.1097/AOG.0000000000002469
