What diseases should be differentiated from acute adnexitis?

Acute adnexitis is inflammation of both salpingitis and oophoritis, of which salpingitis is the most common. The clinical manifestations of acute adnexitis are sometimes easily confused with acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion or ovarian endometriosis cyst.

1. Acute appendicitis: Right-sided acute adnexitis is easily confused with acute appendicitis. There is mild periumbilical pain accompanied by gastrointestinal symptoms such as nausea, vomiting or diarrhea. The pain gradually worsens and moves to the right lower abdomen. It is persistent and the body temperature may rise.

2. Ectopic pregnancy: Ectopic pregnancy has a history of amenorrhea, vaginal bleeding and signs of internal bleeding such as pale complexion, rapid pulse, decreased blood pressure or shock. During examination, there is abdominal muscle tension, tenderness and very severe rebound pain.

3. Ovarian cyst pedicle torsion: Among ovarian cysts with pedicle torsion, the most common one is ovarian teratoma. There may be a history of lower abdominal mass, sudden severe lower abdominal pain, often accompanied by nausea, vomiting, fever and even shock. During the examination, there is abdominal muscle tension, tenderness and rebound pain. During gynecological examination, a cyst with large tension, clear boundaries and obvious tenderness can be felt in the adnexal area on one side.

4. Ovarian endometriosis cyst: There is a history of dysmenorrhea, infertility, and pain during sexual intercourse. Abdominal pain often occurs during menstruation, usually without fever. Gynecological examination can palpate a retroverted and fixed uterus, tender nodules on the posterior wall of the uterus, thickening of the uterosacral ligament, painful nodules, and a mass in the adnexal area with mild tenderness.