Special Operations Forces Medical Handbook

3-43

Inflammatory Bowel Disease or Irritable Bowel Syndrome- abdominal pain rarely sudden in onset; will have a
past history of intermittent symptoms including diarrhea and bloody stools.

Plan:
Treatment
Primary:

1. Stabilize patient (airway, breathing, circulation, etc).


2. Start 2 large bore IVs and initiate fluid resuscitation for unstable patients (see Shock: Fluid Resuscitation).


3. If PID, then treat per PID section (antibiotics and bedrest).


4. Initiate transfer/evacuation if patient has: possible ovarian torsion, ectopic pregnancy or is
   hemodynamically unstable.


5. If the patient’s diagnosis is consistent with ruptured ovarian cyst and she is hemodynamically stable, she
   can be placed on bedrest. Repeat vital signs and physical examination q 4 hours. She should improve
   and be ambulatory in 6-12 hours, NSAIDs may be given, as well as mild narcotics (should only be
   necessary for the 1st 12-24 hours, if at all. If a significant narcotic need exists beyond 12 hours the
   patient should be evacuated).
   Primitive: If you are unable to evacuate the patient immediately, institute bedrest and fluid resuscitation with
   lactated Ringer’s or normal saline. Blood transfusion may be life saving and should be given if patient has
   failed resuscitation with crystalloid or is otherwise showing signs of inadequate tissue perfusion. Type and
   crossmatched vs. type specific vs. O negative depending on urgency and availability

Patient Education
General: Reassure patient and discuss treatment plan even in emergency situations.
Activity: Bedrest
Diet: NPO initially
Medications: Give adequate narcotics to patients whose care is delayed or who must be transferred. Do
not over-sedate.
No Improvement/Deterioration: Return for evacuation.

Follow-up Actions
Return evaluation: Start a patient with recurrent ovarian cysts (see Mittelschmerz - chronic pelvic pain
section) on oral contraceptive pills to suppress ovulation. A good pill to start would be Ortho-Novum 1/35
if available.
Evacuation/Consultation Criteria: Acute pelvic pain can only be observed if the facility has the capability to
intervene surgically. If not, the patient must be transferred. These patients often need abdominal ultrasound
or CT, which is not available in primitive areas.

Symptom: GYN Problems: Pelvic Pain, Chronic

MAJ Ann Friedmann, MC, USA

Introduction: Defined as pelvic pain of greater than 6 months duration, chronic pelvic pain is usually
multifactorial in etiology. Pain is often not proportional to amount of disease present. A multidisciplinary
approach is most effective in treating this disorder. For the field medic, chronic pelvic pain cannot be cured,
but simple, helpful treatments can be initiated. The four most commonly seen diagnoses are discussed below.
For a more complete differential diagnosis see the CD-ROM. Also see the Abdominal Pain and Acute Pelvic
Pain sections for more information. In non-western countries where routine medical care is not available,
female patients with chronic pelvic pain may have more serious disease such as uterine, cervical or ovarian
cancer. These women are more likely to have weight loss, fatigue, loss of appetite, night sweats, frequent