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Because the adnexal space is located near urinary and gastrointestinal organs, disorders of these organs may cause symptoms in the pelvic area that need to be distin-guished from gynecologic disorders. The most common urologic disorders are upper and lower urinary tractinfection, and the less common renal and ureteral cal-culi. Even rarer are anatomic abnormalities such as a ptotic kidney, which may present as a solid pelvic mass.An isolated pelvic kidney may likewise present as an asymp-tomatic, solid, cul-de-sac mass. Right adnexal signs and symptoms are associated with acute appendicitis, which should be considered in the differential diagnosis of acute right-lower-quadrant pain. Less commonly, symp-toms in the right adnexa may be related to intrinsic inflammatory bowel disease involving the ileocecaljunction. Left-sided bowel disease involving the recto-sigmoid is seen more often in older patients, as in acute or chronic diverticular disease. Because of the age of these patients and the proximity of the left ovary to the sig-moid, sigmoid diverticular disease is included in the differential diagnosis of a left-sided adnexal mass. Finally, left-sided pelvic pain or a mass may be related to rec-tosigmoid carcinoma. Midline disease can sometimesbe related to a process involving a Meckel diverticulum, or a sacral tumor.
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