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Pain post Ablation

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History of Present Illness:

  • A 47-year-old female presents to the ED in severe distress screaming and moaning with pelvic pain.  She states that she had endometrial ablation about 8 months ago and since then has had recurrent visits for severe pain which is worse on the left. She’s had subjective fevers and nausea at times but none currently. Pain is worse today than it has ever been.  In the past symptoms were attributed to a degenerating fibroid.
  • She took one Norco before coming
  • She denies any bleeding since the procedure, fever, vomiting or other complaints.

Vital Signs & Physical Exam:

  • Vital signs are normal except for a pulse of 112 and a BP of 166/98.
  • Physical exam is normal except for moaning/screaming in pain and a very tender suprapubic area

Initial Differential Diagnosis:

  • PID
  • Ruptured ectopic
  • SBO
  • other stuff

Initial Diagnostic Testing:

  • CBC and BMP are normal
  • An US is shown below

QUESTIONS:

  1. What does the case image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image image show?  The image shows hematometrium (retained menses)
  2. What should you do next?  Treat with pain meds.  Consult Gyn.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: The patient underwent a cervical dilation with evacuation of 220 mL of hematometra.  Her pain resolved following the procedure.

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