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Pelvic Pain

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 32-year-old female presents to the ED for 1 week of left hip pain per triage.  She actually has left groin pain, bilateral lower quadrant pain and intermittent anal cramping.  She denies any fever or vomiting. ?She denies any vaginal discharge or new sexual partners other than her husband. ?She denies any other complaints.

Vitals & Physical Exam:

Vital signs are normal except for.   Exam is otherwise normal except for diffuse mild to moderate tenderness with guarding w/o rebound

Initial differential diagnosis:

  • Trochanteric bursitis
  • Inguinal hernia
  • Ectopic pregnancy
  • Diverticulitis
  • Ovarian Cyst…

Testing: 

  • Chemistry – normal
  • CBC – normal
  • Beta-HCG – 87
  • Bedside sonogram – See below

QUESTIONS:

  1. What does the case image show?  
  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 show?  The image shows small pockets of black free fluid behind an empty uterus (sunglasses sign)
  2. What should you do next?  Prep the patient for the OR and call OB.
  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.

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E-meducation for medical topic of this case: Read the yellow highlighted area of the page-shot below from our #1 title, the Emergency Medicine 1-Minute Consult Pocketbook

 

Source: The Emergency Medicine 1-Minute Consult Pocketbook

CASE OUTCOME: Went to OR in stable condition.  Had a 5 cm ectopic pregnancy in ampulla of left fallopian tube with ~100 cc of blood in the posterior cul de sac.

  

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