- March 21, 2016
- Posted by: emobile
- Category: Patient's Corner
Emobileclinic Patient’s corner
A 20 year lady came with the complaints of amenorrhea of 11 weeks, abdominal pain of 10 days duration and fever of 7 days. Her problem actually started 10 days before she came to the hospital when she terminated an 11 weeks old pregnancy. The abortion was done in a chemist shop owned by a nurse. She started having this lower abdominal pains some hours after the procedure.
It was initially mild but worsened 2 days later. Since then it has been progressive. It was initially located in the lower abdomen but later became generalized. There was associated foul smelling vaginal discharge that was occasionally blood – stained. There was no abdominal swelling. The fever started a week before presentation. It was high grade and continuous. There was associated vomiting and passage of loose watery stools. The stool was copious and sometimes mucoid and offensive.
There was no dysuria or frequency of micturition. She reported back to the chemist and was given some injections and capsules for 3 days but there was no improvement in her condition. She had a termination of 7 weeks old pregnancy 2 years before she had the current one. There was no complication then. There was no history of contraceptive usage. She was the first of 3 children of her mother who was a petty trader. The parents were separated. She neither smoked cigarette nor drank alcohol. She was a final year student in a secondary school.
At general examination, she looked ill, mildly pale, febrile (T. 38.8%) and moderately dehydrated. She also had a tingle of jaundice. Her breast were normal. At investigation, her abdomen was slightly distended with fullness in the lower abdomen. There was generalized tenderness with guarding and rebound tenderness. There was a lower abdominal mass compatible with 16 weeks gestation. It was smooth, soft and fluctuate. It was not mobile and it was not possible to get below it. It was uniformly dull to percussion and ascites was not demonstrable.
Vaginal examination shows hyperaemic cervix with features suggestive of instrumentation and trauma to the cervix. Mucoprurulent discharge was noted in the fornices and pouch of Douglas was full. No masses were seen in the vagina or on the cervix. Endicervical swab and high vaginal swab were taken for microbiology, culture and sensitivity. Culdocentesis done yielded about 4mls of pus which was sent for culture and sensitivity. The cervix was soft and Os was closed. There was marked cervical excitation tenderness bilaterally. The size and position of the uterus was difficult to access because of tenderness. The pouch of Douglas was full. The gloved finger was stained with offensive slightly blood – stained mucoprurulent discharge.
Pelvic Abscess secondary post-abortal sepsis?