35 years old woman with H/O recurrent PID presents in emergency with sudden onset of abdominal pain with fever. She had her regular period 5 days back. Physical examination reveals abdominal tenderness with guarding and rigidity. Per speculum finding shows diy vaginal discharge. Per vaginal examination shows adnexal tenderness. Lab investigation shows increased TLC & increased ESR, Most probable diagnosis is -
The history of a recurrent PID and a sudden deterioration points towards a ruptured T/O mass . Alone PID, will have pain and fever with Increased TLC, but not present with the above mentioned acute onset. Acute onset goes in the our of a ruptured abscess. Appendicitis and diveiculitis may have similar onset but the systemic symtoms of toxicity are more profound and both of these are not associated with Vaginal discharge This case can be managed with a exploratory laparotomy & lavage, antibiotics and then follow up of the cultures taken at surgery.
Ruptured ectopic
Ruptured tubo ovarian mass
Diveiculitis
Appendicitis
Genital Tract Infections (Too hot to handle!)