1/6. An unusual cause of pelvic mass.BACKGROUND: pelvic pain with an associated pelvic mass is a common problem in the emergency room (ER) or physician's office. Concerns about ectopic pregnancy, infection, or malignancy usually dominate the diagnostic evaluation. At the same time, domestic violence as the cause of a pelvic mass is seldom suspected by physicians. CASE: A 38-year-old woman came to the ER with left lower quadrant pain and a left pelvic mass. After four hospital days and multiple diagnostic imaging studies, the diagnosis of hematoma caused by physical trauma to the abdomen was elucidated. CONCLUSION: Proper diagnosis of the cause of the pelvic mass could have been made earlier by careful attention to the social history and by recognizing the high incidence of domestic violence as opposed to the relative infrequency of some other diagnostic entities for which the patient was tested.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Fitz-Hugh-Curtis syndrome after laparoscopic tubal ligation. A case report.BACKGROUND: Minimally invasive techniques are being used throughout all fields of surgery. With the increasing use and complexity of these cases, new complications will also develop. Fitz-Hugh-Curtis syndrome is an uncommon finding from the spread of infection in pelvic inflammatory disease, causing perihepatitis. CASE: A 29-year-old woman presented 2 weeks after an apparently uneventful laparoscopic tubal ligation with a complaint of right upper quadrant pain. She also had elevated liver function tests but normal ultrasound of the gallbladder. Eventually an intravenous pyelogram showed a bladder injury. Computed tomography revealed fluid in the pelvis and enhancement around the liver. During surgery, intense inflammation with multiple adhesions throughout the peritoneal cavity and around the liver were found. CONCLUSION: The findings were similar to the perihepatitis that occurs when Fitz-Hugh-Curtis syndrome complicates pelvic inflammatory disease. The unusual presentation in this patient made diagnosis very difficult and should remind physicians that unusual complications must be considered as technology evolves and spreads throughout all surgical fields.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/6. Ruptured tubo-ovarian abscess as a complication of IVF treatment: clinical, ultrasonographic and histopathologic findings. A case report.Tuboovarian abscess is a rare complication of IVF treatment, which can be lethal on rupture. Hereby, we present a case of a ruptured tubo-ovarian abscess, following transvaginal ultrasound-guided oocyte retrieval for IVF and transcervical embryo trasfer in a 38-year-old white female patient with five years of primary infertility who underwent aspiration of bilateral hydrosalpinges at the time of oocyte retrieval. This case suggests that the reactivation of latent pelvic infection due to a previous pelvic inflammatory disease (PID) was the possible route of infection after transvaginal ultrasound-directed follicle aspiration--transcervical embryo transfer. We conclude that physicians should consider the diagnosis of tubo-ovarian abscess in the differential diagnosis of abdominal pain, fever and leukocytosis after ovum retrieval and transcervical embryo transfer for IVF treatment. Preservation of the uterus and unaffected uterine adnexa should be attempted in such cases if future pregnancy is desired.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/6. Psychiatric side effects of ofloxacin used in the treatment of pelvic inflammatory disease.The Clinical Effectiveness Group of the Medical Society for the Study of Venereal Diseases and the association of Genitourinary medicine published guidelines on the management of pelvic inflammatory disease in 1999. Subsequently, the use of ofloxacin has increased in our department. However, ofloxacin can cause serious psychiatric side effects, particularly in those with a past psychiatric history. This is of relevance to genitourinary medicine (GUM) physicians as there is a high prevalence of psychiatric illness amongst patients attending GUM clinics. We present two cases of ofloxacin causing severe psychiatric symptomatology, in one case causing an acute psychotic reaction. It is recommended a psychiatric history is taken prior to prescribing ofloxacin and that consideration is given to alternative therapy for those with previous psychiatric illness.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/6. The Majzlin spring revisited.The Majzlin spring is a stainless steel intrauterine device that was used by about 100,000 women between 1967 and 1973. Although the device was withdrawn from the market, some women still have this IUD in place. Many physicians have little knowledge of the Majzlin spring and its potentially serious complications, which include bleeding, infection, perforation and difficult removal.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/6. Misdiagnosis of bilateral ectopic pregnancies: a caveat about operator expertise in the use of transvaginal ultrasound.Reported is the case of a 24-year-old female who presented to the Emergency Department complaining of lower abdominal pain and vaginal bleeding, whose initial transvaginal ultrasound was interpreted as showing a viable intrauterine pregnancy (IUP) of 8 weeks gestation. Repeat transvaginal ultrasound during a subsequent Emergency Department (ED) visit 3 days later revealed bilateral ectopic pregnancies of 6.5 weeks gestation. ED physicians should be familiar with the limitations of transvaginal sonography, and should be wary of early "intrauterine" pregnancies that are diagnosed ultrasonographically by inexperienced operators.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |