A 30-year-old woman presented to the Emergency Room with sudden severe and sharp abdominal pain for the last three hours, radiating to the right shoulder. She has an irregular mens... A 30-year-old woman presented to the Emergency Room with sudden severe and sharp abdominal pain for the last three hours, radiating to the right shoulder. She has an irregular menstrual cycle, and the last episode was six weeks ago. Examination revealed a rigid abdomen with guarding of note (see report). Pelvic Ultrasound: Abundant fluid in the pouch of Douglas. Which of the following is the most appropriate management? A. Laparotomy B. Suction evacuation C. Medical termination of pregnancy D. Ultrasound-guided fluid aspiration
Understand the Problem
The question presents a clinical scenario of a 30-year-old woman with acute abdominal pain, irregular menstrual cycle, and ultrasound findings suggestive of fluid in the pouch of Douglas. The question asks for the most appropriate management, requiring knowledge of potential diagnoses and their respective treatments.
Answer
Laparotomy
The most appropriate management is Laparotomy.
Answer for screen readers
The most appropriate management is Laparotomy.
More Information
Given the patient's presentation (sudden severe abdominal pain, radiation to the right shoulder, irregular menstrual cycle, rigid abdomen with guarding, and free fluid in the pouch of Douglas), the most likely diagnosis is a ruptured ectopic pregnancy with hemoperitoneum. The abdominal pain radiating to the right shoulder is likely caused by phrenic nerve irritation from blood in the peritoneum. A rigid abdomen with guarding suggests peritonitis, which can be caused by blood or other fluids in the abdominal cavity.
Laparotomy is the most appropriate management in this case because it allows for immediate surgical exploration to identify and control the source of bleeding, as well as to evacuate the hemoperitoneum. This is a life-saving procedure in cases of ruptured ectopic pregnancy.
Tips
The question describes a classic presentation of a ruptured ectopic pregnancy, and rapid identification is key as it poses a high risk of mortality for the patient. Look for keywords such as 'sudden severe abdominal pain, radiating to the right shoulder, irregular menstrual cycle'.
Sources
- Life-threatening haemoperitoneum secondary to rupture of simple ... - pmc.ncbi.nlm.nih.gov
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