25 April
A 36y old female patient came to my ER, complained of abdominal pain and diarrhea for 4 hours. She said she began having these symptoms at noon without any noticeable inducement. Her abdominal pain was paroxysmal, and followed by diarrhea which produced loose stool. She ate some medicine(Bao ji wan), but no effect. Past History, she had a supper with colleagues in a restaurant yesterday evening, without any abdominal injury history. Gynecology Data: No amenorrhea. Have a son, 8y. Using interuterine device for contraception up to the present. PE: Vital normal; Cardiorespiratory (-); Abdomen flat, soft; Peristaltic sound 7-8/min. Lab Data: WBC: 6800, RBC, Hb and N% normal. First Impression: 1.Acute Gastroenteritis? 2.Ectopic Pregnancy suspected (because one of interuterine device side-effects is vaginal bleeding, and about 16% ectopic pregnancy patients without amenorrhea). As expected, emergency abdomen B-Ultrasound indicated: dissociated water in abdominal cavity with a 4cm×4cm echo lump in left adnexal area. Gynecology consultation was asked for at this time. Culdocentesis was performed, aspirated 2mL non coagulation of blood. Ectopic Pregnancy confirmed! The patient was immediately admitted to Gynecology Ward for surgery.
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