Radha

 POD - 3 UNDERWENT EMERGENCY EXPLORATORY LAPAROTOMY WITH LEFT OOPHORECTOMY IN VIEW OF 35 YEAR OLD P3L3 POST HYSTERECTOMISED WITH SPONTANEOUS RUPTURED LEFT OVARIAN CYST 



35  YEARS OLD P3L3 POST HYSTERECTOMISED WITH 3 PREVIOUS LSCS WITH COMPLAINTS OF PAIN IN THE LEFT ILIAC FOSSA SINCE TODAY (12/9/23) MORNING 7 AM

HISTORY OF PRESENTING ILLNESS- PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY MORNING AFTER THAT SHE DEVELOPED SUDDEN PAIN IN LEFT ILIAC FOSSA, CONTINUOUS DRAGGING TYPE RADIATING TO GROIN. NO AGGRAVATING AND RELIEVING FACTORS.

HISTORY OF BURNING MICTURITON WITH INCREASED FREQUENCY SINCE YESTERDAY AFTERNOON WHILE PASSING URINE FOR WHICH PATIENT WENT TO LOCAL DOCTOR WITH SIMILAR COMPLAINTS. TOOK INJECTION AROUND 7 PM ON 11/9/23. PAIN GOT SUBSIDED (NO DOCUMENTATION AVAILABLE)

NO HISTORY OF VOMITING

HISTORY OF 3 EPISODES OF STOOLS WITH NORMAL CONSISTENCY

HISTORY OF FEVER 10 DAYS BACK FOR WHICH SHE TOOK TREATMENT IN KIMS NARKETPALLY


PAST HISTORY

PATIENT HAD SIMILAR COMPLAINTS (LEFT ILIAC FOSSA) 4 MONTHS BACK IN THE MONTH OF JUNE FOR WHICH SHE GOT ADMITTED IN KIMS NARKETPALLY AND WAS DIAGNOSED WITH LEFT OVARIAN HEMORRHAGIC CYST OF SIZE 4.5 x 3.5 CMS FOR WHICH SHE WAS STARTED ON ORAL CONTRACEPTION PILLS (FEMILON) AND WAS ASKED TO FOLLOW UP AFTER ONE CYCLE FOR THE SIZE OF THE CYST. 

SHE CAME IN THE MONTH OF JULY BUT ULTRASOUND MACHINE WAS NOT WORKING IN KIMS NARKETPALLY SO ULTRASOUND WAS NOT DONE. IN JULY SHE USED ANOTHER CYCLE OF FEMILON.

NOW SHE PRESENTED WITH ACUTE PAIN ABDOMEN

NOT A KNOWN CASE OF DIABETES, HYPERTENSION, EPILEPSY, TB, ASTHMA, CAD, THYROID DISORDERS

NO HISTORY OF BLOOD TRANSFUSIONS OR OROFER INFUSIONS.


SURGICAL HISTORY

HISTORY OF 3 PREVIOUS LSCS. HYSTERECTOMISED AND TUBECTOMISED AFTER LAST CHILD BIRTH.


FAMILY HISTORY

INSIGNIFICANT


MENSTRUAL HISTORY

LMP - HYSTERECTOMISED 2 YEARS BACK

AOM - 15 YEARS

5-6/28-30, REGULAR, 4-5 PADS/DAY

PAIN + , CLOTS + 1 x 1 CMS


MARITAL HISTORY

MARRIED LIFE - 21 YEARS

CONSANGUINOUS MARRIAGE


OBS HISTORY

1ST PREGNANCY - MALE, 16 YEARS, FULL TERM LOWER SECTION CESAREAN SECTON (IN VIEW OF OLIGOHYDRAMNIOS) @ SURYAPET PRIVATE HOSPITAL, BIRTH WEIGHT- 1.5 KGS, ALIVE AND HEALTHY

2ND PREGNANCY - FULL TERM LOWER SECTION CESAREAN SECTION IN VIEW OF PREVIOUS LSCS @ NAKREKAL PRIVATE HOSPITAL. FEMALE, BIRTH WEIGHT - 2.5 KGS, 13 YEARS, ALIVE AND HEALTHY

3RD PREGNANCY- MALE, 12 YEARS, FULL TERM LOWER SECTION CESAREAN SECTION, 2KG, NAKEKAL PRIVATE HOSPITAL, ALIVE AND HEALTHY


GENERAL EXAMINATON

PATIENT IS CONSCIOUS, COOPERATIVE AND COHERENT. 

HEIGHT - 152 CMS

WEIGHT - 52 KGS

BMI - 22.5

TEMPERATURE- 97 F

HR - 90/ MIN

RR - 18 CYCLES/MIN

BP - 130/90

GRBS - 94


SYSTEMIC EXAMINATION

CVS - S1S2 + 

RS - BILATERAL AIR ENTRY + , NORMAL VESICULAR BREATH SOUNDS

CNS- HIGHER MENTAL FUNCTIONS INTACT

P/A - SOFT, TENDERNESS PRESENT IN LEFT ILIAC FOSSA, VERTICAL SCAR +

P/V - PALPABLE MASS IN LEFT FORNIX, MOBILE

          POSSIBILITY OF TORSION AS IT IS FREELY MOBILE



EXPLORATORY LAPAROTOMY WITH LEFT OOPHORECTOMY DONE ON 12/9/23

INTRA OPERATIVE FINDINGS

  1. THICK ADHESION PRESENT BETWEEN OMENTUM AND ANTERIOR ABDOMINAL WALL
  2. SPONTANEOUS RUPTURE OF LEFT OVARIAN CYST PRESENT
  3. LEFT OVARY IS THICKLY ADHERENT TO. LADDER, OMENTUM, LEFT PELVIC WALL AND OVARIAN LIGAMENT
  4. PERITONEAL FLUID SENT FOR CYTOLOGY
  5. ADHESION REMOVED LEFT OOPHORECTOMY DONE
  6. RIGHT OVARY NOT VISUALIZED (ABSENT)
  7. APPENDIX NOT VISUALIZED (ABSENT)
  8. MULTIPLE CYST PRESENT IN THE LEFT OVARY APPROXIMATELY 3 x 3 CMS. ONE SPONTANEOUS RUPTURED PRESENT. ONE HEMORRHAGIC CYST PRESENT. 


INVESTIGATIONS 

CBP ON 12/9/23

HB- 13.3

TLC - 9700

PLATELETS - 2.24

SMEAR - NORMOCYTIC NORMOCHROMIC ANEMIA

POST OP CBP ON 13/9/23

HB - 12.1

TLC - 9100

PLATELETS - 2.26


BGT - AB POSITIVE


BT - 2 MIN 00 SEC

CT - 4 MIN 00 SEC


CUE

ALBUMINS - NIL

SUGARS- NIL


RFT

BLOOD UREA - 14

SERUM CREATININE - 0.6

SODIUM - 136

POTASSIUM - 3.8

CHLORIDE - 104

CALCIUM IONIZED - 1.37

 

RBS - 82


SEROLOGY - NEGATIVE


ULTRASOUND

EVIDENCE OF 50 x 50 MM CONGLOMERATED CYSTIC LESIONS WITH INTERNAL ECHOES NOTED IN LEFT OVARY WITH PARTIAL TWISTED VASCULAR PEDICLE 

LIKELY PARTIAL OVARIAN TORSION

FLUID NOTED IN POD



TREATMENT GIVEN

  1. IV FLUIDS
  2. INJ TAXIM 1 GM IV BD
  3. INJ METRONIDAZOLE 100 ML IV TID
  4. INJ PANTOP 40MG IV OD
  5. INJ ZOFER 4MG IV SOS
  6. INJ NEOMOL 100 ML IV TID
  7. JONAC SUPPOSITORY PR SOS
  8. ABDOMINAL BINDER USAGE


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