| Misdiagnosis of appendicitis in tubally sterilized women. | |
| | |
MedLine Citation:
|
PMID: 8466465 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Sterilization by tubal occlusive methods has a small but definite incidence of failure which is not well recognized among general surgeons. As a result of the failure to appreciate the possibility of ectopic pregnancy after tubal ligation, right-sided abdominal pain in this patient population is commonly misdiagnosed as appendicitis. One such case is presented, and the literature is reviewed and discussed. Sterilization by tubal occlusive methods is not always successful. This fact is not, however, well recognized among general surgeons. When failures occur, ectopic pregnancy is the usual outcome, most commonly in the Fallopian tube. Ectopic pregnancy has a reported mortality of approximately 3.5/1000, with the majority of deaths associated with delay in diagnosis. The failure to consider this possibility of ectopic pregnancy after tubal ligation when female patients present with right-sided abdominal pain causes health personnel to commonly misdiagnose the condition of appendicitis. A 26 year old woman presented to the Accident and Emergency Department of the Royal Hobart Hospital with lower abdominal pain mainly in the right iliac fossa. Pain was intermittent for two weeks prior to presentation. On the morning of presentation, the pain became severe and was exacerbated by coughing and movements. The patient was nauseated, but had not vomited; there was neither fever nor rigors. Four years earlier, in England, the patient had undergone elective laparoscopic sterilization. Sexually active, she believed that she was menstruating at the time of presentation, especially since her last menstruation occurred four weeks previously. The patient was noted upon examination to have a "grey look," pulse rate of 80 beats/minute, blood pressure of 120/80 mmHg, and a generally tender abdomen, maximally in the right iliac fossa. There were no bowel sounds and rectal examination proved to be extremely painful in all directions. The accident and emergency staff took blood for a full blood count, serum human chorionic gonadotrophin, and arranged surgical consultation. The surgical diagnosis was for acute appendicitis and the patient was transferred to the operating theater for appendectomy. Just prior to anesthetic induction, the pathology results became available, indicating a hemoglobin of 10.3 g/dl and a positive serum HCG. The diagnosis was thus revised to ruptured ectopic pregnancy and laparotomy was performed through a Pfannenstiel incision. 1000 ml of blood was removed from the peritoneal cavity, a ruptured tubal pregnancy was found in the right distal tube, and the appendix was normal. A right salpingo-oophorectomy was performed after which the patient recovered uneventfully and was discharged five days postoperatively. Histopathology confirmed a ruptured ectopic gestation. |
| | |
Authors:
|
M H Nguyen; S Wilkinson |
Related Documents
:
|
7989505 - Refinements in the methodology of injection for transvaginal gamete intra-fallopian tra... 10329055 - Pregnancy with primary tubal placental site trophoblastic tumor--a case report and lite... 2001435 - In vitro fertilization: effective alternative to surgery for distal tubal occlusion. 7657755 - Sterilization reversal: fertility results. 6881075 - Quantitative and qualitative aspects of selenium utilization in pregnant and nonpregnan... 10759205 - Heterotopic pregnancy presenting as an acute abdomen: a diagnostic masquerader. |
Publication Detail:
|
Type: Case Reports; Journal Article; Review |
Journal Detail:
|
Title: The Australian and New Zealand journal of surgery Volume: 63 ISSN: 0004-8682 ISO Abbreviation: Aust N Z J Surg Publication Date: 1993 Jan |
Date Detail:
|
Created Date: 1993-05-05 Completed Date: 1993-05-05 Revised Date: 2005-11-16 |
Medline Journal Info:
|
Nlm Unique ID: 0373115 Medline TA: Aust N Z J Surg Country: AUSTRALIA |
Other Details:
|
Languages: eng Pagination: 68-70 Citation Subset: IM; J |
Affiliation:
|
Department of Surgery, University of Tasmania, Hobart, Australia. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Abdominal Pain
/
diagnosis Acute Disease Adult Appendicitis / diagnosis* Diagnosis, Differential Diagnostic Errors Female Humans Pregnancy Pregnancy, Tubal / complications, diagnosis*, surgery Rupture, Spontaneous Sterilization, Tubal* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Carl Langenbuch and the Lazarus Hospital: events and circumstances surrounding the first cholecystec...
Next Document: Right chylothorax following left radical neck dissection.