ABSTRACT
Idiopathic spontaneous intraperitoneal haemorrhage is a rare and potentially fatal condition. Pre-operative diagnosis is difficult or rarely possible. Urgent surgical exploration is the treatment of choice. We report a case of spontaneous intraperitoneal haemorrhage that was observed undergoing sudden deterioration of her condition while in a hospital ward. She was attending to her child admitted in the ward. She developed lower abdominal pain and extreme weakness. Hospital staff recognized her to be gradually undergoing a state of shock. She was resuscitated and urgent ultrasound abdomen revealed free fluid in the abdomen and pelvis. Immediate laparotomy confirmed the diagnosis of spontaneous intraperitoneal bleeding, however, no significant cause of bleeding was found except for a very small area of breached peritoneum in the pouch of Douglas. Haemostasis was secured by two stitches of vicryl. Postoperative CT scan of abdomen and pelvis did not reveal any abnormal finding. Patient was followed-up in the OPD for 6 months and she was symptom-free and in a healthy state
ABSTRACT
The present study was conducted to find the spectrum of determining factors for selection of treatment options by the patients suffering from menorrhagia. It was a descriptive study and was conducted at departments of Obstetrics and Gynaecology of Combined Military Hospitals of Mangla Cantt and Malir Cantt from May 2004 to October 2004. Total of 100 patients above 35 years of age complaining of menorrhagia were enrolled in the study group. Detailed history especially about age, parity, wish for further child bearing, previous history of medical therapy and contraindications for hormone therapy was taken followed by pelvic examination and pelvic ultrasonography. Treatment options i.e. medical therapy, hormone releasing intrauterine device [Mirena] and surgery in the form of hysterectomy were discussed with the patients. Sixty five [65%] patients opted for surgical treatment in the first place because they had already tried some form of medical therapy and were not ready to accept further medical trial. Twenty seven [27%] patients accepted medical therapy but 12 patients took medical treatment only for 3 months and 04 more patients requested for surgery after another 02 months. Only 08 [8%] patients accepted Mirena as treatment option. In patients of perimenopausal age hysterectomy remains the main treatment option. Major determinants are low socio-economic status, completion of family and poor compliance for medical therapy. It is recommended that patients should be educated and made aware of mortality and morbidity so that compliance for medical therapy is enhanced