Hydronephrosis and loin pain as a presentation of tubo-ovarian abscess developing after Mirena coil removal.

We present an unusual and complicated case of a 39-year-old woman who was admitted three times in hospital over a period of 4 weeks, with abdominal pain initially and then right loin pain, fever and feeling generally unwell. She was investigated on each admission with different diagnoses set each time, but only on her last admission due to persisting symptoms, an MRI scan revealed a tubo-ovarian abscess associated with pelvic inflammatory disease (PID). We believe that the PID had developed secondary to the intrauterine device and a few weeks after the removal of the Mirena coil she was diagnosed with a tubo-ovarian abscess. As the case unfolds, we will introduce the possible diagnoses and causes that were likely to have led to the development of the abscess.

An unusual haemoperitoneum--secondary abdominal pregnancy.

A 36-year-old amenorrhoeic patient presented with vague abdominal discomfort, and haemodynamic instability, a large haemoperitoneum was identified on transvaginal ultrasound. Ruptured tubal ectopic pregnancy was suspected. At laparotomy ruptured primary tubal ectopic pregnancy was identified, with 12-14 week secondary abdominal pregnancy implanted onto the omentum, confirmed by histopathology. Salpingo-oophrectomy with peritoneal washout was performed, and three units blood transfusion was required. The patient had an uneventful recovery to health.

Management of unscarred ruptured uterus.

AIMS AND OBJECTIVES: Rupture of an unscarred gravid uterus is a rare and dangerous event. We carried out a postal questionnaire survey of the Fellows of the Royal College of Obstetricians and Gynaecologists (United Kingdom), to ascertain the past and present management policies in such an event. 210 Fellows responded (43.5%) and 85 of them managed at least one case of uterine rupture in previously unscarred gravid uterus. RESULTS: A total of 108 cases were reported of which 74 (68.5%) were diagnosed during labor. The tear was repaired and the uterus conserved in 56.5% cases. Maternal mortality was 10.2% (95% CI 5.2, 17.5) and perinatal mortality was 34.3% (95% CI 25.4, 44). When asked how they would manage such a case in the absence of life threatening circumstances in future, 80.8% of Fellows would opt for uterine repair. Fellows with previous hands-on experience of uterine rupture would involve urologists more often in operative management (22% v 8%, OR 3.4, 95% CI 1.2, 10.1). 48% of Fellows felt that in-patient management is indicated in subsequent pregnancies and 91% would perform an elective cesarean section in subsequent pregnancy.