WELCOME TO

CLINICAL
PRESENTATION
A 25 years old lady
presented with
lump and severe
lower abdominal
pain.
Presented by:

Dr. Ashrafee Noor

Assistant Registrar
Gynae Unit-III
SOMCH
Particulars of the Patient

Name : Mrs. Swapna Begum

Age : 25 yrs
Husband’s Name : Md. Farid Miah
Religion : Muslim
Occupation : Housewife
Address : Kanaighat
Date of Admission : 08.08.17 at 7:00 am
Date of Examination : 08.08.17 at 8:30 am
Chief Complaints:

 History of lump in lower abdomen for 4 months.

 Sudden severe lower abdominal pain with nausea & vomiting for
last 6 hours.
History of Present Illness:
According to the statement of the patient she was reasonably well 4
months back. Then she noticed a lump in the lower abdomen which was
gradually increasing in size and initially not associated with pain. But for last
6 hours she developed severe lower abdominal pain associated with
nausea & vomiting. Pain was
History of Present Illness:
sudden in onset, severe spasmotic in nature,
aggravated by physical movements with no
relieving factors, not radiating, not associated with per vaginal bleeding.
She gave no history of amenorrhoea, dyspareunia, dyspepsia and weight
loss. Her bowel and bladder habit was normal. She had no previous history
of pain.
 History of Present Illness:
With these complaints she got admission into SOMCH for further
management
Menstrual History:

Menarche at the age of 13 years

MC 28  30
days
MP 5  6
Menstrual flow- Normal
Dysmenorrhoea- Absent
LMP- 26.07.17
Contraceptive history- OCP
Obstetrical history:
Married for 3 years
Para : 1 (Vaginal Delivery)
ALC : 2 years
History of Past Illness:
Nothing contributory

Socioeconomic history:
She comes from a lower middle class family

Immunization history:
She is immunized against TT vaccine (full dose).
Drug history:
Nothing contributory

Personal History:
Nothing contributory

Family history:
Nothing contributory
General Examination:
Appearance : Ill looking
Body build : Average
Anaemia : Absent
Jaundice : Absent
Oedema : Absent
Dehydration: Absent
Cyanosis : Absent
General Examination:
Pulse : 100 bpm
BP : 100/70 mmHg
Temperature : 100o F
Respiratory rate : 20 breaths/min
Heart : Nothing abnormality
detected.
Lungs : Nothing abnormality
detected
General Examination:
Breast : Normal

Thyroid Gland : Not enlarged

Lymph node : Not palpable

Per Abdominal Examination:
Inspection:
Lower abdomen is
mildly distended and
not moves with
respiration.
Flanks: not full.
Umbilicus:Centrally
placed and inverted
No scar marks or visible
engorged vessels
present.
Per Abdominal Examination:
Palpation:

There was a lump in the lower abdomen measuring about 10 cm  8 cm,

smooth surface, cystic in consistency, well-defined margin, tender with
restricted mobility.

Percussion: Dullness present over the lump.

Auscultation: Bowel sound present.

Per Vaginal Examination:
Inspection: Vulva was Healthy.

Perspeculum examination:
Per vaginal Bleeding : Absent
Cervix : tubular, Healthy
OS : Closed
Uterus : Normal in size
Per Vaginal Examination:

Fornix : A lump is felt through anterior and right fornix which is tender
and separated from uterus.

Movement of lump : Not move with cervix

Salient Feature:
Mrs. Swapna Begum, 25 years, primipara housewife, hailing from
Kanaighat, sylhet got admission into SOMCH with the complaints of
lump in the lower abdomen for 4 months & sudden severe spasmatic
lower abdominal pain with cause a vomiting for 6 hours which was
aggravated
Salient Feature:
by physical movements with no relieving factors, not radiating, not
associated, dypareuria, dyspesia, weight loss with normal bowel &
bladder habit. Her menstrual cycle regular and she used OCP. On
general examination, patient was ill-looking, not anaemic, pulse: 100
bpm,
Salient Feature:
BP:100/70mmHg ;Temperature: 100oF;

PR: 20 breath/min. Abdominal examination revealed a swelling in the

right side of lower abdomen which not moves with respiration
measuring about 10 cm x 8 cm having cystic in consistency, smooth
surface well defined margin, tender with
Salient Feature:
restricted mobility.

Pervaginal examination: A tender lump is felt through anterior and

right fornix, separated from the uterus.
Provisional Diagnosis

Twisted Ovarian Tumor

Differential Diagnosis
Differential Diagnosis
1. Rupture ectopic pregnancy.
2. Torsion of subserous pedunculated fibroid.
3. Chocolet cyst.
4. Rupture ovarian cysts.
5. Appendicular lump.
Investigations
Investigations
I) For Diagnosis:
USG of whole abdomen
USG shows- well defined large cystic lesion
with internal echoes (measuring about 11.3
cm x 10.4 cm) seen in pelvic cavity close to
the right adnexal region.
Mild fluid collection is seen in the cul-de-sac.
Impression: Large right sided pelvic cystic
mass- possibly ovarian origin.
Investigations
I) For Management:
 Blood grouping & Rh typing: Blood group:
A+ve

 CBC: Hb-10.9gm/dl

 RBS: 90 mg/dl

 Urine RME: Pus cells - 1-2 cells/HPF

Epithelial cells - 0 -3 cell/HPF

Clinical Diagnosis:

Twisted Ovarian Tumor

Management

 NPO- UFO
 Inf. Hartsol (1litter) i/v @ 30 drops/ min
 inj. Ceftriaxone (1 gm)
 1 vial i/v stat & bd
 Inj. Nalbun- 2
 1 amp i/m stat.
 Inj. emistat 1 amp i/v stat & sos
 Inj. Omeprazole (40 mg) 1amp i/v stat & bd
 Continuous catheterization.
 After taking informed written consent from patient’s
attendance, patient was prepared for laparotomy.
Operation Note:

Date : 08.08.2017
Time : 10.00 AM
Name of operation : Laparotomy followed
by right
sided salpingo- oophorectomy.
Indication of operation : Twisted ovarian
tumor
Name of anaesthesia: General
anaesthesia.
Follow up immediately after operation

Pulse : 90 bpm
BP : 100/60 mmHg
Temperature : 99 F
Urine output : 300 ml
Bandage : Dry
This patient had an uneventful postoperative
recovery and was discharged on 5th
postoperative
day after corner off and close dressing.
vice on discharge

 Take medicine & nutritious food regularly

 Avoid heavy weight bearing for 3 months
 Avoid coitus for one & half months
 Come for follow up after 2 weeks
 Use OCP for contraception
Thank
you