CASE HISTORY - CASE 6
A 25 year old female comes into the Accident and Emergency Departent complaining of severe abdominal pain and of feeling faint. She is clutching her lower abdomen.
When questioned, she reports:
- Two day history of worsening intermittent abdominal pain on the right side of abdomen
- Three day history of mild/moderate bleeding per vagina
- No bowel problems (normal movements, stools etc)
- No problems with:
- palpitations/chest pain
- passing water
- Smokes one pack a day and drinks 15-20 units of alcohol per week.
- Reports falling on to a table at a club whilst drunk (2 nights ago). Claims it was extremely painful - thought pain may be due to fall and that was why she was reluctant to come in.
- Blood pressure of 90/50 mm Hg
- Heart rate of 120 bpm
- Raised respiratory rate
- Very tender right iliac fossa with guarding
- A 5 inch appendix scar in right iliac fossa
- Brief examination confirmed no other major system based problems.
Her pain worsened, her BP fell even more and she lost consciousness. A peritoneal aspirate showed heavy blood staining. She showed classic symptoms of hypovolaemic shock.
Colloid and blood were given but patient failed to recover and died.