32 yrs female, p1L1 , amenorrhea since 2 mths, UPT-negative, withdrawal bleeding on 17/5/18 shows decidual cast like picture,at present complaining of moderate pain over left iliac fossa since 3 days,her USG A+P- normal, no GS ,ET 10 mm,both ovaries normal,repeat UPT negative,P/S- minimal cervicitis and vaginitis+, PV - uterus normal RV ,Rt fornix free ,left fornix severely tender can't locate anything due to pain,no bladder or bowel problems, during passing gases she feels pain.what could be the diagnosis, should I go for MRI or CTpelvis?with or without contrast,?

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Go for high resolution TVS with Doppler to rule out Left Adnexial Pathology , ? TOMass, torsan, Hydro-pyosalpings Endometriotic adhesion with Coecum Tab. Off-Oz 1 bd Tab. Diclo-para-serraiso 1 bd Tab. Rabeprazole- D 1 bd Tab. Becozyme :C fort Plenty of fluids orally Reassess pelvic examination after 5 days of course

Shouldnt exclude the Ectopic too ? Which could be missed out on TVS ? Beta hCG with double values in 48 hrs.@Dr. Ramesh Patel
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Do beta hcg if not in pregnant range than give a course of doxy 100 mg bd and tab flagyl 400 mg tds for 14 days for both partners. Advice abstinence during course of treatment. Do PPD and Chest X ray. Take PAP smear If symptoms not relieved than do laparoscopy to see for endometriotic deposits and further intervention as required. Review

CT Pelvis is the final conclusive impressions including Ectopic. Beta HCG can be with false higher value ...

Do serum beta hcg and MRI pelvis to rule out ectopic in other sites Give a course of antibiotics and do diagnostic Laparoscopy

Rpt UPT, beta HCG,. Give Tinidazole 1gm/day ,doxycycline 1/day.Reassas after three days. Then do all the routine investigations

B hcg values n CT. Ectopic, to mass, acute pid as diff diagnosis

Get the Beta hCG and repeat after 48 hrs for Double Value to confirm the Ectopic. MRI is most reliable too

Thanks everyone, today I repeated her TVS - s/o oophoritis,minimal free fluid in pod.given doxy metro,lets see how it works.

Try to rule out intestinal obstruction also...x-ray abdomen AP erect

Give her high injectable antibiotic with trypsin chymo Also give a course of inj. Placentrex for 10days with preprobiotic it will help

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