This is a 26-year-old female patient, nulliparous, sexually active, whose personal history highlighted hormonal contraception with vaginal ring, approximately 5 episodes of abnormal vaginal discharge differential diagnosis with rectal abscess 1 month before treatment.
He smoked 15 cigarettes a day without other toxic habits and did not follow usual treatment.
The patient was admitted for 5 days of evolution of pain in the right hypochondrium with a rapidly progressive onset, exacerbated by deep inspiration, movements and maneuvers of Valsalva, initially irradiated to the right iliac flank and f.
Coinciding the onset of pain with the onset of the last menstruation, it was accompanied by mild to moderate hypogastric pain.
He had no fever, abnormal bowel habits or other symptoms.
The physical examination in the emergency room was hemodynamically stable, afflicted.
Pulmonary and cardiac abnormalities were normal.
Undistended abdomen, conserved peristalsis, very painful blando, difficult to perform superficial fixation and defense in right hypochondrium, mild to severe pain.
Positive Blumberg reflected in this location.
Location: positive right lumbar percussion reflected to right hypochondrium.
Genital examination revealed erythema vulvar and perianal, ring-shaped vagina and leucorrhea.
Posterior cervix formed and closed.
Analytically highlighted: Hb: 12.1 g/dl; leukocytes: 12800; neutrophils: 77%; platelets: 281,000, quick: 103%, fibrinogen 3.1 mg/dl; total bilirubin: 3.5 mg/dl;
Urine sediment was normal.
The chest X-ray was normal, and the abdomen showed only pneumatization of the colon.
No dilation of small bowel loops and gas in rectal ampulla.
minimal suspicion of hepatobiliary disease, because it is the most common cause of pain in the upper right quadrant, although there is no alteration in the analytical walls, it is decided to perform an abdominal ultrasound that reports a dilated gall bladder,
When ruling out liver, gallstone biliary and vesicular pathology, an abdominal CAT with contrast is performed, which aims homogeneous hepatomegaly without focal lesions, diffuse edema; periportal biliary tract had normal intestinal fluids, kidneys.
Normal cygo and appendix pelvic location.
Normal pancreas.
Minimum pelvic fluid located in the left perianexial region.
Normal rectum.
Other pathologies causing pain in the upper left quadrant were ruled out, such as hepatobiliary pain, pneumonia, renal disease, etc., both by analytical guide wire and by imaging studies, and taking into account the homogeneous echocardio-vaginal pain CT findings suggestive fluid elevation.
Vaginal flow samples are obtained for cultures that are positive for Candida albicans, Gardnerella vaginalis and Ureraplasma urealiticum.
The study of genetic amplification of PCR (polymerase chain reaction) for Chlamydia trachomatis was positive.
Once the diagnosis of C. trachomatis infection was confirmed, treatment was initiated with orally administered azithromycin in a single dose of 2448 g.
We also started treatment with clotrimazole ovules with improvement in pruritus and leukorrhea.
Because Chlamydia trachomatis is a sexually transmitted germ, serological tests were performed to rule out other agents of the same category such as HIV and VDRL, both negative.
After antibiotic treatment was completed, abdominal control tomography was performed, highlighting a liquid collection line at the bottom of the Douglas sac.
The rest of the study was normal.
After 1 month, the patient is cited to assess clinical status and control, who was in good general condition, without leucorrhea,eu, or abdominal pain to new analytical disparity superficial and deep.
