I’m currently on holiday in Nairobi so I have not been attending to patients, however I have been available for consultation and help whenever my colleagues here need me. Last evening I was in the kitchen making dinner with mum (a rare occurrence in our house, my mum hardly ever gets time to cook due to her intensely tight schedules) when a clinician friend requested me to rush and attend to a patient who adamantly insisted on being attended to by a Female Muslim Doctor. My name clicked in his mind and he immediately called me; we are quite few and highly in demand. (I would advise any willing Muslim girl to study medicine, we can never be enough).
I drove to his hospital, luckily I was going against traffic so I was there in no time. I attended to the patient, was very scared about a case of Ectopic Pregnancy because she was in significant pain but finally made the conclusion.
I kept wondering if I relied too much on the negative urine bHCG pregnancy test and wrongly ruled out ectopic pregnancy so I was extra careful when co-relating my clinical findings.
This was a case of PELVIC INFLAMMATORY DISEASE (PID).
This particular case had presented with a one sided moderate lower abdominal pain which had lasted for a few days. She had menses a few days back. On examination the abdomen was significantly tender on the left. Vaginal examination exhibited marked tenderness on the left adnexa (tube and ovary region). Pregnancy test was negative, Ultrasound showed significant fluid accumulation in the Pouch of Douglas (behind uterus) but free Fallopian tubes. Ovaries were visualized well and were normal. It kept me wondering. I have encountered 2 ectopic pregnancies with negative pregnancy tests so I didn’t want to leave anything to chance.
I wondered if P.I.D can present as a one sided pain. It mostly presents as a diffuse lower abdominal pain.
Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures. Infection and inflammation may spread to the abdomen. SYMPTOMS INCLUDE, – Constant or intermittent pelvic pain which is usually bilateral but can also be concentrated on one side. – Low backache for several days before menstrual period, subsiding once period starts – Pain during intercourse (rarely, some vaginal bleeding after intercourse) -Pain on urination and/or during bowel movements (rarely, blood in urine or stool) -Painful menstrual periods (dysmenorrhea) -Severe cramps or sharp pains – Persistent fever -Vaginal discharge
On pelvic examination, there is usually tenderness in both vaginal fornices (unlike an ectopic pregnancy, in which there is usually tenderness on one side). (MY PARTICULAR CASE WAS DIFFERENT BECAUSE PAIN WAS MOSTLY ON ONE SIDE).Pain may be so intense that you have to repeat the examination after you have given an analgesic. Symptoms are usually mild, but can be severe with signs of an acute abdomen and occasionally septic shock.
The typical chronic case complains of infertility due to blocked tubes, and pelvic pain, often with pain on coitus, poor general health, and much misery. The diagnosis may be difficult.
CAUSES OF P.I.D
(1) It can occur due to sexually transmitted organisms(gonococci, chlamydia, and mycoplasma). (2) Post-abortion PID (septic abortion,).Postabortal sepsis is particularly deadly and has a mortality of 50%. (3) Infected obstructed labour(4) Puerperal sepsis after delivery (”puerperal PID’). (5) Sepsis after Caesarean section (”postcaesarean PID) especially if done in a non-sterile environment. (6)Patients using Copper-T (IUD) in the uterus as a means of family-planning, which increases the risk of serious infection and may delay recovery. This kind of PID is seldom fatal. TREATMENTTreatment is often started without confirmation of infection because of the serious complications that may result from delayed treatment. Treatment depends on the infectious agent and generally involves the use of antibiotic therapy.Treating sexual partners for possible STIs can help in treatmentCOMPLICATIONS Recurrent pelvic inflammatory diseaseRecurrent pelvic inflammatory disease is where a woman develops repeated episodes of PID. The more often a woman gets PID, the more likely she is to get it in the future.
Abscesses
Sometimes, PID can cause an abscess in the pelvis. An abscess is a collection of infected fluid or pus. It can usually be treated with antibiotics. If an abscess does not respond to antibiotics, you may require surgery.
Ectopic pregnancy
Over 95% of ectopic pregnancies occur in a fallopian tube. If PID develops in the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through leading to ectopic pregnancy.Ectopic pregnancy is therefore a potentially complication.
Infertility
It is estimated that one in five women become subfertile as a result of PID. This means they will be unable to get pregnant naturally. PID can make a woman infertile by scarring the fallopian tubes so severely that it blocks them. Delaying treatment for PID can increase your chances of becoming infertile.
