Which of the following is the most likely diagnosis? A 27-year-old woman presents to the emergency room with extreme abdominal pain. The pain came on suddenly, beginning in the lower left quadrant. She has been in a monogamous sexual relationship for 2 years. She denies any trauma. She says her last menstrual period was about 6 weeks ago. She is afebrile, BP 90/50 and dropping, heart rate 100.
A. Pelvic inflammatory disease B. Appendicitis C. Toxemia of pregnancy D. Fallopian tube rupture from ectopic pregnancy E. Fibroma-thecoma
Fallopian tube rupture from ectopic pregnancy-the only option that fits all of the womans symptoms is a ruptured ectopic pregnancy. one in every 150 pregnancies is an ectopic pregnancy, and 90% of those are in the fallopian tubes. neisseria gonorrhoeae can cause pelvic inflammatory disease leading to scarring of the fallopian tubes, which predisposes to ectopic pregnancy. appendicitis is possible, but the facts that she is afebrile with lower left pain make it less likely. moreover, appendicitis tends to occur in adolescents and young adults. this womans lowering blood pressure indicates that she is bleeding into the abdominal cavity. this is clearly a medical emergency.