Yasmin Muhudin Ga'alover 4 years ago

A 27-year-old woman attends the emergency department with irregular vaginal bleeding and abdominal dis comfort. She noticed the bleeding 2 days previously and it is dark red, sufficient for her to need to wear a sanitary towel, but not heavy. The abdominal discomfort is suprapubic and crampy, slightly more on the right-hand side. She is systemically well with no fever, change in appetite, nausea or vomiting. She says that her bowel and urinary habits are normal. Her last menstrual period commenced 45 days previously and she usually has a slightly irregular cycle, bleeding for 3–5 days every 28–35 days. She has never been preg- nant. She has been with her regular sexual partner for 2 years and they generally use con- doms but there are some occasions where they do not. She had a sexual health screen 6 months ago at the genitourinary clinic where she was told all her swabs were negative. She has no previous gynaecological history and no significant previous medical problems.  Examination The blood pressure is 128/72 mmHg and heart rate is 82/min. The abdomen is soft and non-distended. There is tenderness on deep palpation in the suprapubic and right iliac fossa regions, but no rebound tenderness or guarding. Bimanual examination is not performed. Questions What is the diagnosis? What are the management options in this case? How would you counsel the woman postoperatively?