A 45-year-old feverish and unwell woman presents with a month-long history of increasing abdominal pain and a green/yellow vaginal discharge . The pain is across the lower abdomen but worse on the left. She has no urinary symptoms, lack of appetite but no vomiting and has normal bowel clearance. She has no other pregnancy history than two normal vaginal delivery. She had a laparotomy about 4 years ago for drainage of a pelvic abscess.
Recently she has been under the care of a gynaecologist for heavy and prolonged periods , for which she is taking cyclical norethisterone . Physical examination The temperature is 37.8°C, pulse 95/min and blood pressure is 136/76 mmHg. The abdomen appears slightly distended and a mass is palpated arising from the pelvis on the left. There is focal tenderness in the left iliac fossa without rebound tenderness or guarding. Speculum examination reveals no…
