MINISTRY OF PUBLIC

HEALTH OF UKRAINE
IVANO-FRANKVISK
NATIONAL MEDICAL
UNIVERSITY
Department of Obstetrics and Gynecology
 CASE HISTORY

Students name: Somesh Nagendra Takkekar

Faculty : Medicine
Course: 4th
Group: 59f-
Teacher's name: Бендас Мирослава Петрівна
 Passport Details of the Patient

Name& Surname: Olena Kennedy

Age: 22 years
Address: Avenue Street, Brussels.
Place of work: team principal manager, F1
Martial Status: unmarried.
 ○Complaints: Pain in abdomen and pelvic area, acute
pain in the lower abdomen irraddiating to lower back,
• Pain occured suddendly after excersice, single vomiting
and bloating.

○History of disease: 1 month ago a cyst of the ovary

of 5 cm was detected on an ultrasound and sent for
gynecological consultation but patient didn't went for
consultation.
○Life history: No extragenital diseases, family and allergy history is
not found.

○Obstetric and gynecological history:

menstrual function: menarche at age 14, settled cycle after six
months, lasting 28 days. Menstruation for 3-4 days, not painful,
moderate; during the last 3 months notes menstrual disorders (delays
of 5 -6 days, menstrual periods of 7 -8 days, abundant); last
menstruation - a month ago;
sexual function: the beginning of sexual life at the age of 24, used
contraceptives (condoms), pain and pathological discharge were not
present.
secretory function: notes before menstruation increase in mucous
secretions; gynecological diseases: denies, there were no operations.
○Objective: the general condition is satisfactory. The skin and mucous membranes
are
pale.
Height 164 cm, weight 58 kg. AT 130/80 mm Hg Pulse 88 beats / min.,
Temperature
37.4ºC
Breasts without pathological changes.
The abdomen is moderately bloated, the Schottkin-Blumberg symptom is positive.
Gynecological status: external genitalia without pathology.
Speculum examination: the cervix is cylindrical, pale pink, clean, mucous
secretions,
abundant.
Bimanual examination: the uterus is not enlarged, dense, the excursion of the
uterus
is painful, to the left of the uterus is palpated formation of 7x8 cm, dense-elastic
consistency, sharply painful, right appendages are not defined.
• Laboratory tests:
• BLOOD TEST BIOCHEMICAL BLOOD TEST URINE TEST
• Hemoglobin..115 g / l
• Erythrocytes ... 3.2 x 1012 / l
• Color index ... 0.9
• Leukocytes..5.1 x 109 / l
• Formula:
• Basophils .... 1%
• Eosinophils ... 2%
• Stick-nuclear ... 11%.
• Segmental .. 59%
• Lymphocytes .. 25%.
• Monocytes .... 7%
• ESR ....... 20 mm / h
• Platelets ...... 220 x 109
• /l
Creatinine - 72 mkmol / l
ALT - 0.31 mmol / l / h
AST - 0.32 mmol / l / h
Microscopic examination of
vaginal discha
Mucus.......... amorphous
Epithelium .. 4-6 per high power
field
Leukocytes -6-8 per high power field
Clue Cells-0-1-2 per high power
Laboratory tests:
BLOOD TEST BIOCHEMICAL BLOOD TEST URINE TEST
Hemoglobin..115 g / l

Erythrocytes ... 3.2 x 1012 / l

Color index ... 0.9
Leukocytes..5.1 x 109 / l
Formula:
Basophils .... 1%
Eosinophils ... 2%
Stick-nuclear ... 11%.
Segmental .. 59%
Lymphocytes .. 25%.
Monocytes .... 7%
ESR ....... 20 mm / h
Platelets ...... 220 x 109
/l
COAGULOGRAM
PTI 90%
Toler. plasma to heparin 8 min
Recalcified plasma time ..96 sec
The amount of fibrinogen .... 3.2
g/l
Fibrinogen B .... -
Blood clot retraction time…. 0.4
Total protein - 68 g / l
Albumin - 37 g / l
Total bilirubin - 19 μmol / l
Glucose (plasma) - 4.2 mmol / l
Urea - 4.2 mmol / l
Creatinine - 72 mkmol / l
ALT - 0.31 mmol / l / h
AST - 0.32 mmol / l / h
Microscopic examination of
vaginal discharge
Mucus.......... amorphous
Epithelium .. 4-6 per high power
field
Leukocytes -6-8 per high power field
Clue Cells-0-1-2 per high power
field
GN ......... not found
Flora ..... Gardnerella vaginalis
Pap Smear- I type
Color .... straw yellow
Specific gravity ...... 1018
Protein ................. -
Sugar ................. –
Microscopy
Leukocytes ...... 4 - 6 per
high power field
Erythrocytes ........ 1-2 per
high power field
Epithelium .. flat 2 - 5 per
high power field
Salts ........... urate
The pregnancy test is
negative.
Blood Type: O (I) Rh
(positive)
 ○Interpretation of clinical and laboratory examinations:
leukocytosis with a shift of the formula to the left,
Plevicoperitonitis.

○ Preliminary diagnosis:
Generalised inflammation of the peritoneum surrounding
the uterus and fallopian tubes,Cyst of the left appendages
of the uterus with torsion.

○ Final Diagnosis: Cyst in the left appendages with torsion

with pelvicoperitonitis.
○Diagnosis. The diagnosis of retention cysts is usually based on findings
of bimanual vaginal examination and is made when a formation measuring
up
to 10-12 cm is palpated to the left or right side from the uterus. It is softly
elastic, mobile, and painless. Retention cysts are more frequently observed in
young age. The diagnosis of a retention cyst of the ovary in elderly women
should be made with considerable caution and only following the exclusion
of a true ovarian tumour.
○ Differentialdiagnosis: Ovarian cysts should be differentiated from true
ovarian tumours, uterine myoma (subserous nodes), tubo-ovarian formations
of the inflammatory nature, and extragenital tumours.
To specify the diagnosis, one can resort to laparoscopy. In this case a
retention cyst is visualized as a thin-walled formation; one can see only an
unaltered portion of the ovary (most commonly in the area of its hilum) and
the uterine tube.
 ○Patient management plan:
hospitalization in a gynecological hospital in the department of
operative
gynecology;
- control of blood pressure, heart rate, respiratory rate, temperature,
diuresis;
Ultrasound of the pelvic organs.
○Treatment plan:
-laparoscopy, cystectomy (if impossible - laparotomy, cystectomy or
adnexectomy); -pathological examination of the removed tissue;
-antibiotic therapy (Ceftriaxone); -antianemic therapy (Gino -
tardiferon);
-treatment of bacterial vaginosis (metronidazole, clindamycin) -
combined oral contraceptives.