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Lady with Right Sided Lower Abdominal Pain

Thursday, February 18, 2010

32 year old lady who married for 10 years presented with Right Sided lower abdominal pain since 22nd of January.She had intermittent type of pain lasting for 15-20 minutes.In between that ,there were pain  free periods.Pain was radiating to the to the Thigh and Buttocks.During the painful period she also had Sweating and and faintishness.There is no vaginal Bleeding associated with lower abdominal pain.
There was No fever and No vomiting.

Menstrual History 
She attend the Menarche at the age of 14 years.
She had 25 days regular cycle with normal bleeding with is usually lasting for about 4 days.
She also complained that she had experienced  pain 2 day before menarche and lasting it for about 3 days.
That pain felt in both sides of the Lower abdomen but more prominent in the Left side of the Abdomen.
Her last menstrual period in  02nd of January of which due date was 15th of January.

Obstetrics History
Her 1st pregnancy was in 2000 and she has no history of Abortions.She did not have any antenatal complications.She has only 1 child.She used contraceptive pills for 1 year after the delivery and then withhold treatment for 4-5 years.And again she used pills since 6 months back and stopped in the 18th of January.

There is no significant past medical,surgical or drug history.

Trans Vaginal Ultra sound Scan was done and the report is given below.
Antiverted Uterus
Small irregular Sac in Uterine Tube
No fetal pole
Bilateral ovaries are normal
No free  fluids

Urinary hCG was positive.

Only the history and the investigations are given in this case.
What would be the possible diagnosis?

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