A 26-year-old woman suffered from vaginal bleeding for 6 days after menopause, with lower abdominal pain 1 hour.

The patient started a small amount of vaginal bleeding 6 days ago, self-examination urine test (-) 5 days ago, and sudden right lower abdomen tearing pain with anal dilatation 1 hour ago. Vomiting once, stomach contents, no diarrhea, normal urine. Last menstruation (3-4)/30 days, moderate blood volume. I was born once two years ago, married for nearly a year, without contraception and pregnant.

Physical examination: T 36.5 degrees, P 124 times/minute, R 24 times/minute, blood pressure 80/40mmHg.

Heart rate 124 beats/min, regular, pale. The total tension, tenderness and rebound pain of the right lower abdominal muscle are obvious, and the moving dullness is suspicious.

Gynecological examination: vulva (-), a little dark blood in vagina, smooth cervix, cervical pain (+), full posterior vault, normal anterior size of uterus, soft mass with unclear boundary in the right attachment area.

Auxiliary examination: white blood cell 5.8× 109/L, hemoglobin 85g/l, platelet 210×109/l.

Preliminary diagnosis:

1. Ectopic pregnancy, rupture

2. Hemorrhagic shock

3. Anemia (moderate)

Diagnostic basis:

1. Ectopic pregnancy, rupture basis: menopause, vaginal bleeding, acute lower abdominal pain. * * * History of fertility infertility. There is tenderness and rebound pain in the right lower abdomen. Gynecological examination: cervical pain (+), full posterior vault, soft mass with unclear boundary in the right accessory area.

2. The basis of hemorrhagic shock: blood pressure: 80/40mmhg.

3. Anemia (moderate) basis: pale face, HB85g/L.

Differential diagnosis:

1. Abortion

2. Torsion of ovarian cyst pedicle

3. Rupture of corpus luteum cyst

4. Acute appendicitis

Further inspection

1. Blood β-hcg detection.

2.b-ultrasound examination.

3. Puncture of posterior fornix of vagina.

4. Preoperative test.

Treatment:

Blood volume supplement, anti-shock treatment, and laparotomy immediately.