So this 30ish year old woman comes in last night complaining of “stomach pains” and said she was diagnosed with a UTI a few days ago by her primary and given Cipro and Vicoden. That part of the story alone sounds fishy to me…I’ve never given vicoden for pain associated with a UTI, and a week of Cipro is overkill for a UTI.

I asked more informaiton about the quality and location of her pain. She pointed right above her pubic bone and said it spreads to the right…pointing right over her right ovary. She said it was painful to urinate but when I asked her where, she pointed over her bladder area, not at her urethra. This really wasn’t sounding like a UTI to me at all.

“Are you having regular periods?” I asked, beginning a gyn history.

“Yes, I have it for 3 days every month.”

“When was your last period?”

“On the first of this month.”

“COUld you possibly be pregnant?” I asked.

“No.”

“How do you know?”

“I had myself checked for it 2 months ago.”

Hmm. I couldn’t help myself. So I asked her, “Did you know that it’s possible for you to get pregnant every month?”

I send off the urine and blood tests, do the pelvic exam and guess what… OK, you’re right, thepelvic didn’t really help me much, but the pregnancy test was more than just a little bit positive.

I got our bedside ultrasound and put it on her belly…I found her uterus pretty quickly, and her bladder, and a largish fluid filled sac adjacent to the uterus. It just didn’t hit me though…I assumed that it was part of a loop of fluid filled bowel since I could see peristalsis of adjacent bowel loops as well. I scanned around, longitudinal, transverse, looked for the ovaries…no luck. We got a formal utlrasound, and sure enough, that sac sitting outside the uterus was an embro. It appeared to be an abdominal implantation, which would be very rare (but not reportable). I called the OB/Gyn on call to come to the rescue.