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Case Study 3

    • Patient Name
      Patel Manishaben Hareshbhai
    • Age
      36 years
    • Residence
      Nutan farm,Gandhinagar,Gujarat
    • Presenting complains
      Swelling and pain involving lower abdomen for 3 months
    • Past history
      Surgery of Abdominal Hysterectomy ( April 2017 ) Casserian Section ( 1st 2006 , 2nd 2008 )
    • Drug history
      Analgesic tablets since 2.5 months, anti-tuberculosis, antibiotics medicines with no relief.
    • Clinical findings
      Irregular, tender lump involving lateral half of AH scar
    • Reports done
      ULTRASOUND dated 27/01/2018 – Well defined hypoechoic lesion of 30x28x15 mm at anterior abdominal wall of pelvis involving subcutaneous fat, rectus sheath and preperitoneal fat. Possible subcutaneous infective etiology/ old hematoma / scar endometriosis.
      ULTRASOUND dated 20/11/2017 – Irregularly marginated hypoechoic lesion of 28x19 mm in anterior abdominal wall of pelvis involving the subcutaneous fat, rectus sheath and pre peritoneal fat. Possibility of infective lesion or endometriosis. Hemoglobin 12.8 gm , Total WBC counts 7,800/cmm , Blood group O+ve S.Creatinine 0.89 mg/dl , SGPT 43 U/L ,FBS 110 mg/dl , HIV non reactive , HBSAg non reactive , Clotting parameters normal , Urine microscopy normal.
    • Treatment
      Operated for Exploration under spinal anesthesia on 28/01/2018 Per op – stucked omentum involving lateral half of incision found. Excision done and closure in layers. No drain was kept.
    • Post-operative care
      Hospital treatment for 3 days with nursing care, IV antibiotics, dressing.
    • Follow up consultation
      2/02/2018 , 6/02/2018 ( stitches removed ) , 13/02/2018 , 25/02/2018 (last follow up patient asymptomatic)
      Every post operative case in a female does not mandate scar endometriosis or need anti Tuberculosis treatment. Trapped omentum at scar site is one of the common cause for such presentations.

Why case study

    • Patient was in agonising pain since 3 months with no relief by multiple consultants including surgeon, gynaecologist.
    • She was being kept on Anti Tuberculosis therapy on empirical basis without histological evidence.
    • Clinical experience does matter in all such matters of controversy.
    • Patient was completely recovered within 20 days from first consultation on 27/01/2018


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