Ascending

A 35 year old, sexually active woman presents with fever and right upper abdominal pain for 3 days, and pelvic pain for a week. She also vomited twice, just prior to admission. The abdominal pain was sharp and exacerbated by inspiration and movement.

Her last menstrual period was 2 weeks ago. Her medical history is unremarkable.

Her full blood count shows only a leukocytosis of 12,000/mm3, 80% neutrophils.

Select Relevant Investigations
Liver function tests

Performed

AST: 16 U/L (normal)
ALT: 7 U/L (normal)
ALP: 50 IU/L (normal)
S. Bilirubin: 0.2 mg/dl (normal)
Albumin: 5.2 g/dl (normal)
Ultrasound abdomen + pelvis

Performed

The hepatobiliary system appears normal, with no gallstones. There is a small amount of free fluid in the pelvis. There are no tuboovarian masses, or features suggestive of a pelvic abscess.
Endocervical swab + GC/CT NAAT

Performed

Positive for Chlamydia trachomatis
Negative for N. gonorrhoeae
Multiphase CT abdomen + pelvis

Performed

The CT scan demonstrates thickening of the fallopian tubes and uterosacral ligaments. The pelvic fat appears hazy. There is marked enhancement of the liver capsule during the arterial phase.

Select Relevant Management
Antibiotics
Exploratory Laparotomy
Steroids
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