Quandary

A 22 year old lady presents with intermittent pain in the right lower abdomen for 2 days, with sudden worsening over the last 4 hours. She also experienced mild fever, nausea and vomiting. Her medical and drug histories are unremarkable.

She is nulliparous, with irregular menstrual cycles. Her last period was 7 weeks ago. She has not been sexually active for the last year and has no history of sexually transmitted disease (STDs).

Select Relevant Investigations
Full Blood Count

Performed

WBC: 14,500
Neutrophils: 90%

Hb: 12.4 g/dl
Hct (PCV): 37%

Plt: 356,000/mm3
Urinalysis

Performed

Pus cells: 3 - 4 / hpf (normal: < 10 / hpf)
RBC: nil / hpf

pH: 5.5
Nitrite dipstick test: negative
Beta-hCG

Performed

The beta-hCG urinary dipstick test is negative.
Pelvic Ultrasound

Performed

A 8 x 10 mixed solid and cystic mass is visualized inferior to the bladder. Color doppler shows no evidence of blood flow. The right ovary cannot be identified. The uterus and left ovary appear normal.

Select Relevant Management
IV Antibiotics
Methotrexate
Steroids
Urgent Surgery