A healthy 36-year-old woman presented with onset of pelvic pain that began about 8 h prior to arrival in the emergency department (ED). She described the pain as cramping but intermittently sharp. It was throughout her pelvis and made worse with movement. The patient had no reported medical or surgical history. On initial evaluation, the patient's vital signs included a blood pressure of 122/78 mm/Hg and a heart rate of 76 beats/min. Remaining vital signs were unremarkable. The patient appeared uncomfortable but was not in severe distress. She had tenderness to palpation in both her left and right lower quadrants without rebound or guarding. Laboratory tests had not yet resulted at the time of initial evaluation, though initial findings when reported included a hemogoblin level of 10.5 g/dL and a normal serum chemistry panel. A bedside focused assessment with sonography in trauma (FAST) examination was performed and showed free fluid in the right upper quadrant (Figure 1), as well as an intrauterine device (IUD) in place in the uterus (Figure 2).
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Published online: September 24, 2019
Accepted: July 18, 2019
Received in revised form: July 10, 2019
Received: April 10, 2019
Reprints are not available from the authors.
© 2019 Elsevier Inc. All rights reserved.