A housewife with recurrent pelvic pain
A 45-year-old Malay housewife was seen at a health clinic with the chief complain of recurrent lower abdominal pain for 9 months. The pain was colicky in nature and occasionally it radiated to the back. There was no history of fever, vaginal discharge or any urinary or bowel symptoms. She had been using an intrauterine contraceptive device (IUCD Cu250) for the past 5 years. The last change of the IUCD was 2 years ago. Her annual pap smear results were normal. She had been to many primary care clinics and was reassured by the doctors that her symptom was due to her IUCD. She was prescribed mefenamic acid repeatedly for the past 9 months. However her symptoms worsen and she was worried because prior to this she did not have similar problems.
Her physical examination was unremarkable. On pelvic examination, the IUCD string was visualised, indicating that her IUCD was still in-situ. Her cervix was pink and healthy. There was no abnormal vaginal discharge. (copied from article)
Lifford KL, Barbieri RL. Diagnosis and management of chronic pelvic pain. Urol Clin N Am 2002 Aug;29(3):637-47.
Lawrence LL. Unusual presentations in obstetrics and gynecology. Emerg Med Clin North Am 2003 Aug;21(3): 649-65.
Epperly ATA, Viera AJ. Pelvic inflammatory disease. Clinics in Family Practice 2005;7:67-78.
Weir E, Society of Obstetricians and Gynaecologists of Canada. Preventing pregnancy: a fresh look at the IUD. CMAJ. 2003 Sep 16;169(6):585.
Eray O. The efficacy of urinalysis, plain films, and spiral CT in ED patients with suspected renal colic. Am J Emerg Med 2003 Mar;21(2):152-4.