Unilateral gonorrheal salpingitis in bicornuate uterus

Abstract

Miss M. M., aged thirteen years, came to the office on May 26, 1936, with a chief complaint of vaginal discharge of about two months’ duration. The onset was gradual and was not associated with pain. There was, however, a frequency of urination noted with the onset. The rest of the history of the present illness and the history by systems was of no consequence. Menstrual periods began when she was eleven years old. The periods were always regular, twenty-eight days apart, and lasting five to seven days. The flow was rather profuse but not associated with pain, backache, or headache. Last menstrual period May 16, 1936. Past History.-Patient had pertussis at age of three years, otitis media at fifteen months, and the left ear has drained at irregular intervals ever since. She is deaf in the left ear. She had a tonsillectomy at twenty months and has had a scoliosis of dorsal spine since two years of age. Physicai Examination.-On inspection of the patient I was impressed with the precocious secondary sexual development, also the low tone quality of the voice. Her height was 57YC inches, weight 94 pounds. Skin showed acne of face and neck. Her teeth were carious. Her thyroid was palpable, smooth and diffusely enlarged. There was a marked kyphosis and left scoliosis of spine with wasting of muscles of left shoulder. Her breasts were large, but there was no discoloration of nipples and no secretion present. Heart and lungs negative. Abdomen: short type with flare of ribs at the epigastrium; no pain nor tenderness. Pelvic examination showed introitus to be of the marital type, admitting 2 fingers with ease. There was a profuse foul vaginal discharge, greenish in color and rather thick in consistency. On entering the vagina there was a large fluctuating mass extending from under the symphysis to the posterior fornix on the left side. The mass was not particularly painful. It was impossible to outline the uterus and on speculum examination the cervix was very difficult to find; when found it revealed the point of exit of the discharge. Laboratory Studies.-Blood, Kahn and Wassermann, negative ; count normal ; urine negative ; smear : mixed bacteria--no gonococci. On May 27, 1936, a posterior colpotomy was performed under nitrous oxide oxygen anesthesia and about 500 C.C. of foul smelling, thick, tenacious pus was obtained. Two Penrose drains were inserted. On June 3, 1936, all drains were removed. The discharge had stopped. Patient had no elevation in temperature and felt fine. Pelvic examination at this time revealed an irregular painless movable mass on the right side of the pelvis. It was decided at this time to follow with a course of Elliott treatments for a week to see what improvement or change would occur. At the end of one week there was no change and laparotomy was advised.