What is your diagnosis?

Abstract

An adolescent girl aged 16 years presented to the emergency department with features of shock. She had severe pallor with feeble pulse of 120/min, blood pressure: 80/40 mm Hg, respiratory rate: 22/min, peripheral capillary oxygen saturation (SpO2): 98%, and urine output was almost nil. Initial resuscitation was performed. The history could not be elicited from the patient herself. Her relatives revealed that she had a 4-month history of amenorrhea along with pain in the abdomen and bleeding per vaginum for the last one day. A urine pregnancy test was positive. The parents denied any history of pill intake or surgical procedures for termination of pregnancy. The abdominal examination was within normal limits. There was no guarding, rigidity, tenderness or any palpable mass felt. Bleeding was present on local examination. A gentle vaginal examination revealed a 6x6 cm smooth, tender, round mass in the vagina, the cervical rim and uterus could not be felt. The patient did not allow a proper examination because it was very painful. An urgent blood investigation was suggestive of hemoglobin of 6.9 gm%, total leucocyte count: 28,000/cumm with normal coagulation profile. The patient was planned for examination under anesthesia (EUA).