30F comes to ER with a distended (not rigid) abdomen, rebound, guarding, nausea, intermittent fever, BRBPR, +urinary retention w/ 500cc in foley after void, normal UA. COVID neg. CTAP with luteal cyst, no other findings. TVUS neg.
-BMI 20,
-G4P1, h/o 2 ectopics, ovarian torsion now s/p bilateral salpingectomy and L oopharectomy,
-h/o primary umbo hernia repair
-h/o gastric ulcer, medically managed
Dx Lap: Pristine colon, SB normal from Treitz to Treves, stomach, gallbladder, appendix, spleen normal. Uterus enlarged, remaining ooph with small cyst. Small volume serous fluid in pelvis (appeared physiologic)
Next steps: GI viral/bacterial panel, STD testing, FOBT
What else could we be missing?