Case of the Week — March Case #2: Abdominal Pain

31 y/o AAF presents to the ED with complaints of abdominal pain increasing over the past 3 days. She denies N/V/D or F/C. She admits to vaginal discharge and dysuria. She denies vaginal bleeding. LMP 1 month prior? PMHx: G5P2 PSHx: none Meds: none Allergies: NKDA SocHx: +tob/ETOH/cocaine PE: BP 110/72, P 75, R 16, POx 100% (RA) GEN: WNWD, AAF, appears in pain CHEST: CTA B, nonlabored CV: RRR, no M/R/G ABD: diffusely TTP, greatest over suprapubic/pelvic area with guarding and mild rebound, +BS PEL: cervix thick and closed, erthymatous and friable with copious purulent discharge protruding from the os, +TTP over R adenexa, no masses palpable WET PREP: sheets of WBCs, no trich, yeast, occasional clue cells Bedside ultrasound is performed and reveals the following: What is the diagnosis? Thanks to Dr. Kristin McKee for submitting this case!