Case notes
A 31-year-old nulligravida presented with a 5-day history of new, constant, stabbing pain in the suprapubic region and right lower quadrant of the abdomen. It was not associated with activity, menses, gastrointestinal symptoms, or bladder symptoms. Her history was significant for polycystic ovarian syndrome, anemia, endometriosis, and a splenectomy at age 17 years for rupture after a motor vehicle accident.
Abdominal examination revealed voluntary guarding but no rebound tenderness or palpable masses. Pelvic examination disclosed a 2-cm, firm, nodular mass in the right posterior cul-de-sac. Palpable on rectovaginal examination, it was tender to the touch. A serum β-human chorionic gonadotropin test revealed negative findings. Ultrasound confirmed a fixed, 4- × 2-cm, solid, homogeneous, bilobed mass with hilar blood flow in her right posterior cul-de-sac ( Figures 1 and 2 ). Palpation with a probe reproduced her pain.
The patient underwent operative laparoscopy. A gnarled, 3- × 2-cm, reddish-purple implant was found on her right uterosacral ligament ( Figures 3-5 ). After excision of the mass, her pain resolved.
