40 yr old female c/o dragging of pelvis sensation and retroperitoneal mass

 NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT. 

PATIENT HISTORY: Pt is a 40 yr old female, homemaker. Mother of 8 children ( birth via normal delivery process). First pregnancy at the age of  15 yrs, last pregnancy at age 28 yrs.

10 yrs ago, pt started c/o constipation and nausea on seeing food. No defecation for 2-3 days, 4th-day defecation in huge amounts (loose consistency and quite smelly). Whenever symptoms got worse, she took ayurvedic tablets which temporarily restored her normal bowel movement.

10 yrs ago, while urinating she felt tissue bulging in her vagina, a feeling of heaviness in the pelvis, a dragging discomfort inside the vagina.  She went to Dr. who diagnosed it to be due to uterine prolapse. Recommended Sx but due to financial problems did not seek further treatment. At that time, DM was also detected. Pt is on medicine for DM but due to economic issues, medicine intake is inconsistent. Whenever she stops taking medicine for DM her urine becomes foamy and smelly. Though for the past 2 months she is taking medicine for DM somewhat continuously, her last month's PP was 380 mg/dl.

In 2018 i.e 5 yrs later, she started c/o lower back pain which is elevated on doing movements, sometimes very intense.

In 2018, she started c/o diffused pain in the epigastric and left lumbar region. She c/o of a palpable mass which is not fixed in position. The pain is not intense and continuous throughout the day. Actions that put pressure on the abdomen such as sitting, and washing clothes elevate the pain.

During the same time, she also started c/o rt lumbar region pain. The pain is diffused continuously throughout the day, elevated while walking, and reduced on lying down. 

Dr. suggested doing USG which detected a large heterogenous, retroperitoneal mass (? pancreatic mass) and bulky uterus. Dr. recommended Sx, pt could not afford it so changed Dr. multiple times. Pt was on an Ayurvedic medicine course from 2018-2019 for the same with no positive result.

For the past 3-4 yrs, she complains that she can palpate a hard mass inside the tissue bulging in her vagina.

For the past 2 months c/o constipation, abd bloating, and sour burps. 

Her menstrual cycle used to happen on the 8th of each month but for the past 2 months happening on the 26th of the previous month. She neither c/o any pain nor excessive bleeding during periods. Pt also complains of wt loss for the past 2 months (first 49 kg, 6 months ago 53 kg, now again 49 kg)

1 month ago her BP was found to be high when she went for a blood sugar test. She is a patient of DM for the past 10 yrs.

CHIEF COMPLAINT AND PATIENT REQ: Pt c/o pain and a palpable lump in the left lumbar region.

C/o pain in the right lumbar region, a feeling of heaviness or pulling in the pelvis, lower back pain constipation, and abdomen bloating with sour burps. 

C/o feeling a hard mass inside the tissue bulging inside her vagina.

Uncontrolled DM. For 4 yrs took Diamicron XR 60 inconsistently, with no effect. For the past 6 months taking Jalra - OD 100 mg OD and Geminor M2 OD after lunch inconsistently, with little to no effect.

FAMILY HISTORY: None of her family members reported any health issues.

REPORTS:































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