Medical Ethics and Practice
SUKHIT PHAOSA VASDI, MD*, SURASAK TANEEPANICHSKUL, MD*, YUEN TANNIRANDORN, MD*, CHUMSAK PRUKSAPONG, MD**, AUARCHART KARNCHANAPITAK, MD***
Affiliation : * Member of Thai Medical Association. ** Director General of lnstiute of Forensic Science. *** Member of the Royal College of ENT, Deputy Secretary General of Medical Council.
Thai female, 29 years old with two children, has been using birth control pills since her last
pregnancy. She notified in her medical records for her occasionally slight menstrual pain.
She had her last mense on August 10, 2003, for three days duration of same amount but with
severe pain in lower abdomen. She came to nearby medical clinic and got 3-4 medications for gastric
enzyme, stomachache and fever relieve. She also was given fleet enema.
Three hours later, her severe stomachache didn't get better, then her relatives brought her to
the hospital and asked for ultrasound examination. She could have some food and beverages, no nausea,
normal feces and urine. That morning at the hospital, she felt hungry and thirsty, her temperature was
36.7"C, pulse rate was 80/min, blood pressure was 110170mm Hg, respiration rate was 18/min, well
conscious and painful expression on her face. She could walk and testify her symptoms clearly. Her
lungs, heart and bowel were normal but her abdomen was distended. There was no abdominal mass on
palpation, but severe pain and tender on both right and left lower abdomen. Menstrual blood was found
in her vagina, the cervix was closed and no tenderness. Uterus was normal size and moveable. Both
adnexae were tender but no palpable mass was detected. White blood cell was 20,000 cells/mm3 and
hematocrit was 38 per cent. Ultrasound examination on both abdomen and vagina revealed no mass, but
some shadow of liquid like stripe was found outside intestinal wall in pelvis.
The patient and her relatives provided good cooperation and she was hospitalized for treat
ment. The next day, she developed high fever, began to vomit and had diarrhea. White blood cell was
18,000 cells/mm3 and more fluid was found in CUL-DE-SAC on ultrasound re-examination. When the
doctor pressed to examine this liquid through her vagina she felt pain and tender. She was operated on
as an emergency case and some abominal fluid like pus, and collection of pus in CUL-DE-SAC were
found. Both adnexae were normal but appendix was inflamed with perforation.
We would appreciate your comments on medical ethics and practice of this case in order to
share ideas among our society members.
Keywords : Ethics, Medical Practice
