Patient profile Mrs C is a 56 year old woman that was referred for Gynaecological specialist assessment and treatment

by her GP following a worsening (past 3-4 months) history (7 years) of stress induced urinary incontinence and more recently bladder urgency. History HPC 7 year history of urinary incontinence stress and urge Six months ago, incontinence whilst walking began, and during a bout of bronchitis, coughing was persistent and exacerbated the problem. Over past few weeks as moving house, the lifting and bending has made the problem worse Distress of incontinence causing anxiety and impact on lifestyle new incontinence pads have helped Visited Pelvic floor physio specialist who has begun exercise program with her Additional symptoms: strong smell, Nil PV bleeding, no nocturia Menstrual History Vaginal hysterectomy sans ovaries and fallopian tubes 15 years ago after diagnosis of CIN II Obstetric History Has two children son 37 and daughter 35 years old both vaginal delivery births (6 lb 1 oz and 7lb 1 oz) PMSHx Hepatitis A (uncertain of Hep B and C however pt recollects she was advised to take care of liver and refrain from alcohol) Depression Laparoscopy and D&C at age 23 yrs after recurrent infections Vaginal Hysterectomy CIN II Uterus and cervix removed Regular thrush infections Lower back pain Dysmenorrhea and dyspareunia Sexually abused age 9-15 yrs Medications Current Amoxicillin (mouth infection after dental treatment) Zinc, Magnesium supplements Homeopathic remedies sought when ill Past meds Antibiotic treatments for past bladder infections and Hepatitis treatment (uncertain of what) Nil Allergies Family Hx 81 year old mother - Type 2 diabetes mellitus, Hypertension, Renal failure Father died in war Social Hx Lives alone Non smoker (ceased 15 years ago) Drinks alcohol on special occasions only (1-2 glasses) formerly very heavy drinker Nil recreational drugs (former user of amphetamines, IV) Currently working as carer (2 adults) Examination Alert, cooperative, no signs of distress

IV line inserted, normal saline amended with Abx On examination there were no signs of anaemia or cyanosis Afebrile PR 69 and regular; RR 16; BP 115/67 No obvious oedema Heart: dual heart sounds, no murmurs, apex beat not palpable, no heaves or thrills Lungs: clear, bilateral entry, no additional sounds Abdomen: soft, left iliac fossa tenderness, bowel sounds present, nil guarding, rebound tenderness, no obvious masses, no organomegaly Drain present for abscess drainage Investigations Abdominal CT: showed diverticular abscess at rectosigmoid junction FBC, biochemistry: CRP, WCC and neutrophils elevated other wise within normal limits Urinalysis: parameters within normal limits Summary Diverticular abscess detected via abdominal CT CT guided drainage of the abscess was performed This greatly relieved LJ pain and discomfort Management CT guided drainage of abscess. Removed 20 ml of straw coloured fluid Drain was left in situ and flushed regularly. No further output from drain Placed on IV antibiotics (gentamycin, flagyl) Observed on surgical ward for any further complications Given prescription for Augmentin DF upon discharge LJ would like surgery in the future for a bowel resection to remove diverticular pouch Progress Post-drainage of abscess, pain was significantly reduced and symptoms started to resolve Stayed on the ward for 6 days with drain in situ for 5 days but there was no further output from drain Eating well with no nausea Discharged 6 days post-admission into the care of her GP