Two days later, the patient returned to the ED with a fever of 38.3 ☌ and worsening abdominal pain, described as “excruciating.” A repeat transabdominal transvesical ultrasonography scan of the pelvis was conducted, results of which showed a left adnexal dilated tubular structure and mild pelvic free fluid. Strict return precautions were given, including return of pain. Given the patient’s remission of her pain, stable vital signs, and painless re-examination, the decision was made to establish close follow-up with gynecology and discharge the patient with a diagnosis of constipation. Gynecology was consulted, and a repeat ultrasonography scan to ensure remission of the hydrosalpinx was planned. The sonogram ultimately showed good flow to the bilateral ovaries with unilateral left hydrosalpinx. She had good remission of her pain with the enema and had a bowel movement.
While waiting for the official read, the patient was given an adult fleets enema. The ultrasonography scan was performed at this time. Results of the urinalysis were negative for infection and blood, and results of the pregnancy test were negative. The abdominal radiographs were interpreted by radiology as normal but showed a slightly increased stool burden. The patient was given acetaminophen for the pain upon presentation.ĭiagnostic testing. Given her symptoms, diagnostic workup was initiated, including an abdominal radiography scan, urinalysis, urine pregnancy test, and transabdominal transvesical ultrasonography scan of the pelvis. The physical examination was otherwise grossly benign. Initial examination showed voluntary guarding and tenderness in the lower left quadrant without rebound, rigidity, mass, or distension. However, no conditions were diagnosed in our patient. Her family history was notable for renal disorders and vesicoureteral reflux. The patient denied sexual activity and vaginal insertions. There was associated nausea and vomiting without any other gastrointestinal or urinary symptoms. Onset of menarche was 2 weeks prior to presentation, and the patient had no current bleeding. She described the pain as intermittent cramping and stabbing and rated the pain as moderate to severe depending on timing, but it never fully remitted. The pain had started approximately 4 to 5 hours prior to presentation.
Parag Bhattarai, MD, Cape Fear Valley Medical Center, 1638 Owen Dr, Fayetteville, NC 28304 ( 11-year-old girl was brought to our emergency department (ED) by her parents with pain in the left lower quadrant of her abdomen. The authors report no relevant financial relationships. What is the cause of this left lower quadrant pain in an 11-year-old girl? Consultant.
1Department of Pediatrics, Cape Fear Valley Medical Center, Fayetteville, North CarolinaĢDepartment of Emergency Medicine, Cape Fear Valley Medical Center, Fayetteville, North CarolinaģDepartment of Family Medicine, Cape Fear Valley Medical Center, Fayetteville, North Carolinaīhattarai P, Carswell L, Bartsch L.