Case of the Girl with Abdominal Pain

Chapter

Abstract

Case: A 14-year-old postmenarcheal female presented to the emergency room with an 8-day history of right lower quadrant abdominal pain and associated nausea, vomiting, sweating and headache. Ultrasound demonstrated a complex cyst with normal vascular Doppler flow.Discussion: Functional cysts typically present with chronic aching abdominal pain. They may be associated with adnexal torsion, which should be ruled out immediately in any female presenting with lower abdominal pain. On ultrasound, functional cysts appear as simple, anechoic, thin-walled masses. However, they may also appear complex if they are hemorrhagic in nature. Functional cysts resolve spontaneously and therefore should be managed expectantly with follow-up ultrasound 2 to 3 months following initial presentation. Combined hormonal contraceptives can be used to prevent recurrence of functional cysts. If the cyst persists and is greater than 4 cm, diagnostic laparoscopy should be performed to rule out other adnexal pathologies.

Bibliography

  1. 1.
    Kirkham YA, Kives S. Ovarian cysts in adolescents: medical and surgical management. Adolesc Med. 2012a;23:178–91.Google Scholar
  2. 2.
    Kives S, Gascon S, Dubuc E, Van Eyk N et al. No. 341-Diagnosis and management of adnexal torsion in children, adolescents and adults. J Obstet Gynaecol Can. 2017;39(2):82–90.Google Scholar
  3. 3.
    Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2001;180(6):462–5.CrossRefGoogle Scholar
  4. 4.
    Graif M, Shalev J, Strauss S, Engelberg S, Mashiach S, Itzchak Y. Torsion of the ovary: sonographic features. AJR Am J Roentgenol. 1984;143(6):1331–4.CrossRefPubMedGoogle Scholar
  5. 5.
    White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas. 2005;17(3):231–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med. 2008;27:7–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Rogers EM, Cubides GC, Lacy J, Gerstle JT, Kives S, Allen L. Preoperative risk stratification of adnexal masses: can we predict the optimal surgical management? J Pediatr Adolesc Gynecol. 2014;27:125–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Templeman CL, Fallat ME. Benign ovarian masses. Semin Pediatr Surg. 2005;14(2):93–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Kirkham YA, Lacy JA, Kives S, Allen L. Characteristics and management of adnexal masses in a Canadian pediatric and adolescent population. J Obstet Gynaecol Can. 2011;33:935–43.CrossRefPubMedGoogle Scholar
  10. 10.
    Okai T. Transvaginal sonographic appearance of hemorrhagic functional ovarian cysts and their spontaneous regression. Int J Gynecol Obstet. 1994;44:47–52.CrossRefGoogle Scholar
  11. 11.
    Zhang M, Jiang W, Li G, Xu C. Ovarian masses in children and adolescents - an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol. 2014;27(3):e73–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Laufer MR. Adnexal masses. In: Emans JE, Laufer MR, editors. Emans, Laufer, & Goldstein’s pediatric and adolescent gynecology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 381.Google Scholar
  13. 13.
    Surratt JT, Siegel MJ. Imaging of pediatric ovarian masses. Radiographics. 2001;11:533–48.CrossRefGoogle Scholar
  14. 14.
    Fisher M, Lara-Torre E. Update on key topics in adolescent gynecology. J Pediatr Adolesc Gynecol. 2013;26:51–7.CrossRefPubMedGoogle Scholar

Recommended Reading

  1. Kirkham YA, Kives S. Ovarian cysts in adolescents: medical and surgical management. Adolesc Med. 2012b;23:178–91.Google Scholar
  2. Kives S, Gascon S, Dubuc E, Van Eyk N et al. No. 341-Diagnosis and management of adnexal torsion in children, adolescents and adults. J Obstet Gynaecol Can. 2017;39(2):82–90.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Hanna R. Goldberg
    • 1
  • Jasmine Multani
    • 1
  • Sari Kives
    • 2
  1. 1.Faculty of Medicine, University of TorontoTorontoCanada
  2. 2.Section of GynecologyHospital for Sick ChildrenTorontoCanada

Personalised recommendations