Case of the Girl with Abdominal Pain
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.
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