Fig. 5.1
Management of postmenarchal patient presenting with abdominal pain
Back to the Case
It was recommended that the patient follow up with gynecology in 8 weeks to confirm resolution of the cyst. The patient was counseled to return to the emergency department if she had symptoms of adnexal torsion, including acute lower abdominal pain, associated with nausea, vomiting, or fever.
At the follow-up visit, the patient described minimal abdominal pain. She denied any associated symptoms, such as nausea or vomiting. On exam, the abdomen was soft and mildly tender in the right lower quadrant. Ultrasound showed a normal uterus and normal ovaries with complete resolution of the hemorrhagic cyst.
Clinical Pearls and Pitfalls
Ultrasound is the best diagnostic tool for evaluation of adnexal pathology.
Adnexal torsion should be ruled out in cases of patients presenting with lower abdominal pain, especially those with associated nausea and vomiting.
Patients with functional cysts typically present with chronic, aching lower abdominal pain.
On ultrasound, functional cysts may appear simple or complex, such as in cases of hemorrhagic cysts .
Goal of management is preservation of structure and function of the ovary with conservative management.
Functional cysts resolve spontaneously, without any treatment.
Follow-up ultrasound should be performed to ensure resolution of a functional cyst.
If the cyst persists and is greater than 4 cm, diagnostic laparoscopy and possible cystectomy is recommended.
If a functional cyst recurs, combined hormonal contraceptives can be used to prevent further recurrence.
Bibliography
1.
Kirkham YA, Kives S. Ovarian cysts in adolescents: medical and surgical management. Adolesc Med. 2012a;23:178–91.
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.
3.
Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2001;180(6):462–5.Crossref
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