GU/Gyn Flashcards
1
Q
12yo with acute onset intermittent abdominal pain and vomiting. Febrile, HR 120, BP 120/65. She is lying in the fetal position despite torso and morphine. She has RLQ tenderness, negative psoas and obturator signs. US shows a normal appendix. Pelvic US shows enlarged r ovary but normal Doppler flow. The BEST next step in management is:
A) CT scan of abdomen/pelvis
B) consult GI
C) consult surgery
D) MRI abdomen/pelvis
A
C. Ovarian torsion is a surgical diagnosis. US with Doppler is preferred imaging modality but there is a high rate of false negatives due to intermittent nature of torsion. Next step for this patient with suspected torsion would be ex lap. Other options just delay diagnosis and may cause further damage to torsed ovary.
