A 17-year-old girl named Ananya presented to the emergency department with sudden, severe pain in her right lower abdomen that had started six hours earlier. The pain was constant, sharp, and radiated to her back and right thigh. She also experienced nausea and one episode of vomiting. Her menstrual cycles were regular, with her last period occurring 12 days ago. On examination, she was tachycardic with mild guarding in the right iliac fossa. A pelvic examination revealed tenderness in the right adnexal region, and no vaginal discharge was noted. A urine pregnancy test was negative, and blood tests showed mild leukocytosis.
Pelvic ultrasound, including Doppler, revealed an enlarged right ovary with peripheral follicles and absent blood flow. There was also a small amount of free fluid in the pouch of Douglas. The left ovary and uterus appeared normal. These findings were concerning, particularly given the acute onset of pain and the imaging features.
What can be the differential diagnosis for the same case ?? And what diagnostic tests and management can we use ?
If we consider pain in right iliac fossa there can be many differentials: ovarian cyst, renal stones, ovarian carcinoma appendicitis etc
Since there is adnwxal tenderness along with fluid in POD so probably might be a case of ***pelvic inflammatory disease***
Differential diagnosis includes ovarian torsion, appendicitis, and ovarian cyst rupture or hemorrhage. Given the ultrasound findings and acute onset of pain, ovarian torsion is the top concern. Diagnostic tests would include pelvic ultrasound with Doppler (already done) and potentially CT abdomen/pelvis or laparoscopy. Management would involve emergency laparoscopy or laparotomy, detorsion of the ovary if torsion is confirmed, pain management, and close monitoring post-surgery.
What can be the differential diagnosis for the same case ??