Case by Gabby Jasmin, CNH PEM Fellow

10 year old female with no significant medical history transferred from an outside hospital with LLQ pain. Pain started 1 day ago and is intermittent. Associated symptoms include nausea and vomiting. Denies any fevers, or URI symptoms. No history of constipation and reports daily regular bowel movements. No sick contacts at home or history of travel. Patient was taken to outside hospital and CT abdomen/Pelvis demonstrated “prominence of left ovary is likely related to ovarian cyst, Recommend follow-up US for further evaluation” US Pelvis demonstrated: “No acute process. Mildly enlarged left ovary with multiple follicles. Normal color and spectral Doppler flow with both ovaries.” XR abdomen demonstrated:  “Mild amount of fecal debris throughout the colon.” She was given 500cc NS bolus, Zofran x2, and morphine 3mg IV. She continued to have pain despite morphine and was transferred for further evaluation. On arrival, the pain is now 2/10. 

Vitals: Temp: 37.2, HR: 105, RR: 26, BP: 109/66, SpO2 99% 

Patient continues to have pain that is worsening upon reassessment. The second read is still not resulted from radiology. 

US pelvis is repeated and demonstrated an enlarged left ovary with no central flow and minimal peripheral flow. Findings raise suspicion for left ovarian torsion. 

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