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Abdominal pain in a four year old girl - A diagnose problem

Catarina Ladeira, Sara Carmo, Maria Knoblich, Aline Silva, Paollo Casella

Serviço de Cirurgia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE

4th World Congress of Pediatric Surgery, 13 a 16 de Outubro 2013, Berlim. (poster)


Introdução: Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. This is even more true in females where the unique anatomy and biology necessitates the consideration of a broad variety of additional genitourinary problems not encountered in the male

Método: A 4-year-old girl with no previous relevant history was admitted with an acute pain in the lower abdomen associated with vomiting that was present for 48h. The physical examination revealed a pale and prostrated child, with a tender abdomen, especially in the lower quadrants but with no guarding. Laboratory findings were leucocitosis and neutrophilia and a mild elevation of C reactive protein. the ulttrasound showed a pelvic complex heterogenic mass that envolved the uterus and both anexes. An exploratory laparotomy was performed and revealed a tumor in the right ovary that conditioned torsion and a partial bicornuate uterus wich was also torsed and a normal left ovary. The uterus was detorsed and maintained viability. A rigth anexectomy and left ovary biopsy were performed.

Resultados: Histologic examination revealed a cystic teratoma of the right ovary and normal parenchyma on the left ovary.
The patient was discharged uneventfully on the third post-operative day and there have been no recurrence or complaints after one year follow up.

Conclusão: Evaluation of a child with abdominal pain is always difficult especially in the female where you have to take into consideration the additional genitourinary problems that may be present. Delay and misdiagnosis of adnexal torsion is common and may result in loss of the ovary. Although the loss of a single ovary is unlikely to result in significantly reduced fertility, early diagnosis allows conservative treatment and reduction in complications.