An adolescent girl with acute abdominal pain and abdominal mass

A girl in her early teens presented to the general paediatric department with 24 hours of acute, continuous, lower abdominal pain. She had not experienced menarche, but for the past year she had experienced monthly lower abdominal pain that lasted 1-2 days. This pain had not concerned her.She was under paediatrician care for an eating disorder. Knowing that some eating disorders cause delayed menarche,1 the patient, her mother, and the? paediatrician were not concerned that the girl had yet to show menarche. She reported no dysuria, no urinary retention, no previous urinary tract infection, and no experiences of sexual intercourse.According to Japanese standard criteria for body mass index (BMI),2 the girl was underweight (height 156 cm, weight 36 kg, BMI 14.8). Her body temperature was 37°C, blood pressure 90/60 mm Hg, and pulse 72 beats/min. On examination, slight tenderness was observed in her lower abdomen and an abdominal mass was…
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