Mar 16, 2009 9:12 am US/Pacific
Dr. Mallika: Case Of The Abdominal 'Ouch'
BOSTON (CBS) ―
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Mallika Marshall, M.D., shares experiences highlighting medical cases.
WBZ
Dr. Mallika Marshall is the medical reporter for CBS station WBZ-TV in Boston and a regular contributor to the CBS Early Show. Trained as both a pediatrician and internist, Marshall currently treats patients at an urgent care clinic near Boston. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case
A 15-year-old girl comes to the clinic saying she was getting dressed for school that morning when she suddenly felt a sharp pain in her lower abdomen. It lasted for a few minutes and has since eased up, but she still feels some discomfort. She hasn't had any fever, vomiting, diarrhea, constipation, pain with urination, or vaginal symptoms. She has never had this pain before. Her last menstrual cycle was two weeks ago.
On exam, she has some mild tenderness in her right lower abdomen, but her pelvic exam is unremarkable. A routine urine test and pregnancy test are negative.
Discussion
Anytime someone complains of sharp belly pain, especially on the right side, you always want to think about appendicitis. However, people with appendicitis often have other symptoms such as fever, loss of appetite, or nausea and vomiting. And the pain of appendicitis usually gets worse over time.
Other common causes of abdominal pain in an adolescent female include constipation, urinary tract infection, sexually transmitted disease, and pregnancy, but neither her history nor her exam is consistent with any of these.
A relatively common cause of sharp pelvic pain is something called Mittelschmerz. Mittelschmerz is pain on one side that occurs at or around the time of ovulation or about two weeks before their period begins. It's thought to be caused by stretch of the surface of the ovary or irritation of the abdominal lining when fluid or blood is released from the ruptured egg. About 20% of women experience Mittelschmerz. It's not dangerous and can be treated with over-the-counter pain relievers.
Follow-up
The patient was told to try ibuprofen for the pain and to return if it got worse. The next day, she reported that the pain had resolved and that she was feeling just fine.
(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)
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