SRP Discussion
Overview
This S-R-P Rounds focused on rare presentations of adnexal pathology in teenage girls, including case studies of large abdominal masses and associated symptoms. The discussion covered various imaging techniques and surgical approaches for managing complex ovarian conditions, with emphasis on preserving ovarian tissue and differentiating between benign and malignant tumors. Presented were two challenging cases involving adolescent patients with complex inflammatory conditions, including discussions of potential diagnoses and treatment approaches.
Case 1. 15-yr-old Girl Presenting with a Large Abdominal Mass
This was a case of a 15-yr-old girl presenting with a large abdominal mass and associated symptoms. The patient, who had been experiencing worsening left lower quadrant pain and bloating for 3 mos, was transferred to the hospital after a severe episode of abdominal pain and non-bilious vomiting. Despite the significant size of the mass, the patient was hemodynamically stable. The abdomen was distended but not tender. The discussion highlighted the importance of early diagnosis and management of such cases, with emphasis on the need for further imaging and tumor marker testing.
Case 2. Challenging Case of Female Patient 14 Years Old with Pelvic Inflammation
This was a complex case involving a 14-year-old female patient with pelvic inflammation and a tubo-ovarian abscess. The surgical team discussed the diagnostic process, including imaging findings and surgical intervention, which revealed a large fibroinflammatory cystic lesion originating from the ovary. The case was challenging because of its rarity in non-sexually active adolescents, the lack of clear response to antibiotics, and the need for extensive surgery, with the team considering various differential diagnoses and ultimately preserving the patient's left ovary.