Evaluation of the Adolescent Female With Acute Lower Abdominal Pain

The clinical evaluation of acute lower abdominal pain in an adolescent female presents a unique diagnostic challenge. Because of the intraabdominal presence of female reproductive organs, the differential diagnosis of abdominal pain in these patients includes diseases of the ovaries, fallopian tubes, and uterus in addition to the typical diseases considered in other patients presenting with acute abdominal pain. Diseases such as ovarian torsion, ovarian masses, pelvic inflammatory disease, tuboovarian abscess, and ectopic pregnancy must be considered alongside more common causes of abdominal pain. A thorough history with focus on the gynecologic history and physical examination are of paramount importance. First-line imaging should be abdominal ultrasonography. Diagnostic laparoscopy is an important adjunct in those patients whose clinical picture is unclear and in those patients who have a high suspicion of ovarian torsion and potential ovarian loss.