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Evaluation of acute pelvic pain in the adolescent female

Authors
Kathleen Brown, MD
June A Lee, MD
Section Editor
Stephen J Teach, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will review the differential diagnosis and approach to the adolescent female presenting with acute pelvic pain with an emphasis on gynecologic conditions. The gastrointestinal and urologic causes of abdominal pain are discussed in greater detail separately. (See "Causes of acute abdominal pain in children and adolescents".)

The evaluation of acute pelvic pain in older women is also discussed separately. (See "Evaluation of acute pelvic pain in women".)

DIFFERENTIAL DIAGNOSIS

Pelvic pain most often involves the gastrointestinal or the urinary systems in prepubertal girls. However, gynecologic conditions become more prevalent as etiologies for pelvic pain, especially during late adolescence. The gynecologic causes of acute pelvic pain in adolescent females are listed in the table (table 1).

Life- or organ-threatening conditions — Complications of pregnancy (eg, ectopic pregnancy, acute abruption, uterine rupture) comprise the most frequent life-threatening gynecologic causes of pelvic pain in adolescent females. Gastrointestinal causes of pelvic pain can be life-threatening if they lead to peritonitis and sepsis. Of these, appendicitis is most common and will be presented briefly here. Other conditions (eg, abscess, bowel obstruction) are reviewed separately. (See "Causes of acute abdominal pain in children and adolescents", section on 'Life-threatening causes'.)

Life-threatening pelvic trauma in female adolescents is usually the result of a high-energy mechanism, such as a fall from a height or motor vehicle crash. Injury patterns and management are similar to the approach in adults and are discussed elsewhere. (See "Pelvic trauma: Initial evaluation and management", section on 'Fracture types' and "Pelvic trauma: Initial evaluation and management", section on 'Initial management'.)

                           
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Literature review current through: Oct 2017. | This topic last updated: Jun 06, 2017.
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