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Wednesday, May 13, 2020

MDM - Ovarian Torsion

[##]-year-old female with history and exam consistent with [right/left-sided] ovarian torsion.

Initial consideration in this patient included ovarian torsion, ovarian cyst (functional, follicular, and hemorrhagic), ovarian neoplasm, polycystic ovarian syndrome (PCOS), pregnancy, ectopic pregnancy, appendicitis, diverticulitis, other intra-abdominal etiologies, urinary tract infection (UTI), ureteral stone and pyelonephritis, and vaginitis among others.

Patient presented with [right-sided/left-sided] abdominal and pelvic pain [with/without] a history of prior ovarian cyst.  Patient was noted to have [no] evidence of peritonitis on exam in the ED [prompting early discussion with gynecology due to concern for ovarian torsion/bedside FAST exam due to concern for ruptured ectopic].  [Due to evidence of acute abdomen and high likelihood of ovarian torsion, gynecology was consulted prior to obtaining imaging.]  A pelvic [speculum/bimanual] exam was performed and notable for [right-sided/left-sided tenderness/mass/cervical motion tenderness (CMT)].  A pregnancy test was obtained and noted to be negative making pregnancy-related complications unlikely [specify torsion in pregnant patient].  A pelvic ultrasound was obtained and [notable for ## cm right-sided/left-sided ovarian cyst/evidence of dminished blood flow on Doppler ultrasound concerning for torsion/increased ovarian size concerning for ovarian torsion].  Patient [noted to have evidence of torsion on ultrasoungd/felt to be high risk for torsion despite equivocal findings on ultrasound/based on history and exam] with case discussed with Dr. [Name] of Gynecology who examined the patient in the ED.  

Patient noted to have no evidence of significant anemia on [exam/hemoglobin and hematocrit].  Patient noted to have no evidence of coagulopathy on [history/exam/labs].  No evidence of UTI on urinalysis in the ED.  Vaginitis considered unlikely based on history and exam.

We discussed plan for [confirmatory ultrasound/admission for likely operative management in the OR/admission for serial exams and further management per gynecology].  Patient reported improvement in pain with [treatment] in the ED, and demonstrated understanding and agreement with planned admission.

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