title: Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.
abstract: Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: lauren.riney@cchmc.org.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Riney
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Reed
authors.affiliation: Division of Gynecology, Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Kruger
authors.affiliation: Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Brody
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Pomerantz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008572:Menarche; D010147:Pain Measurement; D014592:Uterine Hemorrhage / Q000209:etiology; D014599:Uterus / Q000601:surgery*