Dr. Margaret R. Connolly (Surgery): A 15-year-old girl was admitted to this hospital because of abdominal pain and an ovarian mass. The patient had been in her usual state of health until 6 weeks before the current presentation, when lower abdominal pain developed along the midline. The pain was sharp and crampy, increased with movement, and decreased with lying down. During the next 24 hours, the pain shifted from the midline to the right side. The patient was taken to the emergency department of a hospital affiliated with this hospital for evaluation. On examination, the temporal temperature was 36.7°C, the blood pressure 125/82 mm Hg, the pulse 102 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 98 while the patient was breathing ambient air. The lower abdomen had mild tenderness that was present on both sides but was greater on the right side. The abdomen was soft and nondistended. Bowel sounds were normal, and there was no rebound, guarding, or tenderness at the costovertebral angle. The white-cell count was 14,270 per microliter (reference range, 4500 to 13,500) and the hemoglobin level 10.9 g per deciliter (reference range, 12.0 to 16.0). Blood levels of electrolytes, glucose, and lactate dehydrogenase were normal, as were the results of kidney-function and liver-function tests. The urinalysis was normal. A urine test for human chorionic gonadotropin was negative. Other laboratory test results are shown in Table 1. Imaging studies were performed.
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