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Endgames Case Review

An adolescent girl with acute abdominal pain and abdominal mass

BMJ 2022; 379 doi: (Published 20 October 2022) Cite this as: BMJ 2022;379:e068444
  1. Shigeki Matsubara, gynaecology specialist1,
  2. Takashi Watanabe, gynaecology specialist2
  1. 1Jichi Medical University, Department of Obstetrics and Gynecology, Tochigi, Japan
  2. 2Haga Red Cross Hospital, Department of Obstetrics and Gynecology, Tochigi, Japan
  1. Correspondence to S Matsubara matsushi{at}

A girl in her early teens presented to the general paediatric department with 24 hours of acute, continuous, lower abdominal pain. She had not experienced menarche, but for the past year she had experienced monthly lower abdominal pain that lasted 1-2 days. This pain had not concerned her.

She was under paediatrician care for an eating disorder. Knowing that some eating disorders cause delayed menarche,1 the patient, her mother, and the? paediatrician were not concerned that the girl had yet to show menarche. She reported no dysuria, no urinary retention, no previous urinary tract infection, and no experiences of sexual intercourse.

According to Japanese standard criteria for body mass index (BMI),2 the girl was underweight (height 156 cm, weight 36 kg, BMI 14.8). Her body temperature was 37°C, blood pressure 90/60 mm Hg, and pulse 72 beats/min. …

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