Differential Diagnosis for a 12-year-old Girl with Lower Abdominal Pain
- Single most likely diagnosis:
- Ovarian torsion or ovarian cyst, given the severe, constant lower abdominal pain, the presence of a tender suprapubic mass, and the exacerbation of pain with bowel movements. However, the most fitting diagnosis considering the age, symptoms, and physical findings (especially the bulge between the labia that increases with Valsalva and the anterior tender central mass on rectal examination) is Ovarian Torsion or a complication related to an Ovarian Cyst. But considering all symptoms, Constipation with a possible Rectal Prolapse or an Ovarian Pathology could be high on the list.
- Other Likely diagnoses:
- Constipation with possible rectal prolapse: The sensation of incomplete evacuation and the exacerbation of pain with bowel movements, along with the finding of a bulge between the labia that increases with Valsalva, could suggest constipation complicated by rectal prolapse.
- Functional constipation: Given the decreased appetite, weight loss, and the specific symptoms related to bowel movements, functional constipation could be a contributing factor.
- Gastrointestinal issues such as inflammatory bowel disease (IBD): Although less likely given the absence of bloody stools, diarrhea, or fever, IBD could present with abdominal pain, weight loss, and changes in bowel habits.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Appendicitis: Although the pain pattern and location might not perfectly align with classic appendicitis, it's crucial to consider due to its potential severity and the need for prompt surgical intervention.
- Ectopic pregnancy: Despite the patient's reported lack of sexual activity, it's essential to consider in any female patient of childbearing age presenting with lower abdominal pain, to rule out sexual abuse or other unforeseen circumstances.
- Intestinal obstruction or volvulus: These conditions could present with severe abdominal pain, vomiting (though not present here), and significant illness, requiring immediate medical attention.
- Rare diagnoses:
- Tumors (e.g., ovarian tumors, rhabdomyosarcoma): While rare, these could present with a palpable mass and systemic symptoms like weight loss.
- Malformations of the genital tract: Conditions such as imperforate hymen could potentially cause abdominal pain and a palpable mass due to accumulation of menstrual blood (hematocolpos), though this would be less likely given the patient has not reached menarche.