Abdominal pain in a female adolescent: answer

Excerpt

Differential diagnosis of abdominal pain in a female teenager with autosomal dominant polycystic kidney disease (ADPKD) and insulin-dependent diabetes mellitus (IDDM) ranges from constipation, diabetic ketoacidosis, renal lithiasis, appendicitis, pancreatitis to pelvic inflammatory disease. Others include ruptured renal or ovarian cyst and ectopic pregnancy. Consequently, a staged approach is essential in elucidating the etiology. Serum amylase and imaging studies, such as abdominal ultrasound and intravenous pylogram, are examples of other investigations that could have been performed during the initial examination of our patient, but resolution of the symptoms after the administration of intravenous fluids and analgesics supported the suspicion of kidney stones, hence the initial discharge of the patient home without performing further investigations. With the patient's return to the emergency department, the positive urine culture together with physical examination findings made pyelonephritis more likely, but persistence of the colicky abdominal pain was thought to be unusual, especially with a negative history of renal lithiasis. Hence, the computed tomography (CT) scan, which revealed findings leading to the surprise diagnosis of emphysematous pyelonephritis (EPN). …