Abstract
An adolescent girl presented to the emergency department with a history of abdominal pain, dribbling, and inability to pass urine for the last 24 hours. The initial observations and examination of respiratory, cardiovascular, ears, nose, and throat (ENT), central nervous system (CNS) and musculoskeletal systems were normal. No onset of menses reported by the patient. She was found to have a palpable distended bladder on abdominal examination. A catheter was inserted by the nurse, who reported no abnormalities. The physician did not perform a FAST scan nor conduct a genital examination. The patient was referred to the paediatrics department and the following day an ultrasound examination led to a diagnosis of haematometrocolpos. The patient was the referred to the obstetric and gynaecological department. Corrective surgery was conducted the following day and she was discharged on the fourth day. While the diagnosis and treatment were correct, had a FAST scan and/or genital examination been part of the initial work-up, diagnosis would have been made in the emergency department and an appropriate referral made directly to obstetric and gynaecological team. Rapid diagnosis and treatment would have benefitted the patient, reduced the risks of complications, and cut the length of stay in the hospital by as much as two days.
Highlights
[4] Unnecessary delays can arise in other cases due to inadequate skills, hesitancy to take complete histories or conduct appropriate physical examinations or poor communications among staff. [5,6,7] This case of adolescent haematocolpos, discussed illustrates how these considerations can result in very substantial delays in accurately diagnosing and treating a patient
Presentation In the early afternoon, a previously well adolescent girl presented to the emergency department with a history of abdominal pain, dribbling, and inability to pass urine for the last 24 hours
Looking at the diagnostic process in this case, three ways that treatment of similar cases might be more effectively and efficiently handled may be identified. These changes could result in earlier diagnosis, more appropriate referrals, and more expeditious corrective surgery
Summary
Diagnostic delays are expensive, enhance the risks of complications, protract the patient’s discomfort or pain, and contribute to bed block in the emergency department. [1,2,3] In complex cases, delays are often inevitable, the timing of imaging and laboratory work are not under the control of the emergency department. [4] Unnecessary delays can arise in other cases due to inadequate skills, hesitancy to take complete histories or conduct appropriate physical examinations or poor communications among staff. [5,6,7] This case of adolescent haematocolpos, discussed illustrates how these considerations can result in very substantial delays in accurately diagnosing and treating a patient. [1,2,3] In complex cases, delays are often inevitable, the timing of imaging and laboratory work are not under the control of the emergency department. [5,6,7] This case of adolescent haematocolpos, discussed illustrates how these considerations can result in very substantial delays in accurately diagnosing and treating a patient. Paediatric presentations of acute urinary retention to the emergency department, while certainly not commonplace, are encountered with some frequency. The differentials include trauma, female genital mutilation (FGM), infection, functional disorders, neurogenic dysfunction such as acute disseminated encephalomyelitis, Guillian Barre syndrome, transverse myelitis, cauda equina, as well as tumors and congenital renal tract lesions. The differentials include trauma, female genital mutilation (FGM), infection, functional disorders, neurogenic dysfunction such as acute disseminated encephalomyelitis, Guillian Barre syndrome, transverse myelitis, cauda equina, as well as tumors and congenital renal tract lesions. [8,9,10]
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