RECORD 14 | TYPE: EMERGENCY DEPARTMENT NOTE

PATIENT: Synthetic-014 | AGE: 22 | SEX: F | DATE: 2026-11-28 03:40
CHIEF COMPLAINT: Acute right lower quadrant abdominal pain.

HISTORY OF PRESENT ILLNESS:
The patient is a 22-year-old female who presented to the emergency department at 02:30 with acute onset severe sharp pain in the right lower abdomen which began 4 hours prior while sleeping. Pain woke her from sleep and has steadily escalated (severity 9/10). Associated with two episodes of non-bloody, non-bilious emesis. Denies fever, diarrhea, dysuria, or hematuria. Last menstrual period started 18 days ago (regular 28-day cycle). Denies sexual activity for the past 6 months.

PHYSICAL EXAMINATION:
Vitals: BP 132/84 mmHg, HR 104 bpm, RR 20 bpm, Temp 37.1 C, SpO2 99% on ambient air.
General: In severe distress, curled into fetal position on stretcher.
Abdomen: Severe tenderness to palpation in the right lower quadrant and right iliac fossa with guarding and positive rebound tenderness. Rovsing sign negative. Pelvic exam reveals marked right adnexal tenderness; no cervical motion tenderness.

DIAGNOSTIC WORKUP:
- Serum beta-hCG: Negative (< 1 mIU/mL).
- Urinalysis: Clear, trace ketones, negative nitrites/leukocyte esterase.
- Pelvic Ultrasound with Doppler: Normal-appearing uterus. Left ovary measures 3.1 x 2.2 cm with normal vascular flow. Right ovary is enlarged measuring 6.2 x 5.1 x 4.8 cm with multiple small peripheral follicles, surrounding edema, and absent arterial and venous blood flow on color Doppler, consistent with right ovarian torsion. Trace free fluid in the pouch of Douglas.

ASSESSMENT AND MANAGEMENT:
Right ovarian torsion. Surgical emergency.
1. Immediate gynecology consult obtained; Dr. Ramos evaluated the patient bedside.
2. Kept NPO for emergent diagnostic laparoscopy and right ovarian detorsion.
3. IV access established; 1 liter normal saline bolus infusing.
4. Analgesia: IV Hydromorphone 0.5 mg administered with moderate pain reduction.
5. Preoperative labs sent (CBC, type and screen, coagulation panel). Consented and transported to OR.
