Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP866

Poster Presentation

Recurrent Abdominal Pain in a Female Adolescent:How the Rare Mayer-Rokitansky-Küster-Hauser Syndrome was Diagnosed

Cynthia Utami, Riyani Limoa, Ekarini Aryasatiani, Ariani Dewi Widodo Department of Pediatrics, Grha Kedoya Hospital Jakarta Department of Obstetrics and Gynecology, Grha Kedoya Hospital Jakarta Department of Obstetrics and Gynecology, Tarakan Hospital Jakarta Department of Pediatrics, Grha Kedoya Hospital Jakarta

Background: Recurrent abdominal pain remains one of the most challenging problems to diagnose. Most are functional, but a small portion is organic, mostly gastrointestinal, but urinary tract and gynecologic problems could cause similar symptoms. Careful history-taking and examination can help narrow down diagnosis and guide initial decision to perform further diagnostic modalities. Case: A 13-year-old female adolescent patient presented with a history of recurrent lower abdominal pain for the last 10 months. Patient had been hospitalised 5 times with similar symptoms, diagnosed with bowel inflammation and chronic appendicitis. She received various antibiotics, and gastrointestinal medications. Appendectomy was performed 6 months ago but the pain still comes and goes. Upon admission, she complained of crampy abdominal pain, vomiting, slightly febrile, slightly elevated leukocyte (11.700/μl) and CRP (11 mg/dL). Post-appendectomy adhesion was initially suspected, but pain persisted after treatment. We performed a more thorough anamnesis of the pain characteristics: intensity 8/10, located at the pelvic quadrant, colicky, non-radiating, recurrent every 3-4 weeks (approximately 25 days), and each episode lasted for about a week. Puberty status Tanner stage 3-4, menstrual cycle not yet started. CT scan found a small cystic lesion in the uterus, small fluid collection in Douglas space, and sigmoid colon thickening suggestive of colitis with mild adhesion. However, gynecological examination found no vaginal opening without protruding bluish discoloration. Rectal examination palpated enlarged uterus (5x3x3 cm), suspected of hematometra. Fetomaternal ultrasound examination concluded asymmetrical uterine dysgenesis and vaginal agenesis, consistent with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Patient underwent histerectomy and counselling. Patient is now symptom-free. Learning Points: Gynecological causes should always be considered in female adolescents with recurrent abdominal pain. Failure to do so could pose patients to unnecessary procedure. Thorough history should be taken, especially the tendency towards cyclical pattern. Imaging serves as supporting modalities but anamnesis and physical examination is vital.

Keywords: recurrent abdominal pain adolescent gynecologic disorder