Would this have happened to a boy?

Nurses General Nursing

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Disclaimer: This is a rant, not a thread seeking medical advice.

My teenage daughter was taken to the ER...sent from our PCP's office, for severe abdominal pain. The CT scan showed "the tip of her appendix" was inflamed. However, since she was also on her period and the CT wouldn't really show if she had an ovarian cyst or any other "female" problems. She was sent home with Vicodin and Phenergan scripts. BTW, my hubby took her because I was at work when this happened and due to freezing rain, my relief was late and I didn't get out of work until after my daughter was discharged from the ER.

A few days later she had an ultrasound showing she had an ovarian cyst but according to our male PCP it should not cause her so much discomfort. His advice was "Let's just take it day to day and see how she does."

I just wonder, if when she was in the ER if she had been a boy with the same symptoms and the same CT results would she still have her appendix? I never heard of not doing anything for an inflamed appendix.

Something is still causing her a lot of pain. We have an appointment with a gynecologist tomorrow. Hopefully she will take more than a wait and see attitude. Whatever this is, we need to get this under control so my daughter can get back to her normal self. If all of this is caused by an ovarian cyst maybe she can be put on BCP's and hopefully start feeling better.

Also, I am a little miffed at our PCP insinuating an ovarian cyst shouldn't be causing her this much discomfort. I just feel like her pain has been minimized because it might be "female" problems.:banghead:

I know this is a little long, but thanks for allowing me to vent.

Specializes in ICU/Critical Care.

Take your daughter to the doctor and demand a referral to another physician for a second opinion.

Specializes in ER/Ortho.

About 10 years ago I had terrible pain in my lower abdomen, and off course it was a Sunday and my Dr was closed. I went to a primacare to be seen. They said I had a kidney infection, and my appendix was inflamed. I asked if I should go to the ER or what needed to be done. I was put on antibiotics for the kidney infection, and told to go home, put my feet up, and wait and see in regards to the appendix. The Dr. told me that they often get inflammed and cause pain, but then go back down and nothing needs to be done. She said go to the ER if the pain becomes unbearable, and constant.

It did go down, and I didn't have another problem with it until about 5 years later. This time it hit hard, and strong. It was so inflammed that every step I took caused me extreme pain, I couldn't straighten up my body, and I was vomiting and had exteme nausea. I went to the ER, and they took it out a few hours later.

It could be that they feel her symptoms are not severe enough to make it an emergency surgery situation, and they think the appendix could be saved. They are now discovering that appendix that they once thought was usless actually stores the good GI bacteria so saving it would be benificial if its possible.

Specializes in Emergency Nursing.

While I cant speak to the severity of pain associated with an ovarian cyst; As an ER nurse I can speak to the slightly inflammed appendix.

In my ER the surgeons are not quick to operate on an otherwise healthy individual who has a normal white count and no fever. In these situations we do usually send the patient home with instructions to come back in 24 hours if they develop fever or increased pain. We would never send someone home who didn't have their pain and nausea under control first.

As for the lack of education provided to your husband and daughter regarding lab tests and all the different treatment options- it sounds like both the ER nurse and ER MD could have done a better job. While 1 in 3 patients who aren't admitted go home from an ER without a definitive diagnosis, a patient should never leave wondering if everything was considered.

I hope this helps!

Specializes in Cardiac, ER.

I'm trying to look at this from an ER position, as I'm an ER nurse,.and also from a womans and a Moms view.

First, where I work almost any female with ovaries and a uterus, and abd pain gets a pelvic exam. Now that said, if this is a younger teenager, that has never had a pelvic exam, and has a neg preg test we might, depending on her labs, and presentation, rule out other stuff first, ie constipation, appy, gastroenteritis, some sort of mass in the abd etc. Remember here that the ER's focus is to rule out anything that is immediately life/limb threatening.

You would be amazed at the number of people, especially young people, who come in with belly pain and we never find out why and they just get better. "The tip of the appendix is inflamed". I would have to assume that the docs didn't feel that it was significant enough to need to come out ASAP. I honestly have seen kids come in with "minimal inflammation of the appendix" and because their labs are okay and their pain is controlled with PO meds they don't rush these kids to the OR, who wants their kid to have surgery unless it's absolutely necessary. It seems that sometimes these appy's "flair" occasionally, and get better.

I was told during my first routine OB ultrasound that I have two cysts in my left ovary. That was 22yrs and two kids ago. I have been told about it every time I've had an OB ultrasound. It's never been an issue or caused any problems.

Do as they say and follow up with your PCP. If you need to find a new PCP, then by all means find one. Maybe you should take her to your Gyn? If she is still hurting then she needs to keep going back to the doc until you get your answers.

As far as would this happen to a boy. You must admit that a boy has less "stuff" in his abd to cause pain than a girl. Again though,..boy or girl, why do surgery if it isn't absolutely needed? I think as a Mom,.if the docs where comfortable with the "watch and see" attitude, then that's what I would chose. Maybe now we have watched and see that something else needs to be done.

Best of luck, keep talking to your docs!

Specializes in ER/Trauma.

I have routinely seen surgeons wait on an inflamed appendix rather than cut immediately. I would average it as 3 cases out of 10. Like Medic pointed out - it's a case by case basis.

I doubt the gender of the physician had anything to do with it.

I discharged someone last night with pretty much the same complaints as the OPs daughter. The pt. even said that the ER doc (a female) implied that 'cysts shouldn't hurt so much'. I stressed the need for her to follow up with her PCP and to return to the ER if pain became worse/unmanageable.

cheers,

Specializes in pedi, pedi psych,dd, school ,home health.

never have had an appendix issue; but the ovarian cyst i had that ruptured hurt more than labor.

was out of work for a week d/t pain, nausea and general illness from it.

I would ask the gyn for a referral for a new pcp for dd. good luck!

I don't think it would have happened to a boy, because you can't do as many differential diagnoses with a boy.

It sounds like enough education was not provided. Or was it? Is your husband like mine--he doesn't remember the information, doesn't ask questions, and then gets defensive when I ask "What did the chest xray say? What were the lab results? When are we supposed to follow up?" His response is "I don't speak that language. You call and talk to the nurse. I just remember x/y/z." It frustrates me to no end! At least he's honest though, and I've come to expect such a lack of info. I don't send him by himself anymore if I can help it.

It sounds like you have been directed to follow up accordingly. As others have noted, ovarian cysts can be extremely painful. Cysts don't always need to be surgically removed; but if they are causing pain, they do need to be followed. And you have been right on that.

Good luck to you and your daughter.

Specializes in ER.

My teenage daughter was taken to the ER...sent from our PCP's office, for severe abdominal pain. The CT scan showed "the tip of her appendix" was inflamed. However, since she was also on her period and the CT wouldn't really show if she had an ovarian cyst or any other "female" problems.

I never heard of not doing anything for an inflamed appendix.

The PCP did the right thing sending her to the ER. The ER doctor seems to have dropped the ball. When patients in the ER have any portion of their appendix inflamed, even with normal labs, the appendix comes out. The fact that she was on her period at the time does not in any way obscure a ovarian cyst from being seen. The male PCP is allowed to have an opinion that it should not cause her so much discomfort but taking it day to day, knowing she has a portion of her appendix inflammed makes no sense. Something doesn't add up here. I hope she's feeling better soon.

Specializes in RN, BSN, CHDN.

How annoying had you daughter been one of the frequent flyers c/o pain I am sure she would have been admitted and every test possible carried out !!!!!!!!!

Specializes in Peds Critical Care, Dialysis, General.

Actually, this did happen to a guy I who was in my high school graduating class. He presented to the ED on more than one occasion with complaints consistent with appendicitis. They kept sending him home saying it was a viral illness. On his third visit, they realized that it WAS appendicitis and that the appendix had ruptured. He spent several days in ICU.

Unfortunately for the hospital, he's an attorney. There was an out of court settlement.

Overall, though, I think that a woman's complaints are brushed off more than a man's. JMHO.

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