Krista J. Childress

Pediatric Ovarian Torsion

Adnexal torsion is the fifth most common gynecologic emergency. The vague clinical presentation and variable imaging findings make the diagnosis difficult. If suspicion for adnexal torsion is high enough based on clinical symptoms and imaging findings, prompt intervention should include conservative management with laparoscopic adnexal detorsion and ovarian preservation even in the event of a necrotic-appearing ovary because studies persistently show follicular development and ovarian function after a short time period and no increased patient morbidity.

Medical child abuse: a case presenting as ano-genital bleeding of unknown origin in an older child.

BACKGROUND Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms. CASE A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case. SUMMARY AND CONCLUSION Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patients symptoms and work-up do not match.

Discussion: ‘Factor V Leiden mutation’ by Kjellberg et al

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research.