Pediatric emergency medicine trisk 2142 2142
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Cefoxitin 2 mg IM
with probenecid 1
g po
associated with
many cases of
PID and will
enhance
anaerobic
coverage
a Fluoroquinolones
are no longer recommended for the treatment of gonococcal infections.
IV, intravenous; IM, intramuscular; bid, twice a day; qid, four times daily.
Adapted from Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted
diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR-3):1–137; Centers for Disease
Control and Prevention (CDC). Update to CDC’s Sexually transmitted diseases treatment guidelines, 2010:
oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal
Wkly Rep 2012;61(31):590–594.
ADNEXAL TORSION
Goals of Treatment
The primary goals for the emergency physician are consideration of ovarian
torsion on the differential diagnosis of female patients with abdominal pain, rapid
assessment with ultrasonography to make the diagnosis, and rapid referral to an
appropriate specialist for surgical intervention.
CLINICAL PEARLS AND PITFALLS
Ovarian torsion is a difficult diagnosis to make, given the lack of
specific or sensitive historical or physical examination factors.
The diagnosis of ovarian torsion can be made in prepubertal girls,
although postmenarcheal patients account for the majority of
diagnoses.
Enlargement of the ovary is the most common finding on ultrasound;
Doppler findings can be inconsistent due to the dual blood supply of the
ovary, so demonstration of blood flow should not definitively rule out
ovarian torsion.
Current Evidence
Adnexal torsion is a rare diagnosis with an estimated incidence of 2 per 10,000 in
women less than 20 years of age. Pediatric patients represent 15% of cases of
adnexal torsion; large pediatric centers report 0.3 to 3.5 cases annually. The
primary aim of surgical management is conservation of the ovary, unless there is
