Tuesday, October 28, 2008

A testicle is worth 4 hours more than an ovary

28 year old woman walks up to triage looking obviously distressed and in pain. She complains of severe 10/10 LLQ pain. Blood work is drawn and sent to rule out appendicitis and ectopic pregnancy. While waiting for the blood work, she drops the bomb on us – “I had a right salpingo-oophorectomy because of ovarian torsion and I’m afraid the same thing is happening again”. The docs and residents went into panic mode and started calling imaging for a stat ultrasound. The radiology residents said that they would not do an ultrasound unless they get the hCG levels to rule out ectopic pregnancy. Maybe this time around radiology got stuck with a bunch of residents who have shit for brains since an ultrasound provides the definitive diagnosis of pregnancy/structural gynecological issues. Understandably the staff ER doc and ER residents went ape shit and finally got a hold of the staff radiologist who then screamed at his residents for being incompetent buffoons. In the end, it took the poor woman FOUR hours after presentation to get to the OR. Last I heard was that the surgeons found the ovary with arterial blood supply compromised but venous flow uninterrupted. They left the ovary in to see if it might heal. This woman has been wanting to have children since she got married several years ago and felt that now the time was finally right. What kills me is that when a man presents with testicular torsion, a white coated army descends down into the ER faster than you can place a page. I realize that ovarian torsion is much less common than testicular torsion but the woman has a history and records. Why anyone would want a pointless blood test to perform a test that can see the source of the problem directly is beyond me. I really hope this woman’s ovary heals and she can have children. If she decides to sue the hospital, I wouldn’t be surprised – hell, I’d probably support her.

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