You arrive for your shift in the ED. The final patient you are signed out is a 30-year-old woman with lower abdominal pain whose ultrasound results are pending to rule out torsion versus ovarian cyst. You nod dutifully and go about seeing new patients. An hour into the shift, the clerk hands you the ultrasound results with the radiologist’s impression: “No radiological etiology of patient’s abdominal pain is found.” You review the chart and confirm that there is no concern for any nongynecological etiologies for her pain. The previous physician documented mild left adnexal tenderness without cervical motion tenderness or adnexal masses. Labs are notable for a urinalysis that is small leukocyte esterase positive and nitrite negative, and a wet mount without clue cells, yeast, or Trichomonas vaginalis. You confirm the documented history with the patient, who additionally denies any urinary complaints or flank pain. On your physical examination, you note only mild left lower abdominal tenderness. As the patient asks, “Why am I having this pain? Can I just go home?” you wonder if there is something else you should do.
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