By Tedler D. Depaynos, MD
The patient is just 16 years old and still in high school. She was brought to the hospital initially because of abdominal pain. Because she was manifesting the classical signs and symptoms of “acute appendicitis”, she then underwent an emergency surgery. True enough, she had a gangrenous and ruptured appendix. Her recovery was unremarkable and she was able to attend to her classes just a week after surgery.
A week later, however, she was observed to be getting pale and appeared to have lost her appetite. She began getting weaker. She also started complaining of slight dizziness and sleepiness. After taking in even a small amount of food she felt nauseated and sometimes vomited what was taken in. She then failed to continue attending her classes. She was brought back to her surgeon because the possibilities of post-op complications were thought of.
Peritoneal infection (peritonitis) or even post op adhesions were initially entertained by the surgeon but after meticulous physical examination he was not impressed of any surgical complication. Because the patient appeared dehydrated he advised admission for hydration and for possible work-up. She was then referred to a pediatrician.
Routine blood tests were done including a chest x-ray and abdominal ultrasound (UTZ). Except for slight anemia, the blood tests and chest x-ray were all unremarkable. Very minimal “intestinal ileus” was noted in the ultrasound but this was attributed to the electrolyte imbalance and dehydration of the patient. What was more impressive was that her uterus was “slightly enlarged” and the impression of “pregnancy” was entertained by the ultrasonologist. With a simple pregnancy test this was easily confirmed. The teen age patient then was manifesting the early signs of pregnancy which never entered the mind of the attending MDs! She was then referred to an Obstetrician-Gynecologist MD (Ob-Gyn).
The very young patient initially kept on denying that she knew she was pregnant. She even attempted claiming that she never had any sexual contact! With the evidence, however, she started blaming her classmate boyfriend who was noticed to be spending a lot of time to be with her in the hospital.
Nevertheless, the Ob-Gyn as well as the pediatrician prescribed her medications and both took time repeatedly advising her how she should take care of herself as well as her baby.
The surgeon and even the patient’s mother never thought of pregnancy because of the very young age of the patient. Although the mother knew that her daughter has a boyfriend pregnancy was never in her mind. Her delayed menstruation was attributed to be just a part of her irregular cycle.
When the mother with uncontrollable tears went then to visit their surgeon in his clinic, she asked the possibility of “abortion”. She could not imagine how to take care of her very young daughter and incoming “apo”. She was the bread earner of the family for her husband left them many many years ago. She was very grateful that her daughter was admitted as a charity patient again. She wanted her daughter to finish her education so that she will have a better future. She was very much devastated! With much regret, she should have been stricter with her daughter.
The surgeon obviously did not agree with the “”abortion” and did not know what more to say. With much consolation he just suggested that she should take it as a bigger challenge.**