CASE PRESENTATION
A 16-year-old unmarried female presented to the emergency department with chief complaints of lower abdominal pain and per-vaginal bleeding for 1 day. Abdominal pain was acute in onset, continuous, moderate to severe in intensity, non-radiating without aggravating and relieving factor. The patient also had per-vaginal bleeding 1 day back, soaking a full blanket with blood on 1st day of her cycle. She had her menarche at the age of 13. Her cycles were irregular for 1 and a half years with polymenorrhagia cycles repeating in 15-20 days with a flow of 5-6 days with 3 pads soaked per day but no history of dysmenorrhea. There was no history of nausea, vomiting, fever, trauma to the abdomen, abdominal distension, fatiguability, or easy bruising.
At the presentation to the hospital, she was ill-looking pale with a pulse rate of 86 bpm, regularly regular with a blood pressure of 110/60 mmHg. Her respiratory rate was 22 bpm with SpO2 of 96% and temperature of 97.2°F (36.2°C). She had a Glasgow Coma Scale of 15/15 (i.e., E4M5V6). All systemic examinations were normal. The per-vaginal examination was not performed for the unmarried lady.