Background: While nipple discharge is common in adolescents, there are few reports of areolar discharge in the literature. We describe two cases of bilateral areolar discharge and inflammation with no underlying pathology. Cases: The cases involved healthy, 13 and 16-year old girls who presented to pediatric and adolescent gynecology (PAG) clinic with breast swelling and areolar discharge that caused significant patient distress and anxiety. The first case described left breast swelling and pain, with subsequent development of copious non-bloody, clear serous areolar discharge, followed by similar symptoms on the contralateral breast seven weeks later. Physical exam was notable for erythema, edema, and excoriation of the entire areola bilaterally, with diffuse weeping clear, yellowish discharge along the medial aspect of the areola. The second case initially presented to the PAG clinic with unilateral areolar swelling followed by weeping yellow discharge and development of bilateral symptoms over a two-week period. On examination copious yellow serous discharge was noted from the entire areola bilaterally extending approximately 1cm radially to adjacent breast tissue, where erythema and sub-centimeter areas of skin sloughing were also noted. There were no palpable breast masses, axillary lymphadenopathy, or expression of nipple discharge for either case. Cultures of the discharge were negative for bacteria. Breast ultrasound was unremarkable in one case and not performed in the other. Thyroid stimulating hormone (TSH), and prolactin (PRL) were normal. Both cases were treated with a short course of oral clindamycin, triamcinolone cream, and daily use of chlorhexadine gluconate 4% liquid soap with complete resolution of symptoms. Comments: There are few cases of areolar discharge described in the liter
entrapment. Three days post-operatively, the patient had fever and a drop in hemoglobin. Imaging showed hemoperitoneum with no active site of bleeding. She was managed conservatively with IV fluids. At three weeks post-operation, the patient was doing well. She restarted oral contraceptive pills for ovarian suppression and is considering interval oophoropexy via shortening of the utero-ovarian ligament. Comments: This scenario describes unusual recurrent idiopathic unilateral ovarian torsion occurring in a young girl. There are multiple theories regarding recurrent ovarian torsion in this population, and etiology remains unclear. It is agreed upon, however, that the potential causes of ovarian torsion are different between pre-menarchal and post-menarchal patients. In this patient's case, it is interesting that she had occurrences both pre-and post-menarche. Adnexal torsion in pre-menopausal women is an emergency requiring prompt surgical evaluation. Recurrent adnexal torsion without known cause is a suggested indication for oophoropexy. Torsion years after a procedure has rarely been represented in the literature. In addition, an adhesion was found in the posterior pelvis, creating a space that we believed problematic for potential bowel entrapment. This complication of oophoropexy is not described in the existing literature yet, and should be a consideration when managing recurrent ovarian torsion in a young patient.
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