YOU don't have to be in family practice long to realize that right lower quadrant pain in the teen-aged girl is a very common problem. You discover quickly, too, that there are no recent advances to help the clinician here, and that your consultants, medical and surgical, are likely to have widely divergent opinions in their diagnostic and therapeutic advice. Quite regularly this poses a difficult clinical problem.
The diagnostic possibilities are many, the most common being acute appendicitis, acute gonorrheal pelvic peritonitis, granulomatous enterocolitis, acute mesenteric adenitis, cecal gas syndrome, irritable colon syndrome, and a constipation syndrome.
Many experienced pediatricians would not agree with this list of diagnostic possibilities at all. They would say that by far the most common explanation for such pain among patients of this category is a quasimalingering form of emotional response to the superficial problems of growing up. Furthermore, if this is the working