Ovarian Torsion in a Young Adolescent with Rokitansky Syndrome

A report describes a case of a 12-year-old girl presented with lower abdominal and right iliac fossa pain associated with vomiting but without fever, chill, urinary symptoms, or diarrhea. She reported having an adrenarche at age 11. Her labs were normal, and she received a diagnosis of mild appendicitis. 

In the following days, her pain gradually increased in severity, and the abdominal ultrasound revealed a cyst with mixed echogenicity with a diameter of 6*4 cm, located in the midline of the pelvis with minimal free fluid. Collaterally, her uterus couldn't be highlighted in the sonography, while the organs of the upper abdomen are normal. The physicians suspected torsion of an ovary containing a cystic formation. 

A further surgical consultation revealed a treatable abdomen with rebound pain and normal bowel sounds. The patient's external genitalia were normal, while pelvic examination revealed a blind terminal vagina, 1 cm deep. Rectal examination showed a tense elastic mass in the pelvis, painful on mobilization, about 6 cm in diameter, and no blood in the stool. This clinical picture directed prompt surgical exploration. Laparoscopy confirmed the right ovarian torsion with the tube. The ovary was rotated 180° (2 full turns), and the ovarian tissue was viable with a normal appearance. The uterus was absent, replaced with two small-volume rudimentary horns. The surgeons untwisted the right ovary and tube, enucleated the functional cyst in the ovary, coagulated the ovarian parenchyma, and finally fixed it to the right pelvic sidewall. There were no surgical complications, and the patient recovered quickly.

Fedele F, Esposito G, Busnelli A, Parazzini F.Ovarian Torsion in a Young Adolescent with Rokitansky Syndrome. Case Reports in Obstetrics and Gynecology. 2024;2024. https://doi.org/10.1155/2024/1305476