Ovarian Torsion Premenarch

An 11-year-old girl presented with a two-day history of intermittent left lower abdomen pain and dysuria, followed by non-projectile vomiting for one day. 

The child’s parents reported that she had been generally healthy before this episode. Her past medical history included a similar complaint six months ago, managed conservatively, and a history of febrile seizures at two years of age. Her last vaccination was administered at five years of age. 

The initial diagnosis was acute gastroenteritis, which was conservatively managed. However, her symptoms worsened, leading to severe abdominal pain. Her axillary temperature was 98.4◦F; pulse rate was 100 per minute; blood pressure was 110/70 mmHg; respiratory rate was 18 breaths per minute; and she had 100% oxygen saturation on room air. Physical examination revealed absent secondary sexual characteristics, scaphoid abdomen with normal bowel sounds, tenderness in the lower abdomen, more severe in the left iliac fossa, involuntary guarding and rigidity, and absence of rebound tenderness. Systemic examination was unremarkable, except for the patient’s height (128 cm) and weight (25 kgs), below the 3rd percentile for her age.

Laboratory results showed an elevated white blood count, while her hemoglobin, hematocrit, and platelets were within normal levels. 

Temporary relief from pain and vomiting was achieved with intravenous analgesics and antiemetics. Ultrasonography with Doppler study revealed a heterogeneous mass in the left adnexal region, suggesting left-sided adnexal torsion. MRI of the pelvis confirmed the diagnosis, showing an enlarged left ovary with twisting of the vascular pedicle. Emergency laparoscopy revealed an enlarged left ovary with a hemorrhagic cyst, diagnosed as ovarian torsion. 

Detorsion, aspiration of the cyst, and bilateral oophoropexy were performed. The patient was discharged in stable condition, and follow-up ultrasounds demonstrated a reduced size of the left ovary and normal right ovary, emphasizing the significance of prompt diagnosis and management of ovarian torsion in pediatric patients. 

Using ultrasound as a first-line imaging modality, particularly in resource-poor settings, is crucial. Conservative surgical intervention with ovarian sparing surgery and oophoropexy are the most effective treatment modalities––preventing recurrences and achieving positive outcomes.

Source: Wani F J, Nagendhar Y, Reddy R. Indian J Obstet Gynecol Res. 2023;10(4):494-497