Ovarian Torsion in a Premenarcheal Girl

Clinical Presentation

An eleven-year-old premenarcheal girl presented with acute lower left abdominal pain and vomiting. On examination, her vital signs were stable, with absent secondary sexual characteristics and localized tenderness in the left iliac fossa. Imaging via ultrasonography and Doppler revealed a heterogeneous adnexal mass (58 x 31 mm) with minimal vascularity, while MRI confirmed ovarian torsion.

Surgical Findings and Management

Emergency laparoscopy demonstrated a significantly enlarged, blue-black ovary with a hemorrhagic cyst and two twists of the infundibulo-pelvic ligament. The surgical approach comprised de-torsion of the affected ovary and drainage of the cyst, aiming to preserve ovarian function. The contralateral ovary appeared multicystic but otherwise normal. Bilateral oophoropexy was performed using the sandwich technique to prevent recurrence.

Discussion

Ovarian torsion in pediatric and adolescent patients is uncommon but requires prompt recognition and surgical management to preserve fertility and prevent tissue necrosis. Early imaging, including ultrasound and MRI, is critical for diagnosis. Ovarian-sparing surgery is recommended in young patients, highlighting the importance of fertility preservation.

Conclusion

This report emphasizes the necessity of maintaining a high index of suspicion for ovarian torsion in premenarcheal girls presenting with acute abdominal pain. Immediate imaging and prompt ovarian-sparing surgical intervention are paramount for optimal outcomes.

Source: Fozia Jeelani Wani, Yoga Nagendhar, Rani Reddy. Indian Journal of Obstetrics and Gynecology Research. 2023;10(4):494-497.