Case Report on Left Ovarian Torsion: A Rare Complication in an Adolescent PCOS (original) (raw)
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Medical Science Monitor, 2017
Departmental sources Background: Ovarian torsion can be seen in the otherwise-normal ovary and is a challenging issue in the emergency department. The aims were (1) to evaluate and compare the surgically verified ovarian torsion cases in otherwisenormal ovaries and ovaries including a mass or cyst and (2) to investigate whether the normal-appearing ovaries on ultrasound examination affected the diagnosis of ovarian torsion or not. Material/Methods: A retrospective cohort study design was used. The medical records of all postmenarchal adolescent girls with surgically verified ovarian torsion treated in a university hospital from 2010 to 2016 were reviewed. Results: Twenty-nine post-menarchal girls were identified. The subjects were divided into two groups. Eight girls (group 1) had ovarian torsion in a normal ovary, and twenty-one girls (group 2) had ovarian torsion including a mass or cyst. The median ages of group 1 and 2 were 13 and 14 years, respectively. Abdominal pain was the main presenting symptom for all cases in both groups. Doppler flow studies were abnormal in 6/9 (66.6%) in group 1 and 12/21 (57.1%) in group 2. The time from first admission to the operation was statistically longer in group 1 than in group 2 (34.5±24.3 hours vs. 19.5±9.2 hours, respectively; p=0.001). The longitudinal axis of uterine size was significantly shorter in group 1 than in group 2 (34.3±2.9 mm vs. 47.6±4.5 mm, respectively; p=0.001). Conclusions: Ovarian torsion in adolescent girls can be seen within the otherwise-normal ovary. The normal-appearing ovaries on ultrasound in the emergency department may lead to delay in the diagnosis of ovarian torsion in adolescent girls.
Premenarchal Adolescent Female Ovarian Torsion: A Case of Delayed Diagnosis
The American Journal of Case Reports, 2021
Patient: Female, 11-year-old Final Diagnosis: Ovarian Symptoms: Abdomenal • pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Mistake in diagnosis Background: Ovarian torsion is a rare surgical emergency in premenarchal girls. Early diagnosis and surgical detorsion are required to restore blood flow and limit tissue damage. Case Report: Here, we present a case of ovarian torsion and appendicitis in an 11-year-old premenarchal girl who presented to our emergency room with a 4-day history of right iliac fossa pain, limping, and fever. Upon initial evaluation in our hospital, her vital signs were stable and clinical examination revealed abdominal guarding and right lower quadrant rebound tenderness with positive Rovsing’s sign. Abdominal ultrasound and computed tomography scans showed adnexal cysts and torsion, an inflamed appendix, and free fluid in the abdomen. Intraoperative findings included a twisted gangrenous ovary and an edematous appendix. The patient unde...
Ovarian Torsion: Presentation and Management in a Pediatric Patient
Case Reports in Obstetrics and Gynecology, 2022
Background. Adnexal torsion is the fifth most common gynecologic emergency accounting for approximately 20 to 30% of ovarian surgeries in pediatric patients. Case. The patient is a ten-year-old female who presented to the emergency room for severe left lower quadrant abdominal pain. On presentation, she was hemodynamically stable with an acute abdomen. A transabdominal ultrasound showed a predominantly anechoic structure measuring up to 5.6 cm without definitive Doppler flow, concerning for a large cyst causing ovarian torsion. Gynecology was consulted, and the patient underwent a diagnostic laparoscopy, aspiration of the left ovarian cyst, and left ovarian detorsion. Pathology results were consistent with benign cystic contents. Conclusion. Appropriate diagnosis and timely surgical gynecological intervention allowed this pediatric patient to salvage and preserve ovarian function.
Obstetrics & Gynecology International Journal, 2017
Ovarian torsion is an infrequent cause of acute abdominal pain in children. In these patients its etiology, diagnosis and treatment may differ significantly from that of adults. We show here our experience in 28 patients aged 9-16 during a seven years time frame (2008-2014). All patients underwent trans-abdominal Ultrasonography (US) associated to Color Doppler Ultrasonography (CDU) and, in some selected cases, second level imaging methods. The surgical approach included open surgery or laparoscopy, either conservative (detorsion plus cystectomy/tumorectomy plus oophoropexy whenever appropriate) or radical, according to patient's conditions. Clinical presentation is non-specific and this frequently leads to diagnostic delay that might cause adnexal infarction. In case of acute abdominal pain, US is the most useful diagnostic tool, coupled with color-Doppler for the evaluation of blood circulation in the affected ovary.
Update on the management of ovarian torsion in children and adolescents
World Journal of Pediatrics, 2014
Background: Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specifi c symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion.
Pediatric ovarian torsion: case series and review of the literature
Canadian Journal of Surgery, 2013
Background: Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. We sought to more completely characterize ovarian torsion with respect to pain and ancillary studies, such as urinalysis. Methods: We performed a retrospective review of hospital charts of all patients aged 0-18 years with a diagnosis of ovarian torsion at the Children's Hospital at London Health Sciences Centre, in London, Ont., from 1993 to 2008. Results: We analyzed 13 charts of patients aged 7 months to 18 years. Most patients presented with peripheral leukocytosis, vomiting and right lower quadrant pain that did not radiate or migrate. On urinalysis, about half the patients demonstrated pyuria without bacteruria. Pelvic ultrasound revealed an ovarian cyst on the same side of the pain in 11 of 13 patients. Most were found to have a hemorrhagic cyst or ovary and underwent salpingo-oophorectomy or cystectomy within 48 hours of presentation. Conclusion: Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended. Contexte : La torsion ovarienne est une cause rare de douleur abdominale aiguë chez l'enfant, qui commande un traitement chirurgical immédiat pour protéger l'ovaire touché. Le tableau clinique ressemble souvent à celui d'autres pathologies, comme l'appendicite. Nous avons voulu caractériser de manière plus précise la torsion ovarienne sur le plan de la douleur et des examens complémentaires, tels que l'analyse d'urine. Méthodes : Nous avons effectué une revue rétrospective des dossiers hospitaliers de toutes les patientes âgées de 0 à 18 ans chez qui un diagnostic de torsion ovarienne avait été posé à l'Hôpital pour enfants
Recurrent Ovarian Torsion in an Adolescent! A Rare Case Report and Review of Literature
Journal of South Asian Federation of Obstetrics and Gynaecology
Background: Ovarian torsion is a surgical emergency that can affect future fertility. Ovariopexy can be done to prevent recurrent torsion. However, despite ovariopexy, recurrent torsion can occur. Case description: On September 17, 2021, at 12 a.m., a 17-year-old unmarried girl presented to the gynecological emergency department. She gave a history of having had a sudden-onset of severe lower abdomen pain since 1 day. The patient gave a history of having had a laparotomy done for ovarian torsion 1 year back. On reviewing her discharge papers, it was seen that the patient had undergone right oophorectomy with contralateral ovariopexy 1 year ago. A provisional diagnosis of ovarian torsion was made, and at laparotomy, a torted left ovary was seen. Ovarian detorsion with oophoropexy using a new technique (hotdog in a bun) was done. Postoperatively, an ultrasound at 6 weeks follow-up showed a normal detorsion. Postoperatively, after ultrasound at 6 weeks follow-up, the patient is having normal ovary with normal AMH levels. Conclusion: Recurrence of torsion can occur even after oophoropexy. Timely intervention is a must to preserve ovarian function and future fertility.
Ovarian torsion in a 5-year old: a case report and review
Case reports in emergency medicine, 2012
Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.
Asynchronous Bilateral Ovarian Torsion: Three Cases, Three Lessons
Case Reports in Pediatrics, 2017
Background. Ovarian torsion (OT) is a serious condition, and delay in surgical intervention may result in loss of the ovary. Children and adolescents who have suffered from ovarian torsion may be at risk for asynchronous torsion of the contralateral ovary. Study objective. Three cases of asynchronous bilateral ovarian torsion were reported to analyse clinical history of three patients, to review the current literature, and to draw a conclusion for future treatment. Design. Case reports and review of the literature. Result. When a prepubertal girl presents with an ovarian torsion, several considerations have to be taken in account in order to preserve her future fertility; in particular, the pediatric surgeon/gynecologist has to preserve as much as possible the twisted ovary in addition to considering the fate of the contralateral ovary. Summary and Conclusions. Pelvic pain in a young girl has always raised the clinical suspect of an ovarian torsion; the possibility of asynchronous b...