A rare case of ovarian torsion in premenarcheal age- Case report and review of literature

Abstract

Ovarian torsion in childhood and adolescence is rare gynecological emergency. We report a case of ovarian torsion in eleven-year-old pre-menarcheal girl who presented with acute lower left abdominal pain and vomiting. On examination her vital signs were stable, secondary sexual characters were absent, abdomen was scaphoid with tenderness in left iliac fossa. Ultrasonography with doppler study showed a heterogenous mass measuring about 58x31mm in left adnexal region close to uterus with minimal vascularity. MRI findings were consistent with ovarian torsion. Patient underwent emergency laparoscopy and left ovary was found to be enlarged, blue-black with hemorrhagic cyst with two twists along Infundibulo-pelvic ligament. Ovarian Sparing Surgery involving de-torsion of torsed ovary with drainage of hemorrhagic cyst was performed. Right ovary was found to be normal in size with multicystic appearance. Bilateral oophoropexy using sandwich technique was done in order to prevent future recurrences. This case report emphasizes on importance of immediate diagnosis with ultrasound and MRI. Surgical management in form of laparoscopy with ovarian sparing surgery in young patients is important to preserve their fertility.