Characteristics and Risk Factors for Ischemic Ovary Torsion in Children

Ovarian torsion in a 2-year-old girl: A case report

Background

Ovarian torsion (adnexal torsion) is a rare event in pediatric patients which is primarily managed by pediatric general surgeons.

Case presentation

This study presents a case of ovarian torsion in a 2-yr-old girl with a history of episodic lower abdominal pain, nausea, and vomiting for 2 days. Her physical examination was normal except for mild tenderness in the lower abdomen with no palpable mass. A color Doppler ultrasound was performed for further investigation, and an ovarian torsion was reported without sonographic signs of intussusception and acute appendicitis, so she underwent laparotomy. A relatively complete torsion was observed in the left ovarian pedicle. Initially, the left ovary and fallopian tube had a dark appearance, and 10-15% of the ovarian tissue was still normal. Detorsion of ovary was done and it was decided to preserve the ovary. After about 20 min, the color of ovary and fallopian tube returned to relatively normal, indicating normal blood flow. The patient was discharged 2 days later because a follow-up color Doppler ultrasound showed normal ovarian blood flow.

Conclusion

The possibility of ovarian torsion must be considered in all female infants with suspicious abdominal pain.

Pediatric and Adolescent Gynecologic Emergencies

Pediatric gynecology encompasses a wide range of topics from the maternal estrogen impact on the neonate, to the unique pathophysiology of the lack of estrogen on prepubescent females, and the independence and sexual maturation that occurs with adolescence. This article will review the impact of normal hormonal variations in children, unique pathophysiology of certain conditions in the prepubescent period, as well as common injuries and infections of the genitourinary system in children.

Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights

Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.