# Ovarian torsion in an adolescent: A case report and review of diagnostic challenges

## TL;DR

This paper reports a case of ovarian torsion in a 13-year-old girl and highlights the challenges in diagnosing this condition due to its nonspecific symptoms.

## Contribution

The paper contributes a clinical case report and a review of diagnostic challenges in adolescent ovarian torsion.

## Key findings

- Ovarian torsion in adolescents is difficult to diagnose due to nonspecific symptoms and imaging findings.
- Ultrasound with Doppler imaging is key for diagnosis, but absence of Doppler signal does not exclude torsion.
- Early surgical intervention is critical to prevent loss of ovarian function and fertility.

## Abstract

Ovarian torsion is an uncommon but serious cause of acute abdominal pain in children. Due to its nonspecific symptoms and diagnostic difficulties, timely identification and intervention are crucial to preserving ovarian function and future fertility.

A 13-year-old woman presented a 3-day history of pain and vomiting from the right iliac fossa. Clinical examination revealed localized tenderness without abdominal contracture or palpable masses. Laboratory results were unremarkable, and imaging showed a simple 5 cm unilocular ovarian cyst with hyperechoic content and an enlarged right ovary. Laparotomy confirmed a right ovarian torsion with a necrotic ovary. Despite detorsion, no reperfusion was observed, necessitating a right adnexectomy. The postoperative course was straightforward.

Ovarian torsion is rare but poses a significant diagnostic challenge due to its variable clinical and radiological presentation. The primary diagnostic tool is ultrasound, often supplemented by Doppler imaging, although the absence of a Doppler signal does not rule out torsion. Differential diagnoses include appendicitis, hemorrhagic cysts, and other conditions that mimic acute abdomen.

Early recognition and management are essential, particularly in young patients, to mitigate long-term reproductive consequences.

•Ovarian torsion is a serious cause of acute abdominal pain in children. It presents significant diagnostic challenges due to nonspecific symptoms, making timely identification and intervention crucial to preserving ovarian function and future fertility.•The article discusses the case of a 13-year-old girl with a three-day history of right iliac fossa pain and vomiting. Imaging revealed a 5 cm unilocular ovarian cyst and an enlarged right ovary. Laparotomy confirmed ovarian torsion with a necrotic ovary, leading to a right adnexectomy. Despite the detorsion attempt, no reperfusion was observed.•The diagnosis of ovarian torsion is complex due to its variable clinical and radiological presentations. Ultrasound, supplemented by Doppler imaging, is the primary diagnostic tool, though the absence of a Doppler signal does not rule out torsion. Early recognition and surgical intervention are essential to prevent long-term reproductive complications.

Ovarian torsion is a serious cause of acute abdominal pain in children. It presents significant diagnostic challenges due to nonspecific symptoms, making timely identification and intervention crucial to preserving ovarian function and future fertility.

The article discusses the case of a 13-year-old girl with a three-day history of right iliac fossa pain and vomiting. Imaging revealed a 5 cm unilocular ovarian cyst and an enlarged right ovary. Laparotomy confirmed ovarian torsion with a necrotic ovary, leading to a right adnexectomy. Despite the detorsion attempt, no reperfusion was observed.

The diagnosis of ovarian torsion is complex due to its variable clinical and radiological presentations. Ultrasound, supplemented by Doppler imaging, is the primary diagnostic tool, though the absence of a Doppler signal does not rule out torsion. Early recognition and surgical intervention are essential to prevent long-term reproductive complications.