Ovarian torsion—A course for severe abdominal pain in children

Abstract

Ovarian torsion is a rare, albeit important cause of abdominal pain as it may lead to ovarian necrosis if not resolved. Although it has been described in all ages, it is very rare in young children. The primary symptom is abdominal pain, and due to the abundance hereof in a pediatric setting and the significant overlap in the clinical manifestations between ovarian torsion and more common entities such as appendicitis, a high level of suspicion needs to be maintained. We report the case of a young girl with a history of severe abdominal pain. A primary hospitalization at the age of 1½ years resolved quickly and spontaneously without any imaging. At the age of 2 years and 10 months, she was once again hospitalized for severe abdominal pain. A CT scan shoved a large dermoid cyst and possible torsion of the ovary. An exploratory laparotomy confirmed the diagnosis and oophorectomy was performed. Histopathological examination of the cyst demonstrated a 5 × 5 × 6 cm mature cystic teratoma without malignancy. This case illustrates how a high level of suspicion for ovarian torsion needs to be maintained, even in otherwise healthy children.