Ovarian Torsion Caused by Teratoma Masquerading as Perforated Appendicitis in a 5-Year-Old Girl

Abstract

Ovarian torsion is a well-known but poorly recognized disease. Although ovarian torsion is the most common complication of ovarian tumors in children, it is an uncommon cause of abdominal pain in pediatric patients. Ovaries can be only salvaged by prompt diagnosis and timely surgical intervention. Acute ovarian torsion without appropriate treatment may result in loss of ovarian function, tissue necrosis, and death. The objective of this article is to present a case of pediatric ovarian torsion and describe the difficulty of distinguishing it from perforated appendicitis in the emergency department (ED). We report a 5-year-old girl who presented to the ED with nausea, tenderness over the right lower guardant of her abdomen, fever, and anorexia. She was initially diagnosed with appendicitis based on physical examination and abdominal computed tomography scan and was sent to the operating room for surgical exploration. The definite diagnosis of the patient was acute ovarian torsion complicated with cystic teratoma. Primary clinicians in the ED should pay more attention to acute ovarian torsion in young children because it is difficult to diagnose in time to salvage the gynecological function when the clinical presentations masquerade as perforated appendicitis.

Ovarian teratoma in children: a plea for collaborative clinical study

“…Those cases are rarely associated with malignancy. Tsai et al revealed that young girls tend to have either torsion of a mature cystic teratoma or torsion without underlying condition, while older patients are more likely to present with torsion and a tumor [ 2 , 26 ]. In our study ovarian torsion was the most common intraoperative finding additional to the tumor in girls with acute presentation.…”

“…As most of the mature teratomas are slow-growing cystic lesions and there are some common characteristic findings, they are easily recognized on US. Nevertheless, their typical features might be less clear in case of prepubertal girls and when the lesion is large [ 13 , 26 , 27 ]. Our study poses limitations in that respect.…”

Paediatric cystic ovarian torsion masquerading appendicitis

“…It is often thought that ovarian torsion is secondary to a cyst or ovarian tumour. 4 However Case report explain torsion in a regular ovary, including excessive movements secondary to a predisposing long utero-ovarian ligament. 5 Appendicitis is considered a clinical diagnosis, with blood tests and imaging playing a supportive role.…”

Pediatric ovarian torsion: an uncommon clinical entity

“…Pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis . In children, it is most common around menarche .…”

“…In children, it is most common around menarche . If left untreated, ovarian torsion may result in tissue necrosis, loss of ovarian function, and may eventually cause infection and peritonitis .…”