Torsion of the uterine appendages in an 11-year old girl with ovarian endometriosis

Abstract

Introduction. It is known that hormonal and immune disorders are the background for endometriosis development. In children, ovarian endometriosis is extremely rare. Enucleation of an endometrioid cyst with preservation of healthy ovarian tissue is an enough surgical volume. However, torsion of adnexa in adolescence is quite an often pathology, and even in case of true ovarian tumor absence, it requires adnexectomy which, as a rule, finishes with uterine appendages removal.A clinical observation. An 11-year-old girl with a history of early menarche was admitted to the surgical department with a clinical picture of twisted adnexa: acute abdominal pain combined with repeated vomiting. After gynecologist’s examination, a torsion of the left appendage was suspected; the patient was transferred to the gynecological department where ultrasound examination revealed a volumetric formation in the left ovary. Indications for emergency surgical treatment were outlined. Laparoscopy and left adnexectomy were performed. Histological examination revealed no necrotic changes in the uterine appendages, but an endometrioid cyst was found. On day 7, the patient was discharged from the hospital. The article presents a clinical observation of 11-year-old girl with twisted adnexa and an endometrioid cyst. To treat this pathology, the girl had laparoscopy and adnexectomy.Conclusion. Immediate and correct diagnosis was put due to a typical clinical picture of twisted adnexa in a teenage girl. The volume of surgical intervention is unreasonably large. Early menarche should be considered as a marker of endometriosis in preclinical diagnostics of the disease so as to prevent urgent conditions and to preserve the reproductive potential. Unjustified ovariectomy during the formation of hypothalamic-pituitary-ovarian axis in a teenager, with the initially unfavorable premorbid background, brings even greater aggravation of hormonal and immune disorders with the stress to homeostasis-regulating systems.