Pediatric Ovarian Torsion in an 8-year Old Girl; A Case Report Study

Pediatric OT; Symptoms and Operative Managements


  • Samaneh Yazdanpanah Supporting the Family and the Youth of Population Research Core, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Malihe Mahmoudnia Supporting the Family and the Youth of Population Research Core, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Pediatrics; Ovarian Torsion; Laparotomy; Conservative Surgery


Background: Ovarian torsion in children causes abdominal pain. The clinical symptoms resemble other abdominal diseases, such as appendicitis. It happens when the ovary twists on its ligamentous attachment, which stops blood from getting to the ovary. A fast diagnosis accompanied by a high level of clinical suspicion and immediate surgical intervention is obligatory to save the ovaries and avoid complications. Case Presentation: In this case study, we describe a case of ovarian torsion in an 8-year-old Iranian girl who came with persistent (non-colicky) right-side abdominal pain. After ultrasonographic examinations, she was identified with an enlarged heterogeneous right ovary indicative of ovarian torsion and underwent emergency laparotomy without oophorectomy. Conclusion: It may be challenging to determine the source of abdominal pain in pediatric patients, due to factors such as insufficiently comprehensive medical histories and examinations, limitations in con-ducting radiological procedures, as well as the comparatively diminished specificity of results in contrast to adult populations. If torsion is confirmed by ultrasonography, detorsion with\ without oophorectomy is advised for conservative treatment. This article presents a case study and a brief examination of the issues and complications associated with the identification and management of pediatric ovarian torsion.


Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics. 2010;125(3):532-8.


Poonai N, Poonai C, Lim R, Lynch T. Pediatric ovarian torsion: case series and review of the literature. Can J Surg. 2013;56(2):103-8.

PMid:23351494 PMCid:PMC3617114

Ochsner TJ, Roos JA, Johnson AS, Henderson JL. Ovarian torsion in a three-year-old girl. J Emerg Med. 2010;38(4):e27-30.


Rody A, Jackisch C, Klockenbusch W, Heinig J, Coenen-Worch V, Schneider HPG. The conservative management of adnexal torsion--a case-report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):83-6.


Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007;37(5):446-51.


Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion--a 15-year review. J Pediatr Surg. 2009;44(6):1212-6.


Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152(4):456-61.


Dunnihoo DR, Wolff J. Bilateral torsion of the adnexa: a case report and a review of the world literature. Obstet Gynecol. 1984;64(3 Suppl):55S-59S.


Rajwani KM, Mahomed A. Pediatric ovarian torsion: an uncommon clinical entity. Clin case reports. 2015;3(3):193-4.

PMid:25838911 PMCid:PMC4377253

Ryan MF, Desai BK. Ovarian torsion in a 5-year old: a case report and review. Case Rep Emerg Med. 2012;2012:679121.

PMid:23326720 PMCid:PMC3542900

Corre A, Dandekar S, Lau C, Ranasinghe L. A Case Report of Pediatric Ovarian Torsion: The Importance of Diagnostic Laparoscopy. Clin Pract cases Emerg Med. 2021;5(1):109-12.

PMid:33560966 PMCid:PMC7872599

Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2000;180(6):462-5.


Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004;39(5):750-3.


Beaunoyer M, Chapdelaine J, Bouchard S, Ouimet A. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004;39(5):746-9.


Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, et al. Ovarian torsion Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759-65.


Rousseau V, Massicot R, Darwish AA, Sauvat F, Emond S, Thibaud E, et al. Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol. 2008;21(4):201-6.


Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med. 2005;159(6):532-5.


Ozcan C, Celik A, Ozok G, Erdener A, Balik E. Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion. J Pediatr Surg. 2002;37(11):1617-20.


Breech LL, Hillard PJA. Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol. 2005;17(5):483-9.


Pansky M, Smorgick N, Herman A, Schneider D, Halperin R. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol. 2007;109(2 Pt 1):355-9.


Pomeranz AJ, Sabnis S. Misdiagnoses of ovarian masses in children and adolescents. Pediatr Emerg Care. 2004;20(3):172-4.


Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25(1):51-9.


Bronstein ME, Pandya S, Snyder CW, Shi Q, Muensterer OJ. A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 2015;25(1):82-6.


McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999;54(9):601-8.


Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 2014;21(2):179-87.


Kives S, Gascon S, Dubuc É, Van Eyk N. No 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults. J Obstet Gynaecol Can. 2017;39(2):82-90.


Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 2004;23(12):1643-9-1.


Naiditch JA, Barsness KA. The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. J Pediatr Surg. 2013;48(6):1283-7.


Childress KJ, Dietrich JE. Pediatric Ovarian Torsion. Surg Clin North Am. 2017;97(1):209-21.


De Silva MHAD, Kolombage P, Kasthuri S. An ovarian torsion in a 2-year-old girl: a case report. J Med Case Rep. 2020;14(1):194.

PMid:33069250 PMCid:PMC7568833

Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg. 2018;53(7):1387-91.


Adeyemi-Fowode O, Lin EG, Syed F, Sangi-Haghpeykar H, Zhu H, Dietrich JE. Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution. J Pediatr Adolesc Gynecol. 2019;32(1):64-9.


Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach S. Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril. 1993;60(6):976-9.


Pansky M, Abargil A, Dreazen E, Golan A, Bukovsky I, Herman A. Conservative management of adnexal torsion in premenarchal girls. J Am Assoc Gynecol Laparosc. 2000;7(1):121-4.


Chen M, Chen CD, Yang YS. Torsion of the previously normal uterine adnexa Evaluation of the correlation between the pathological changes and the clinical characteristics. Acta Obstet Gynecol Scand. 2001;80(1):58-61.


Bertozzi M, Esposito C, Vella C, Briganti V, Zampieri N, Codrich D, et al. Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study. J Pediatr Adolesc Gynecol. 2017;30(3):413-7.


Celik A, Ergün O, Aldemir H, Ozcan C, Ozok G, Erdener A, et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg. 2005;40(4):704-8.


Dumont T, Caccia N, Allen L. Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature. J Pediatr Surg. 2011;46(12):e19-23.


Rossi B V, Ference EH, Zurakowski D, Scholz S, Feins NR, Chow JS, et al. The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population. J Pediatr Adolesc Gynecol. 2012;25(2):109-13.







Case Report/Series