Association Between Use of Pain Medication, Ultrasound Findings, and Adnexal Torsion Among Young Females Presenting With Acute Abdominal Pain

Abstract

day. To our knowledge, we report the first confirmed case of pediatric synchronous bilateral ovarian torsion in bilaterally normal ovaries and offer a review of the literature. Case: A previously healthy twelve year old female was seen in clinic with a two year history of recurrent right lower quadrant pain with no associated symptoms. Initial ultrasound showed normal ovaries. Repeat imaging ten months later revealed bilateral bulky ovaries: right ovary 43x32x38mm (20cc) and left ovary 56x35x55mm (52.3 cc). Peripheral follicles in keeping with polycystic ovaries were noted. The patient was not yet menarchal. Workup for celiac disease was negative. Shortly following this ultrasound, she presented to the emergency department with a thirty hour history of periumbilical pain associated with nausea and vomiting. On exam, the pain was localized to the left lower quadrant with rebound tenderness. There was absence of leukocytosis. Ultrasound showed a significantly enlarged left ovary (61x45x49mm; 70cc) with diminished flow on Doppler assessment. She underwent laparoscopy with a presumed diagnosis of left ovarian torsion. However, on entering the abdomen, bilateral ovarian torsion of 720o was detected (Figures 1 and 2). Both ovaries were enlarged, left greater than right, without obvious focal lesions. Uteroovarian ligaments were noted to be abnormally long. The ovaries were detorted and pexed to their respective uterosacral ligaments using an intracorporeal technique with nonabsorbable suture.