Torsion of ovarian teratoma in a child before menarche

Abstract

Ovarian torsion is the fifth most common gynecological emergency. It affects women of reproductive age. It frequently results from dermoid and benign functional cysts. Patients suspected of ovarian torsion may be investigated with ultrasonography, computed tomography, magnetic resonance imaging, and diagnostic laparoscopic surgery. Ovarian torsion has rarely been observed in pediatric patients. It is difficult to diagnose early, and surgery is required to preserve fertility. This is the case of an 11-year-old pre-menarche girl who visited our hospital thrice for recurrent abdominal pain and vomiting. During her third visit to the emergency room, the patient underwent abdominal and pelvic computed tomography, which revealed a right dermoid cyst or an epithelial cell ovarian tumor torsion. The patient underwent an emergency laparoscopic salpingo-oophorectomy. Intraoperatively, an edematous and hemorrhagic ovarian torsion, twisted thrice, was identified on the right adnexa. Abdominal pain is a common symptom among children, and it has various causes. Ovarian tumors or torsions are rare among pre-menarche female patients, and these entities do not present with prominent symptoms. Thus, their diagnosis is difficult, as seen in this case. Early diagnosis is necessary to preserve the ovarian function.