A brief review of the literature of twisted ovarian cysts in children is presented. The condition is most frequently confused with acute appendicitis because of the greater incidence of right-sided twisted ovarian cysts. A case of twisted ovarian cyst in a 3 year old child with operation and recovery is presented. A symptom complex is suggested to aid in the preoperative diagnosis. A plea is made for more frequent rectal examinations in young children with abdominal pain.