Ovarian torsion in a two-year-old

Abstract

Introduction: Ovarian torsion occurs infrequently; and usually another diagnosis, such as appendicitis or intussusception, is initially suspected. Torsion of ovary and testis occurs with equal frequency, yet oophorectomy exceeds orchidectomy by a factor of two. This disparity is attributed to delay in diagnosis and misapprehension of operative findings. Case report: A two-years-old girl presented with abdominal pain and vomiting. Torsion of the right ovary was diagnosed by ultrasound (Figs. 1– 4). The ovary was untwisted laparoscopically and preserved, despite its grossly abnormal appearance (Fig. 5). Two follow-up ultrasounds were performed; both studies showed normal ovaries bilaterally (Figs. 6 and 7). Discussion: Torsion has these prerequisites:• the mass has bulk and is lopsided.• the mass has no surface adhesions.• the mass has a narrow tether.The ovaries of a two-year-old are tiny and unlikely candidates to twist. Ovarian cysts and tumors may elicit torsion, but these are rare during childhood; their estimated incidence is 5/100,000. Conclusion: These considerations and the appearance of the ovary argued for oophorectomy, especially since malignancy, though rare in pediatrics, occurs most frequently in girls who are 2 years-old or less. Nevertheless, the best practice recommendation is preservation of the ovary; and this decision proved correct.

Keywords

• Ovarian Torsion
• Ovarian Tumors in Children
• Ovarian Preservation