Ovarian Torsion in a 20-Month-Old Child: A Case Report

Introduction: Ovarian torsion is a rare surgical emergency, which consists of the twisting of the ovarian pedicle around the mesovarium, with consequent impairment of the blood flow, which causes haemorrhagic infarction and necrosis1. Although more prevalent in adolescents, this condition can also occur in younger children, necessitating prompt diagnosis and intervention to prevent significant morbidity. We present a case of a 20-month-old girl diagnosed with ovarian torsion, highlighting clinical presentation, the diagnostic challenges encountered, and the management strategies. This case underscores the critical need for heightened awareness among healthcare providers regarding the potential for ovarian torsion in paediatric patients, as timely surgical intervention is essential for preserving ovarian function and preventing long-term complications. Case report: A 20-month-old female presented to the emergency department with a 2-day history of severe right lower abdominal pain. The patient had significant pain, woke her from sleep, and on admission was observed bending over in discomfort, which was temporarily relieved with analgesia. There was no significant prior medical history, and no signs of trauma or infection were noted. The child had been healthy, with normal growth and development. Associated symptoms included occasional episodes of vomiting and reduced oral intake; however, there was no history of fever or changes in bowel habits. The abdominal examination revealed tenderness localized to the right lower quadrant on deep palpation with no guarding. An abdominal and pelvic ultrasound demonstrated an enlarged, echogenic right ovary with an ovarian volume of 16. 8ml and multiple prominent follicles, raising concern for ovarian torsion. Notably, the uterus and left ovary were not visualized. Laboratory investigations showed white blood cell count of 8. 19x10⁹/L, neutrophil count of 4. 23x10⁹/L, and CRP 1 mg/dl, which helped to reduce the likelihood of infectious causes for the patient's symptomatology. Given the concerning ultrasound findings and clinical presentation, the child was taken for urgent laparoscopic surgery. During the procedure, the right ovary was found to be twisted 360 degrees. The ovary was detorted, and the blood supply was successfully restored. The surgeon assessed the viability of the ovarian tissue, confirming it to be intact. A follow-up ultrasound was performed postoperatively, which was normal. This case underscores the importance of early recognition and intervention in pediatric ovarian torsion, highlighting the need for prompt surgical evaluation in similar presentations. Discussion: Ovarian torsion, although rare in young children, must be a key consideration in cases of acute abdominal pain in females. This case highlights the importance of recognizing ovarian torsion as a potential diagnosis, as its clinical presentation can mimic other conditions like appendicitis. Early diagnosis through imaging, such as ultrasound, is crucial, as it can reveal signs of torsion like an enlarged, echogenic ovary. Timely surgical intervention is essential to prevent complications and preserve ovarian function. Research shows that the viability of the ovary diminishes significantly with delays in treatment. Thus, enhancing awareness among healthcare providers about ovarian torsion can lead to quicker evaluations and better outcomes. In summary, maintaining a high index of suspicion for ovarian torsion is vital in young females presenting with abdominal pain. Early recognition and prompt management can significantly impact the preservation of ovarian tissue and he child's overall health.