Presentation
Acute constant lower abdominal pain, crying, and vomiting for two days
Patient Data
The left ovary is enlarged in size (2.5 x 4.3 cm) with a homogeneous oedematous parenchymal echotexture and peripherally distributed follicles. It is seen mildly displaced to the midline posterior to the urinary bladder. No detected colour flow within the left ovarian parenchyma on colour Doppler on low Doppler settings. No ovarian or para-ovarian masses could be detected. No detected pelvic free or localised fluid collections.
The right ovary is average in size and located at the right adnexal region with no detected lesions.
Case Discussion
Ovarian torsion in children is an uncommon cause of acute abdominal pain and should be considered in any girl with acute onset lower abdominal pain accompanied by vomiting 1.
It is an emergency that mandates early diagnosis and timely surgical exploration and detorsion to avoid the catastrophic consequence of further adnexal injury. However, because the signs and symptoms can mimic other acute abdominal conditions, the preoperative diagnosis often remains a challenge for primary care physicians 1.
This case was clinically misdiagnosed until an ultrasound was requested due to the persistence of the symptoms for two days despite analgesia.
Ultrasound is the most useful initial diagnostic modality. However, the absence of flow on Doppler imaging is not always present and can not exclude diagnosis 1.
Conservative management consisting of detorsion and oophoropexy is currently advocated despite the macroscopic appearance of the ovary 1.
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