Ovarian torsion in prepubertal girls with abdominal pain - Imaging findings and literature review

Background: Ovarian torsion occurs when the ovary twists on its pedicle. This uncommon cause of acute abdomen is usually accompanied by ovarian abnormalities in post-menarchal girls. In prepubertal girls, the diagnosis is even less common. Discussion: The signs and symptoms of ovarian torsion are often vague and non-specific, especially in young girls who have difficulty explaining themselves. Ultrasound is the first line imaging modality and can diagnose ovarian torsion, as well as some of the differential diagnosis. In an equivocal case, computed tomography and especially magnetic resonance imaging, can help in making the correct diagnosis. Here, we report the imaging findings of 3 prepubertal girls with ovarian torsion, who had similar clinical presentation. In the first two cases, the diagnosis was made relatively fast. In the third case, the findings of the ultrasound examination were not specific enough and additional examination with computed tomography and magnetic resonance imaging was needed; consequently, the damage to most of the adnexa was irreversible. Conclusion: It is important to remember the ultrasound signs of ovarian torsion when examining young girls with acute abdomen, since early diagnosis followed by prompt surgery enables successful treatment, preservation of the adnexa and of fertility, and prevention of complications.