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Pediatric ovarian torsion is a rare surgical emergency. In premenarchal girls, ovarian torsion can occur with or without an ovarian cyst. Due to its nonspecific presentation, diagnosis can be very challenging. Case Report: A healthy 9-year-old girl presented to the Emergency Department with a six day history of intermittent left sided abdominal and flank pain, associated with vomiting. She appeared well on triage, and was triaged for nonurgent review. In the Emergency Department, the patient reported that she was seen by family doctor three days prior for the same symptoms and was treated for urinary tract infection with cephalexin. She denied any bowel habit changes or other systemic symptoms. She examined well, with mild tenderness over the left iliac fossa without guarding. A renal tract ultrasound was requested, and it showed a bulky left ovary with no vascular flow, suggesting ovarian torsion. The patient was subsequently taken to operating theatre and underwent laparoscopic detorsion of her left ovary. She was followed up in outpatient clinic with a pelvic ultrasound done at six weeks postoperatively which showed normal vascular flow and follicles in both ovaries. Conclusion: In conclusion, ovarian torsion in pediatric premenarchal population is a diagnostic challenge. Abdominal ultrasound is an essential diagnostic aid, and laparoscopy with detorsion is an accepted surgical management.

Left lower abdominal pain in a premenarchal girl: A case of ovarian torsion