ESPE Abstracts

Introduction: Ovarian torsion (OT) occurs with partial or complete obstruction of blood flow as a result of rotation of the ovary around the infundibulopelvic ligament and/or utero-ovarian ligament. OT is very rare in the pediatric population. Although the most common form of presentation is abdominal pain, the unclear symptom profile in children can often result in missed diagnosis or late diagnosis. For the preservation of ovarian functions and future fertility; providing ovarian blood perfusion with early diagnosis is very important in terms of ischemia-reperfusion injury. Current surgical approach is detorsion±cystectomy±oophoropexy with ovarian incision. Here we present the follow-up of a case of ovarian torsion diagnosed with acute appendicitis in a prepubertal case.

Case: A 7 year-6-month old girl presented with the complaint of swelling in the left breast that had been going on for five months. From her medical history, it was learned that she was born 3250 g at term, was followed up due to scoliosis and her mother had a history of PCOS. In physical examination weight:21.3 kg (-0.84SDS), height:123.7 cm (-0.06SDS), breast development right Stage I/left Stage II, no axillary & pubic hair growth. Abnormal sweat odor, acne and cafe au lait spot were not detected. Bone age was 7 years 10 months. Serum gonadotropin and estrogen levels were prepubertal, both uterus and bilateral ovaries were pubertal in size on pelvic ultrasound, both ovaries were similar in size, and both had multiple millimetric follicles. LHRH test was prepubertal and tumor markers were negative. No treatment was required during puberty follow-up. The patient, who applied with the complaints of abdominal pain and vomiting in the second year of her follow-up, was operated with the suspicion of acute appendicitis. Appendectomy and right ovarian detorsion were performed when right ovarian torsion was detected with appendicitis in the diagnostic laparoscopy. Pathologically, it was confirmed that acute appendicitis was also present. In the postoperative 4th month doppler USG;while significant blood supply was observed in the left ovary, the color mode and spectral pattern of the right ovary could not be differentiated. AMH level was 4.68(0.25-6.34)ng/ml. Intraovarian normal blood supply pattern in the right ovarian tissue was observed only in the 13th month postoperatively.

Conclusion: OT is a rare surgical emergency in premenarche girls and its association with acute appendicitis has been rarely reported in the literature. There is a need for experience regarding the duration and permanence of ischemia-reperfusion injury after detorsion. The damage may be temporary or permanent, as in our case.