Ovarian Torsion in Prepubertal Girls: Clinical Characteristics, Biological and Radiological Features, Reccurency Rate

The diagnosis of ovarian torsion is made with delay among pre-pubertal girls and the management after the surgical detorsion is poorly codified. We interested in the French experience during the last two decades.

Retrospective study in French pediatric surgery centers from January 2000 to December 2022 concerning girls who presented with at least 1 episode of ovarian torsion in the prepubertal period. Data collected included patient history, symptomatology, biological and imaging assessment at first episode, emergency surgery, follow-up including recurrence.

Thirty centers participated and we included 502 girls diagnosed with ovarian torsion during a surgical procedure performed due to abdominal pain (with or without ovarian mass). The girls had a mean age of 7.9 years (±2.8) and a median age of 8.3 years (Q1 5.97; Q3 10.12) at the time of the first episode of torsion. Nausea or vomiting was present in 71 % of cases. Fever was present in 23 % of cases and was more displayed 24 h after the onset of abdominal pain (p < 0.0001). Mean follow-up was 2.1 (±2.61) years. Only 42 out of 142 (30 %) girls with enlarged ovaries (>97th percentile) were referred to the endocrinologist to assess the existence of hormonal anomalies. Of the 482 girls without oophoropexy after the first episode of torsion, 71 (14.7 %) experienced at least one recurrence. Among them: 10 (7.5 %) had an ovarian mass and 42 (55 %) enlarged ovaries.

Symptoms of ovarian torsion in pre-pubertal girls are not specific and clinicians should be aware of this insidious presentation in this group. These girls should be systematically referred to endocrinologists.