Ovarian Torsion Secondary to a Dermoid Cyst in a Child: A Case Report

A four-year-old girl presented with a two-day history of progressively worsening right lower abdominal pain, accompanied by anorexia and nausea. The initial assessment revealed lower abdominal tenderness with guarding and rebound tenderness, raising concern for an acute surgical abdomen. Ultrasonography demonstrated mild ascites and an enlarged left ovary with absent Doppler flow, suggestive of torsion. Emergent laparoscopic exploration revealed a 6×7 cm necrotic left adnexal mass with complete torsion of the ovary and fallopian tube. Detorsion was attempted, but the ovary remained nonviable, necessitating a left salpingo-oophorectomy. Gross examination revealed hair within the mass, and histopathology confirmed an infarcted ovarian dermoid cyst. The child had an uneventful recovery and was well at both the one- and three-month follow-ups. This case underscores the importance of the early recognition and prompt surgical management of pediatric ovarian torsion to prevent irreversible adnexal damage and preserve future fertility whenever possible.