Don't Hesitate, Operate: Clinical Implications of Adnexal Torsion in Premenarchal Girls

To compare clinical presentation, imaging features, laboratory parameters, and surgical outcomes of adnexal torsion between premenarchal and early postmenarchal girls.

Retrospective cohort study.

A single tertiary, university-affiliated medical center in Israel.

Girls from birth to 14 years of age who underwent surgery for suspected adnexal torsion between 2016 and 2023 were included in the study.

Diagnostic imaging, laboratory evaluation, and surgical management (laparoscopy or laparotomy).

A total of 62 patients were included: 42 premenarchal and 20 postmenarchal. Confirmed torsion was significantly more common in premenarchal patients (95.2% vs 50%, p <.001), who also had higher rates of bilateral torsion (61.9% vs 30%, p <.001) and ischemic-appearing ovaries (57.1% vs 25%, p = .029). Premenarchal girls more frequently presented with urinary symptoms (28.6% vs 5%, p = .043) and elevated inflammatory markers. Ovarian cysts were more common in postmenarchal patients, while ultrasound findings were less often diagnostic in this group. Detorsion was performed more frequently in premenarchal girls, while cyst drainage was more common in postmenarchal patients. Recurrence was observed only in the premenarchal group (26.2%, p = .012).

Adnexal torsion presents differently in premenarchal and early postmenarchal girls. Premenarchal patients often lack cystic pathology and may present with nonspecific symptoms, including urinary complaints, which can complicate clinical recognition. Awareness of these distinctions is crucial to ensure timely diagnosis, appropriate surgical management, and fertility preservation. In young girls with suspected torsion, early intervention should be strongly considered-even when imaging findings are inconclusive.