Clinical Characteristics and Surgical Outcomes of Pediatric Ovarian Torsion: A 15-Year Single-Center Experience

Ovarian torsion is a pediatric surgical emergency in which timely diagnosis and preservation of ovarian tissue are important considerations for future reproductive and endocrine function. This study aimed to describe the clinical characteristics, diagnostic evaluation, surgical management, and outcomes of pediatric ovarian torsion and explore factors associated with ovarian preservation and oophorectomy.

A retrospective, single-center cohort study was conducted including 56 girls with surgically confirmed ovarian torsion treated at a tertiary pediatric center between January 2010 and December 2025. Secondary analyses of factors associated with oophorectomy were considered exploratory. Demographic, clinical, imaging, operative, and outcome data were extracted from medical records. Variables included symptom duration, degree of torsion, laterality, diagnostic assessment, gynecologist consultation, associated pathology, intraoperative macroscopic color change following detorsion, oophoropexy, oophorectomy, postoperative complications, and recurrence. Univariable comparisons were performed using the Mann-Whitney U test, chi-square test, Fisher's exact test, or Monte Carlo exact test, as appropriate. Exploratory multivariable logistic regression, supplemented by Firth penalized logistic regression, was performed in the postnatal cohort to assess factors associated with oophorectomy.

The median age at diagnosis was 10 years (range 0-17) and the median duration of symptoms before admission was 18 h (IQR 8-72). Ovarian preservation was achieved in 35 patients (62.5%), whereas complete oophorectomy or adnexectomy was performed in 21 (37.5%). Complete macroscopic color change following detorsion was observed in 19 patients (33.9%), partial color change in 13 (23.2%), and no macroscopic color change in 24 (42.9%). Prenatal ovarian torsion represented a clinically distinct subgroup and was associated with a high oophorectomy rate (8/8, 100%), compared with 13/48 (27.1%) among patients with postnatal torsion (p < 0.001). In the postnatal cohort, complete oophorectomy or adnexectomy occurred in 19.4% of patients with preoperative gynecologist consultation and 41.2% of those without consultation (unadjusted OR 0.34, 95% CI 0.09-1.28; p = 0.173). In exploratory multivariable analysis adjusting for age and calendar period, preoperative gynecologist consultation was not independently associated with oophorectomy (adjusted OR 0.41, 95% CI 0.09-1.78; p = 0.234); Firth penalized regression yielded similar results. Associated pathology was identified in 66.1% of patients. Documented recurrence occurred in three patients (5.4%), and postoperative complications were uncommon (3.6%).

Ovarian preservation was achieved in more than half of pediatric patients with ovarian torsion, whereas prenatal torsion was associated with a high oophorectomy rate. Preoperative gynecologist consultation was associated with a numerically lower unadjusted oophorectomy rate; however, this association was not statistically significant in either unadjusted or adjusted analyses, and residual confounding and changes in clinical practice over the 15-year study period cannot be excluded.