Adnexal torsion due to teratoma in a young adolescent

Adnexal torsion is a gynaecological emergency in which twisting of the ovary and/or fallopian tube around the vascular pedicle leads to impaired perfusion and ischemia. Non-specific symptoms in children and adolescents can delay diagnosis.

We present the case of a teenage girl admitted to hospital with lower abdominal pain and a palpable mass. She had a history of chronic constipation and had not had a bowel movement for 5 days. Initial ultrasound evaluation of the mass by gynaecologists and radiologists was interpreted as being of extragenital origin. Her mild symptoms, ultrasound findings and constipation history prompted an initial diagnostic evaluation for faecal impaction. However, CT imaging later revealed a right adnexal mass with suspected torsion. Laparoscopic detorsion with cyst excision was performed, preserving the ovary, with an uneventful recovery.

This case illustrates the diagnostic challenges associated with ovarian torsion in early adolescence. A laparoscopic, fertility-sparing detorsion is advised, with the aim of preserving the adnexa.