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

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Children; Ovarian torsion; Prepubertal; Reccurent torsion.