Original Article Risk Factors, Symptoms, and Treatment of Ovarian Torsion in Children: The Twelve-Year Experience of One Center Ziv Tsafrir, MD*, Foad Azem, MD, Joseph Hasson, MD, Efrat Solomon, BSc, Benny Almog, MD, Hagith Nagar, MD, Joseph B. Lessing, MD, and Ishai Levin, MD From the Department of Gynecology (Drs. Tsafrir, Azem, Hasson, Lessing, Almog and Levin), Lis Maternity Hospital, and the Department of Pediatric Surgery (Dr. Nagar and Ms. Soloman), Dana Children’s Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. ABSTRACT Objective: To assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT). Study Design: A retrospective case review (Canadian Task Force Classification II-2). Setting: Teaching and research hospital, a tertiary center. Patients: Premenarchal children with surgically verified OT. Interventions: Patients underwent either laparoscopy or laparotomy. Results: Twenty-two cases of OTin 20 premenarchal girls (median age 12 years) were identified. Threecases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients under- went Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conserva- tive management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst. Conclusions: Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tender- ness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence. Journal of Minimally Invasive Gynecology (2012) 19, 29–33 Ó 2012 AAGL. All rights reserved. Keywords: Doppler; Ovarian torsion; Premenarchal treatment DISCUSS You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-19-1-11-00285 Use your Smartphone to scan this QR code and connect to the discussion forum for this article now* * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace. Ovarian torsion (OT) rarely occurs in childhood. Its annual prevalence is estimated to be 4.9 per 100 000 females aged 1 to 20 years [1]. Nevertheless, it should be considered in the differential diagnosis of every young girl who presents with acute abdominal or pelvic pain [2]. The symptoms and signs of OT are nonspecific and can be related to other clinical causes, for example, gynecologic, urologic, or gas- trointestinal [3–5]. Abdominal ultrasonography (AUS) is the modality of choice in the evaluation of the young female pelvis, providing clear visualization of the pelvic organs with no exposure to radiation, in addition to being highly available [6]. The demonstration of an ovarian mass or of ovarian enlargement by AUS in a child with abdominal pain must raise the suspicion of OT. The Doppler flow has also been recently studied for the purpose of assisting in the diagnosis of OT, but the results on its accuracy in detect- ing pathology have not been consistent [6]. The preferred treatment in the event of a confirmed OT is still a matter of debate as well. Ovarian vitality in the setting of OT is dependent on the duration of time until the diagnosis is established, before necrosis occurs. A growing number of studies advocate conservative surgery (ie, mainly detorsion The authors have no commercial, proprietary, or financial interest in the products or companies described in this article. The essence of the project was presented at the 13th World Congress On Controversies In Obstetrics, Gynecology & Infertility, which was held in Berlin, Germany, November 4-7, 2010. Corresponding author: Ziv Tsafrir, MD, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. E-mail: zivtsafrir@gmail.com Submitted June 15, 2011. Accepted for publication August 19, 2011. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2012 AAGL. All rights reserved. doi:10.1016/j.jmig.2011.08.722