September 2017 · Volume 6 · Issue 9 Page 4144 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Sharma A et al. Int J Reprod Contracept Obstet Gynecol. 2017 Sep;6(9):4144-4146 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report A case report of tubo-ovarian torsion in 4 years old girl Aarti Sharma 1 , Shivshankar Lasune 2 *, Rupakala B. M. 2 , Harshitha Reddy 2 , Vineeta Yadav 2 INTRODUCTION Ovarian torsion first described by Kuestner in 1891. Torsion occurs secondary to abnormal twisting of involved ovary, fallopian tube or both on its ligaments support, which results in venous congestion, haemorrhage, and eventually ischemia. Prolonged ischemia of ovary or adnexal structure can leads to necrosis, resulting in loss of ovarian function or infection and peritonitis. 5 th most common gynaecological emergency comprising 2-3% of acute surgical emergencies. 1 Ovarian torsion is an infrequent diagnosis in the paediatric age group. The clinical picture is non-specific and children cannot articulate their symptoms, which often makes diagnosis as a challenge. Studies have found an estimated incidence of 4.9 per 100000 among females 1 to 20 years old. 2 and a diagnosis in up to 2.7% of cases presenting with acute abdominal pain. 3 Delay and misdiagnosis of adnexal torsion are common and leads to permanent damage to ovary, tube or both. 4 Current report shows 80-90% salvage of ovary and tube with early surgical intervention. 5 CASE REPORT A 4 years old girl brought to emergency dept of Rajarajeswari hospital with chief complaints. Lower abdominal pain since, 3 days. Fever since, 2 days. 1 episode of seizure. On examination, she was normotensive, temperature 100 F, pulse 110 beats/min and of good volume. CVS s1 s2 heard tachycardia present. RS B/L NVBS heard. PA slightly distended, tenderness present in right iliac fossa, guarding present, no organomegaly. Emergency USG (abdomen and pelvis) had done shown right side Tubo ovarian torsion. Colour Doppler showed absent blood flow, finding confirmed with MRI (Figure 1). CBC shows leucocytosis. RFT, LFT, SE, CXR and ECG WNL. As per ultra sound and MRI reports, which showed right sided Tubo ovarian torsion. Call given to pediatric surgeon and proceeded with diagnostic laparoscopy. Intra operative finding • Right side Tubo ovarian torsion. • Right adnexa twisted 360 0 (Figure 2). • Right side Tubo ovarian mass of 5*5cms with venous congestion (Figure 2). ABSTRACT Tubo-ovarian torsion is infrequent diagnosis, clinical picture is nonspecific and children cannot articulate their symptoms which make diagnosis as a challenge. High index of suspicious and early intervention prevents damage to adnexal tissue. Keywords: Laparoscopy, Laparotomy, Tubo-ovarian, Torsion 1 Department of Pediatrics, 2 Department of Obstetrics and Gynecology, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India Received: 25 June 2017 Accepted: 24 July 2017 *Correspondence: Dr. Shivshankar Lasune, E-mail: dreamradio15@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174079