Ovarian torsion in a 5-month-old infant: A case report

Abstract

Introduction

Ovarian torsion is a rare gynecological emergency in infants. Its rarity and its nonspecific symptoms make its early diagnosis challenging.

Case presentation

A previously healthy 5-month-old infant presented with inconsolable irritability, diarrhea and signs of dehydration. She was a former 32 weeker born by Cesarean section with a weight of 1600 g after an uneventful pregnancy. On physical exam she was tachycardic and tachypneic, but afebrile. She had diffuse abdominal tenderness but no abdominal distension. Bloodwork showed leukocytosis but no other abnormalities. Abdominal ultrasonography (US) showed an enlarged, ovoid, hyperechogenic right ovary (3.6 × 1.9 cm) with multiple internal follicles but no detectable vascular flow, suggestive of right ovarian torsion. The left ovary appeared normal in size and vascularity. She was taken to the operating room emergently for an exploratory laparotomy which was done through an infraumbilical midline incision. We found a swollen, torsed right ovary with signs of ischemia. We detorsed the ovary and wrapped it in gauze soaked in warm normal saline solution. To alleviate intraovarian pressure and further improve perfusion we made several small incisions on the surface of the ovary. The ovary regained normal perfusion within 10 min. The postoperative course was uneventful. She was discharged home shortly after the operation. An US done one month later showed the right ovary still slightly larger than the left ovary but with normal vascular flow.

Conclusion

It is important to include ovarian torsion in the differential diagnosis of female infants that develop acute abdominal pain. Early surgical intervention is key to preserve the viability of a torsed ovary.