Original Report| Volume 32, ISSUE 3, P254-258, June 2019

Ovarian Torsion in Premenarchal Girls

Published:October 24, 2018DOI:


      Study Objective

      To investigate characteristics that differentiate premenarchal girls with ovarian torsion (OT) from those without OT at the time of surgery.


      Retrospective chart review of 36 premenarchal girls who underwent 42 surgeries for either OT (n = 33) or a nontorsed ovarian mass (n = 9) from 2006 to 2017.


      Large, tertiary care academic institution.


      We included patients aged 0-12 years with International Classification of Diseases, Ninth Revision codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube. Controls had International Classification of Diseases, Ninth Revision codes for ovarian mass or cyst, who also underwent surgery and did not have OT.


      Records were reviewed for patient characteristics including laboratory and imaging studies, surgical intervention, and pathologic diagnosis. Fischer exact test and the nonparametric Mann–Whitney U test were used for statistical analysis.

      Main Outcome Measures

      Characteristics predictive of OT in premenarchal girls.


      Twenty-nine premenarchal patients were diagnosed with 33 episodes of OT. Nine patients underwent surgery for ovarian masses but did not have OT. All patients with OT reported abdominal pain (compared with 55.6% without OT; P < .001) and most had nausea and/or emesis (81.8% vs 33.3%; P < .009). Ultrasound findings of ovarian enlargement and decreased Doppler flow were significant in the OT group (P < .083, P < .009). There were 2 cases of malignancy in each group.


      Patients with OT had significantly more nausea, emesis, and abdominal pain compared with those without OT. Additionally, 2 of 4 malignancies were found in patients with OT, indicating that malignancy should still be considered with large, complex masses.

      Key Words

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        • Damigos E.
        • Johns J.
        • Ross J.
        An update on the diagnosis and management of ovarian torsion.
        Obstet Gynecol. 2012; 14: 229
        • Hibbard L.T.
        Adnexal torsion.
        Am J Obstet Gynecol. 1985; 152: 456
        • Childress K.J.
        • Dietrich J.E.
        Pediatric ovarian torsion.
        Surg Clin North Am. 2017; 97: 209
        • Ashwal E.
        • Krissi H.
        • Hiersch L.
        • et al.
        Presentation, diagnosis, and treatment of ovarian torsion in premenarchal girls.
        J Pediatr Adolesc Gynecol. 2015; 28: 526
        • Quint E.H.
        • Smith Y.R.
        Ovarian surgery in premenarchal girls.
        J Pediatr Adolesc Gynecol. 1999; 12: 27
        • Ganer Herman H.
        • Shalev A.
        • et al.
        Clinical characteristics of adnexal torsion in premenarchal patients.
        Arch Gynecol Obstet. 2016; 293: 603
        • Smorgick N.
        • Melcer Y.
        • Sarig-Meth T.
        • et al.
        High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa.
        Fertil Steril. 2016; 105: 1561
        • Schuh A.M.
        • Klein E.J.
        • Allred R.J.
        • et al.
        Pediatric adnexal torsion: not just a postmenarchal problem.
        J Emerg Med. 2017; 52: 169
        • Ashwal E.
        • Hiersch L.
        • Krissi H.
        • et al.
        Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients.
        Obstet Gynecol. 2015; 126: 514
        • Schwartz B.I.
        • Huppert J.S.
        • Chen C.
        • et al.
        Creation of a composite score to predict adnexal torsion in children and adolescents.
        J Pediatr Adolesc Gynecol. 2018; 31: 132
        • Sintim-Damoa A.
        • Majmudar A.S.
        • Cohen H.L.
        • et al.
        Pediatric ovarian torsion spectrum of imaging.
        Radiographics. 2017; 37: 1892
        • Servaes S.
        • Zurakowski D.
        • Laufer M.R.
        • et al.
        Sonographic findings of ovarian torsion in children.
        Pediatr Radiol. 2007; 37: 446
        • Ngo A.V.
        • Otjen J.P.
        • Parisi M.T.
        • et al.
        Pediatric ovarian torsion: a pictorial review.
        Pediatr Radiol. 2015; 45 ([quiz: 1842]): 1845
        • Spinelli C.
        • Buti I.
        • Pucci V.
        • et al.
        Adnexal torsion in children and adolescents: new trends to conservative surgical approach -- our experience and review of literature.
        Gynecol Endocrinol. 2013; 29: 54
        • Dasgupta R.
        • Renaud E.
        • Goldin A.B.
        • et al.
        Ovarian torsion in pediatric and adolescent patients: a systematic review.
        J Pediatr Surg. 2018; 53: 1387
        • Tsafrir Z.
        • Azem F.
        • Hasson J.
        • et al.
        Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center.
        J Minim Invasive Gynecol. 2012; 19: 29
        • Oltmann S.C.
        • Fischer A.
        • Barber R.
        • et al.
        Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance.
        J Pediatr Surg. 2010; 45: 135