An ovarian torsion in a 2-year-old girl: a case report
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(2020) 14:194
CASE REPORT
Open Access
An ovarian torsion in a 2-year-old girl: a case report Mawanane Hewa Aruna Devapriya De Silva1* , Padmini Kolombage2 and Sembakutti Kasthuri2
Abstract Background: Abdominal pain is one of the most common complaints by patients in the emergency department. Diarrhea, constipation, and urinary tract infection are the commonest etiologies among these patients, but there are surgical emergencies, such as appendicitis and volvulus of the intestine, which are less common. Torsion of the ovary is rarer than all of the above conditions. Ovarian torsion occurs following the twisting of the ovary on its ligamentous attachment, possibly with a cyst, leading to the impediment of blood flow. Prompt diagnosis with a high clinical suspicion is essential to salvage the ovaries and to prevent complications, including death. Case presentation: Here, we present a case of ovarian torsion in a 2-year-old Sri Lankan girl who presented with nonspecific abdominal symptoms after being symptomatically treated twice by her general practitioners for 3 days. Following biochemical and radiological investigations, she was diagnosed with a twisted necrotic ovarian torsion and underwent laparoscopic right-sided oophorectomy. Conclusions: Finding the etiology of a child with abdominal pain is challenging, especially because of the limited history, examination findings, the difficulty in carrying out radiological investigations, and the poor specificity of the results compared with adults. This is a case presentation and a brief discussion about the dilemmas and difficulties in the diagnosis and treatment of ovarian torsion in young children. Keywords: Ovarian torsion, Abdominal pain, Oophorectomy, Children
Background Ovarian torsion (OT) is an uncommon gynecological emergency. It is a diagnostic dilemma especially in children, due to non-specificity of the symptoms, overlapping differential diagnosis, and the non-specificity of most of the biochemical and radiological investigations. Hence, a high degree of clinical suspicion and timely investigations are required to confirm the diagnosis. Early diagnosis will salvage the ovary while a delay in diagnosis may lead to ramifications such as loss of ovarian tissue, intra-abdominal sepsis, septicemia, and death. We report a case of OT in a 2-year-old Sri Lankan girl who presented to our emergency department with * Correspondence: [email protected] 1 Department of Paediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka Full list of author information is available at the end of the article
nonspecific abdominal pain. Several factors confounded the diagnosis of OT. First, she was seen by her general practitioner twice prior to the presentation at the emergency department. Second, the mistaken belief of the rarity of OT, especially in very young children. Third, our patient initially had clinical and biochemical investigation findings of a urinary tract infection, although it was later proven to be an aseptic pyuria, which is a common presentation
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