Twist Of Fate: Ovarian Torsion In Adolescent Girls—A Five-Case Series From A South-Indian Tertiary Centre

Abstract

Background. Ovarian torsion (OT) represents about 2.7 % of all surgical emergencies in adolescents, yet it threatens future fertility through vascular compromise and subsequent necrosis Early recognition remains challenging because symptoms overlap with more common causes of acute abdomen .

Methods. We retrospectively analysed five consecutive adolescents (16–19 years) treated for OT at Saveetha Medical College, Chennai (2023-2024). Demographics, clinical presentation, ultrasound/Doppler features, operative findings, procedures and ovarian viability were reviewed. Main outcomes were time-to-intervention and ovary-sparing rate.

Results. Median age was 18 years (IQR 17–18). Right-sided torsion predominated (60 %). Median symptom-to-surgery interval was 11 h. Ultrasound showed enlarged ovaries (6.5–10 cm) with absent or reduced flow in all cases; Doppler venous flow was lost earlier than arterial signals. Three patients harboured benign cystic pathology (dermoid n = 1, functional cysts n = 2) and one had polycystic ovary. Detorsion with cyst management salvaged the ovary in four of five patients (80 %). One required salpingo-oophorectomy owing to three complete twists and frank necrosis. No peri-operative complications or recurrences occurred over six-month follow-up.

Conclusion. Prompt imaging-guided diagnosis and expeditious laparoscopy/laparotomy enabled a high ovarian preservation rate in adolescents with OT. Our series highlights that Doppler changes, especially absent venous flow, should trigger urgent surgical exploration. Conservative detorsion, even when the adnexa appears cyanotic, is safe and preferable to oophorectomy to safeguard endocrine function and fertility.