a 13-year - old premenarchal girl presented with a 2  days history of gradually worsening right iliac fossa ( rif ) pain and vomiting .
she had a background of gastroschisis which was corrected at birth with no further complications . on examination her abdomen was soft with localized tenderness and voluntary guarding of the rif .
ultrasound scan of the abdomen revealed an enlarged and echogenic mass in the pelvis which was difficult to characterize sonographically ( fig.1 ) .
the right ovary was necrotic and enlarged measuring 70    30    30  mm in size ( figs.2 and 3 ) .
histopathology revealed no underlying ovarian lesion ; the ovary was engorged with massive edema and hemorrhage .
findings at exploratory laparoscopy ( a ) right adnexal torsion ( arrow ) with moderate amounts of bloody fluid in the pelvis and ( b ) enlarged right ovary and distal fallopian tube
pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis 1 . in children , it is most common around menarche 2 . if left untreated , ovarian torsion may result in tissue necrosis , loss of ovarian function , and may eventually cause infection and peritonitis 1,3 .
the true incidence of pediatric ovarian torsion is unknown and most cases are due to underlying ovarian pathology 2 .
emergency surgical exploration to salvage gynecological function is crucial in suspected ovarian torsion , however , children usually present too late after the onset of symptoms 3 .
 key clinical messagepediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis . 
 most cases are due to underlying ovarian pathology and if left untreated , ovarian torsion may eventually cause peritonitis . 
 emergency exploratory laparoscopy represents a valuable diagnostic and therapeutic tool in suspected ovarian torsion . 
Case
Discussion
Conflict of Interest