What is the presentation of ovarian torsion in premenarchal girls?

Updated: Jun 27, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Ovarian torsion in premenarchal girls is associated with a longer interval from onset of symptoms and an increased rate of fever and pelvic mass at presentation compared with postmenarchal patients, according to one study. Median duration of symptoms before presentation was 24 hours for premenarchal patients, versus 8 hours for postmenarchal patients. [1]  In another study, of 32 premenarchal patients with ovarian torsion, the main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). Abdominal tenderness was present in 64.1%.On abdominal ultrasound, an enlarged ovary was identified in 28.9%. [2]

In a retrospective study of ovarian torsion in premenarchal and postmenarchal patients in Israel, there was a higher frequency of nausea and vomiting in the premenarchal patients. Ovarian cysts were more commonly demonstrated in postmenarchal patients, and a normal adnexal appearance on ultrasound was more common in premenarchal patients.  Because of a normal adnexa in 69% of cases in premenarchal patients, a high index of suspicion is necessary in any premenarchal patient with acute-onset abdominal pain. [3]


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