A treatment strategy in uterine adnexal torsion with a tumour mass in a 12-year-old girl: a case report

Uterine appendage torsion in children is an urgent problem of pediatric gynecology and surgery. An increase in the ovarian volume is associated with the risk of uterine appendage torsion, while tumor stem torsion is one of the main complications of ovarian tumors. Any newly identified lesion should be evaluated for malignancy which defines the type of surgical intervention. If the malignancy of the formation is excluded, ovarian-sparing surgery can be successfully applied.

The paper presents a case of uterine appendage torsion in a teenage girl with a benign germinogenic ovarian tumor who had been initially hospitalized with a clinical picture of an acute abdomen and non-specific symptoms for torsion. During laparoscopic detorsion, it was decided to refrain from removing the cystic formation from the affected ovary. In 3 months at the repeated hospitalization, the child was examined with ultrasound, magnetic resonance imaging with contrast to determine the concentration of a number of markers (alpha-fetoprotein, lactate dehydrogenase, chorionic gonadotropin). The patients was also consulted by an oncologist: a teratoma was detected and removed laparoscopically. The patient’s management was staged: first, detorsion of the right uterine appendages, then removal of the bulky formation of the ovary using the technique of relaparoscopy. After morphological examination, diagnosis of mature teratoma was put; an immunohistochemical assay confirmed it.

The presented clinical observation underlines the importance of early diagnostics and an individual approach to choosing a curative modality in case of uterine appendage torsion in girls. Laparoscopic organ-preserving surgery is the preferred approach so as to minimize tissue injury and to preserve ovarian reserves.

Presenting this clinical case is an important step so as to raise doctors’ awareness of the complications of ovarian tumors in children and adolescents (in particular, torsion of uterine appendages) which will help to improve diagnostics and treatment of such conditions in adolescent girls.