Ovarian cyst torsion co-existing with acute pyelonephritis in an eight-year-old premenarchal girl

Abstract

연구배경 및 목적: Adnexal torsion is an acute abdominal condition often confused with other diseases in children. We report the case of a premenarchal eight-year-old girl with an adnexal torsion accompanied by acute pyelonephritis with vague, non-specific symptoms.

대상 및 방법: We reviewed the medical record of a case of children whose adnexal torsion diagnosis was proven by surgery.

연구결과: 8-year-old girl presented to our emergency department with lethargy, lower abdominal pain including right flank pain, fever and tachycardia. Using ultrasonography and computed tomography scanning, right adnexal mass with fat component and calcification was detected on the right side. CT images also showed the possibility of appendicitis. Torsion of right dermoid cyst with hemorrhagic infarction and normal appendix were confirmed at laparoscopy and these conditions were combined with pyelonephritis.

결 론: In young girls, symptoms may be vague, with patients complaining of non-specific gastro-intestinal problems. Combination with other complications such as pyelonephritis makes the diagnosis of adnexal torsion even more difficult as the present case. Although the impact on menarchal development of oophorectomy or partial removal of ovarian tissue before menarche remains to be evaluated, timely recognition and treatment of adnexal torsion clearly increases the possibility of retaining the ovary. Therefore, to decrease the time between the onset of symptoms and the identification of patients at risk, sonography should be considered as a first imaging modality for evaluating children with any degree of abdominal pain accompanied by non-specific symptoms.