Characteristics and Management of Ovarian Torsion in Premenarchal Compared With Postmenarchal Patients.

OBJECTIVE To compare the clinical, ultrasonographic, and operative characteristics of premenarchal and postmenarchal patients with surgically verified ovarian torsion. METHODS A retrospective cohort study of all patients with surgically verified ovarian torsion operated on at a single university-affiliated tertiary medical center during 1997-2013. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure, and pathologic findings were analyzed. RESULTS A total of 41 premenarchal and 208 postmenarchal patients were diagnosed with ovarian torsion during the study period. Median ages were 9 and 27 years, respectively. Median duration of symptoms before first presentation was longer among the premenarchal patients (24.0 compared with 8.0 hours, P<.001) as was the median interval from hospital admission to surgery (9.5 compared with 4.6 hours, P<.001). Premenarchal girls had a higher rate of restlessness, fever, and evidence of pelvic mass at presentation and a similar rate of ultrasonographic signs for torsion (78.5% compared with 73.1% P=.53). During surgery, a finding of a black-bluish ovary was more common in premenarchal girls (61.0% compared with 41.3%, P=.02). CONCLUSION 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. These data may aid the physician in the evaluation of abdominal pain in premenarchal girls. LEVEL OF EVIDENCE II.