Case Report on Left Ovarian Torsion: A Rare Complication in an Adolescent PCOS

Introduction: Ovarian torsion is an acute emergency and women in any age group having cysts may have this complication. With increase in number of women having PCOS mainly adolescent girls are also at risk of this complication. Here we report a case of young PCOS girl who presented with acute abdomen who was found to have left ovarian torsion. The emergency was managed by emergency laparoscopic derotation and oophoropexy.

Main symptoms and clinical findings: A 14 year old girl with PCOS presented with severe pain over right lower abdomen and was associated with 2 episodes of non-bilious vomiting. On examination she was anxious with tachycardia of 104 bpm. Right iliac fossa was tender without any distension, guarding or rigidity.

Main diagnoses, therapeutic interventions, and outcomes: Her lab investigation revealed leukocytosis with hormonal profile consistent with PCOS. On USG there was bulky left ovary of 7.9 x 5.5 x 4 cms and volume of 87cc with lack of arterial blood flow. She was promptly taken up for emergency laparoscopy where left ovary was rotated 360 degree clockwise with gangrenous looking cyst wall which improved on detorsion. Left ovary was then fixed to lateral pelvic wall in anatomical position.

Conclusion: All adolescent girls with ovarian torsion but no apparent ovarian pathology should be tested for PCOS using ultrasound and biochemical tests. Also girls with known PCOS in this age group presenting with acute abdomen, ovarian torsion should be considered and promptly investigated.