Polycystic ovary with adnexal torsion before the first menstrual cycle: A case report

Abstract

　Adnexal torsion in adolescents is not often associated with ovarian tumors when compared with that in adults. This is the case of adnexal torsion in a girl before menarche.

　A 13-year-old pre-menarche girl had a low-volume voice and experienced fast hair growth approximately 3 months before her visit. She had unbearable abdominal pain for the past 2 months. She presented at a previous hospital with bilateral polycystic ovaries and showed symptoms similar to those of polycystic ovary syndrome (PCOS). Abdominal echo and magnetic resonance imaging (MRI) showed swollen ovaries. After that, abdominal pain re-occurred, and a repeat MRI revealed that the swelling in the left ovary had increased, and it was edematous with no blood flow. Her pain had worsened, and she was hospitalized. Computed tomography revealed that her left ovary had grown to 8 cm, and the inside of the ovary was poorly deformed. Therefore, she was immediately transferred to our hospital for treatment. We suspected that her ovary had twisted, and left adnexal torsion was diagnosed on laparoscopy. Her left necrotic adnexa were then removed.

　A PCOS-like condition was diagnosed, based on ovarian pathology and the high testosterone level preoperatively.

　PCOS without tumors has the risk of causing ovary torsion. It is important to preserve the ovary function in adolescents. Therefore, when adnexal torsion is suspected, laparoscopy should be performed for diagnosis and treatment.