In general, acute abdominal pain due to ovarian endometrioma is strongly associated with ovarian cyst rupture, as a result of adhesions to tissues around the cyst, especially the broad ligament. Therefore, the choice between surgery or palliative treatment may be difficult. However, torsion of endometrioma can occur, especially among adolescent females with weak adhesions, and palliative treatment in such situations can impair ovarian function.
Here, we describe a case in which torsion of ovarian endometrioma developed in an adolescent female, and we discuss the relevant literature. A 17-year-old female presented with severe abdominal pain. We previously demonstrated that she had a left ovarian endometrioma with a diameter of 7 cm, and planned laparoscopic surgery after magnetic resonance imaging evaluation. At that time, the area of her pain was consistent with left ovarian endometrioma, and its diameter subsequently increased to 10 cm. We diagnosed ruptured endometrioma, and performed emergency laparoscopic surgery. The left ovarian endometrioma with mild adhesions to the broad ligament was found to be twisted 180° counterclockwise around the axis of the point of adhesion and the tubal ligament. Postoperatively, the patient’s pain was relieved, and she is now receiving a prophylactic course of low-dose oral contraceptive medication.
In this case, we performed surgery due to the patient’s severe abdominal pain, and if we had not, her left ovarian function would have been impaired. Torsion of endometrioma should be considered in the differential diagnosis of acute abdominal pain in adolescent females.
