Watch this informative video on a rare case of Torted Ovarian Dermoid Cyst in a 7-year-old girl. This video explains the diagnosis, treatment, and surgical approach in detail, providing valuable insights for medical professionals and students."

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Ovarian dermoid cysts, also known as mature cystic teratomas, are benign germ cell tumors that can contain hair, teeth, fat, and other tissue elements. While relatively common in women of reproductive age, their occurrence in young children is rare. Even more uncommon is the complication of torsion, which can become a surgical emergency.

Case Overview

A 7-year-old girl presented to the pediatric emergency department with sudden-onset severe lower abdominal pain, accompanied by nausea and vomiting. Her parents reported intermittent abdominal discomfort over the past few days, but the acute worsening prompted immediate medical attention. There was no history of trauma or systemic illness.

On physical examination, the child was in distress, with localized tenderness in the lower abdomen. Vital signs revealed mild tachycardia but were otherwise stable. A firm, palpable mass was noted in the lower abdomen.

Diagnostic Workup

Ultrasonography (USG) of the pelvis is the first-line investigation in suspected ovarian pathology in children. In this case, USG revealed:

• A well-circumscribed complex cystic mass in the right ovary.

• Echogenic foci consistent with fat and calcifications, suggestive of a dermoid cyst.

• Signs of torsion: enlarged ovary with peripheral follicles and decreased or absent blood flow on Doppler imaging.

CT scan or MRI may be used in ambiguous cases to further characterize the lesion, but ultrasonography is often sufficient in pediatric emergencies.

Pathophysiology of Torsion

Ovarian torsion occurs when the ovary twists around its supporting ligaments, cutting off its blood supply. Dermoid cysts increase the risk of torsion due to their weight and size, even if small. Prolonged torsion can lead to ovarian infarction, necrosis, and potential loss of ovarian function.

Management

Surgical intervention is the definitive treatment for a torted ovarian dermoid cyst. The goals are to:

1. Untwist the ovary if viable.

2. Remove the cyst (cystectomy) while preserving as much ovarian tissue as possible.

3. Prevent recurrence and maintain future fertility.

In the case of this 7-year-old girl, laparoscopic surgery was preferred due to its minimally invasive nature. Intraoperatively:

• The right ovary was found to be twisted 360 degrees with a dermoid cyst measuring approximately 5 cm.

• Detorsion was performed, and the cyst was excised.

• The ovary appeared viable, and no oophorectomy was required.

Postoperative Care and Prognosis

Post-surgery, the child recovered uneventfully. Pain resolved, and she resumed normal activities within a few days. Follow-up ultrasound confirmed normal ovarian morphology.

The prognosis for pediatric ovarian dermoid cysts is excellent if timely surgical intervention is performed. Ovarian preservation is crucial in prepubertal girls to maintain future fertility. Recurrence is rare but possible, warranting periodic follow-up.

Key Points for Clinicians

• Ovarian torsion should always be suspected in acute lower abdominal pain in girls, even as young as 7 years old.

• Dermoid cysts, although benign, pose a risk for torsion due to their size and weight.

• Prompt imaging and surgical intervention are essential to preserve ovarian function.

• Laparoscopic cystectomy is safe, effective, and preferred in pediatric patients.

Conclusion:

Torted ovarian dermoid cysts in children are rare but potentially serious emergencies. Early recognition and minimally invasive surgical management can save ovarian function and ensure excellent long-term outcomes. Pediatricians and surgeons should maintain a high index of suspicion for ovarian torsion in young girls presenting with acute abdominal pain.