Unfavorable Outcome Following Adnexal Detorsion in a 10-Year-Old Patient

Currently, there are no instrumental or laboratory methods available to assess the extent of ischemic injury to the ovary in cases of torsion. The evaluation of viability of the involved structures is based on visual inspection of the color and appearance of the gonad and fallopian tube. In doubtful cases, a decision is often made in favor of organ preservation in the hope of postoperative functional recovery. This publication presents a clinical case of a 10-year-old girl who had been experiencing intermittent abdominal pain for over three days. Torsion of the right adnexa was corrected surgically in a regional hospital. However, postoperative abdominal pain persisted, and she was hospitalized again 19 days later. Laboratory findings revealed elevated blood glucose levels, signs of hypercoagulation, and active thrombogenesis. Ultrasound imaging demonstrated a fixed, avascular mass measuring 71 × 58 × 89 mm located in the retrovesical space. A repeat laparoscopic surgery was performed. During pelvic revision, an infiltrate consisting of the right ovary, sigmoid colon, and greater omentum was found. The right ovary, which appeared gray, showed no signs of retorsion or perfusion and was excised after aspiration. Histological examination revealed ovarian tissue necrosis. The postoperative course was uneventful. Persistence of pain following adnexal detorsion, absence of blood flow in the affected ovary on transabdominal ultrasound, shortened activated partial thromboplastin time, elevated fibrinogen levels, and increased soluble fibrin–monomer complex may indicate the need for interval laparoscopy.