Recurrent Ovarian Torsion Despite Previous Oophoropexy in a 9-Year-Old Prepubertal Girl: A Pediatric Emergency Department Perspective

Objective: Unusual clinical course Background:Ovarian torsion is an uncommon but time-sensitive gynecologic emergency in children.Diagnosis may be challenging because symptoms can be nonspecific and Doppler ultrasonography may demonstrate residual ovarian blood flow.Although oophoropexy may be performed to reduce recurrence, torsion can recur after fixation.Case Report:A 9-year-old prepubertal girl with a history of left ovarian torsion treated by laparoscopic detorsion and oophoropexy presented with 2 days of severe intermittent left-sided abdominal pain and 1 day of vomiting.She was afebrile and hemodynamically stable, without peritoneal signs.Transabdominal ultrasonography demonstrated an enlarged left ovary measuring 41 × 37 × 32 mm (approximately 27 mL), with diminished vascularity and faint internal flow on color and power Doppler imaging.Urgent laparoscopy confirmed recurrent left ovarian torsion of approximately 360°.The ovary was viable, and no ovarian cyst or adnexal mass was identified.Detorsion and utero-ovarian ligament plication were performed, preserving the ovary.At 8-week follow-up, ultrasonography demonstrated normalization of the left ovarian size to 16 × 14 × 24 mm (approximately 2.7 mL), with no adnexal lesion or pelvic free fluid. Conclusions:Recurrent ovarian torsion can occur despite previous oophoropexy.Residual Doppler flow should not exclude torsion when clinical suspicion remains high.Prompt surgical evaluation can permit detorsion and ovarian preservation.