Clinical characteristics of adnexal torsion in premenarchal patients

Purpose: To compare clinical characteristics of adnexal torsion in premenarchal patients as compared to postmenarchal ones. Methods: A retrospective 22-year cohort of all cases of surgically verified adnexal torsion in premenarchal and postmenarchal patients (excluding postmenopausal and pregnant patients). Data collected included symptoms, signs and imaging at presentation, surgical mode, and procedure and histology. Results: 16 cases of adnexal torsion among premenarchal patients were compared to 302 cases among postmenarchal ones. Clinical presentation was similar, notable only for more nausea and vomiting among the premenarchal group. Ovarian cysts were more commonly demonstrated among postmenarchal patients (82.4 and 30.8 %, p < 0.001), as opposed to a normal adnexal appearance on ultrasound, which was more common in premenarchal patients (69.3 vs. 17.2 %, p < 0.001). Absent Doppler flow, when preformed, did not differ statistically between the groups. Laparoscopic detorsion only was more commonly performed in premenarchal patients (56.2 vs. 19.8 %, p = 0.001), with a trend for detorsion and cystectomy/fenestration, which were more common in postmenarchal surgeries (25 vs. 50.6 %, p = 0.06). Histology was similar among both groups, with no cases of malignancy in premenarchal patients. Conclusion: Adnexal torsion in premenarchal patients is rare, presents similarly to older patients, but involves a normal adnexa in 69 % of cases, therefore requiring a high index of suspicion in any premenarchal patient with acute onset abdominal pain.