A rare cause of acute abdomen in children: a torsioned giant mature cystic teratoma in an 11-year-old girl

Ovarian torsion, which is an uncommon cause of abdominal pain, is usually caused by dermoid and benign functional cysts in pre-menarcheal girls. Therefore, their diagnosis is difficult, as seen in this case. This case is the case of an 11-year-old pre-menarcheal girl who was admitted to our hospital due to abdominal pain and bilious vomiting. During the abdominal examination of the patient, who was in the premenstrual period, she had abdominal pain in both lower quadrants. There was significant tenderness. During rectal examination, a perirectal mass was palpated on the right. Leukocyte count (17,000 /mm³) and tumor markers AFP and beta HCG were at normal levels. Ultrasonography (US) showed a peripherally located, hard lesion with millimetric cystic areas, 12x9x8 cm in size, with a heterogeneous internal structure, in the right ovary region. During the surgery, serohemorrhagic fluid was detected in the abdomen and 720° clockwise right adnexal torsion was detected. The right ovary was deformed. A sample was taken with a syringe for cytology. The mass in the right ovary was approximately 12x9x8 cm in size and contained cystic and solid components. There were necrotic and occasionally hemorrhagic areas in the right ovary and fimbria. Due to the gangrenous appearance of the ovary, a right salpingo-oophorectomy was performed. The patient was discharged with recommendations on the 5th postoperative day. Surgical intervention should be performed early to reduce the risk to the patient's future fertility. In this way, we can prevent losing the ovary after infarction that occurs after ischemia and necrosis.