Late diagnostics of uterine torsion in a 3-year-old girl: a clinical observation

Adnexal torsion in preschool girls is rare, and diagnosis is difficult due to the lack of pronounced clinical manifestations. The pathology is more common on the right side, which is due to the anatomy of the pelvis, and the clinical picture can be mistaken for acute appendicitis. Adnexal torsion is characterized by impaired blood supply and rapid development of necrosis in the affected organ, which requires emergency surgical intervention. The article presents a case of late diagnosis and treatment of a 3-year-old girl who was admitted to the Children's Republican Clinical Hospital in Saransk by an ambulance team with complaints of intermittent, sharp abdominal pain and a preliminary diagnosis of acute appendicitis. During a diagnostic ultrasound examination using color Doppler mapping, signs of a structurally altered right ovary without a vascular pattern were detected. Intraoperatively, a diagnosis of torsion, necrosis of the right uterine appendages, and secondary appendicitis was made. This case of a long diagnostic journey, complicated by the vague clinical picture of torsion combined with inflammation of the appendix, highlights the importance of both clinical and instrumental findings in young children with suspected urgent conditions. Despite the fact that the patient was discharged with improvement under the supervision of a district pediatrician, the girl's reproductive health was affected due to the long diagnostic process caused by the subclinical form of the disease. Thus, when abdominal pain occurs, given the importance of reproductive health for girls, doctors need to be particularly vigilant in order to detect and treat the disease promptly using organ-preserving methods.