Ovarian torsion presenting with epigastric pain in a pediatric patient: A case report

Introduction: Ovarian torsion is a rare gynecological surgical emergency. It typically occurs with a sudden onset of unilateral lower abdominal pain. However, ovarian torsion with epigastric or periumbilical pain in pediatric patients has not been thoroughly reported. Case presentation: A 7-year-old girl presented with a 2-day history of frequent vomiting and acute abdominal pain. The abdominal pain was mild, intermittent, and extended from the epigastric to the umbilical region. Physical examination revealed localized tenderness in the epigastric to the umbilical region. No abnormal findings were observed on abdominal or pelvic ultrasonography. Contrast-enhanced computed tomography (CT) of the abdomen revealed no bowel obstruction, free air, appendicitis, pancreatitis, urinary tract stones, large cysts, masses in the uterus, uterine adnexa, or aorta or mesenteric artery abnormalities. Frequent vomiting and mild epigastric pain improved gradually from day 5 of hospitalization. However, on day 7, the abdominal pain and vomiting recurred and moved from the epigastric region to the middle of the lower abdomen and persisted. Finally, the abdominal pain moved to the right lower quadrant and worsened. Abdominal and pelvic ultrasound and Magnetic Resonance Imaging (MRI) performed on day 11 revealed right ovarian torsion. An elective oophorectomy was performed to remove the right ovary. Her postoperative period was good. Conclusion: This case highlights the need to consider ovarian torsion as a differential diagnosis of epigastric pain in pediatric patients.