Ovarian torsion among girls presenting with abdominal pain: a retrospective cohort study

Background Ovarian torsion (OT) is an important cause of abdominal pain in girls. Prompt recognition of OT may lead to higher rates of ovarian salvage. Objective To identify clinical and laboratory findings that may indicate OT among girls with abdominal pain. Methods Retrospective review of two cohorts of girls aged 5-17 years admitted to a children's hospital. Cohort 1: Girls admitted with abdominal pain from the emergency department (2008). Cohort 2: Girls with a discharge diagnosis of OT (2003-9). Results Cohort 1: 325 girls were admitted from the emergency department with abdominal pain during 2008. Of these, 9 (3%) were diagnosed with OT. Cohort 2: 37 girls were diagnosed with OT during 2003-9. Clinical or laboratory features differentiating OT from all abdominal pain could not be identified. A comparison of girls admitted with confirmed appendicitis showed that OT was more likely to be associated with a mass (RR=4.2, 95% CI 1.1 to 17), and less likely to be associated with anorexia (RR=0.46, 95% CI 0.23 to 0.93), guarding (RR=0.53, 95% CI 0.34 to 0.85), an elevated C reactive protein (RR=0.32, 95% CI 0.14 to 0.83), or leucocytosis (RR=0.4, 95% CI 0.21 to 0.78). Findings were similar in girls with an admission diagnosis of 'possible appendicitis'. Conclusion Clinical or laboratory features that would identify cases of OT among girls admitted with abdominal pain could not be identified. Some findings help to differentiate OT from appendicitis, but there is a large degree of overlap. OT is an uncommon condition, but has important management implications, and should be considered in all girls presenting with abdominal pain.