The Twisted Ovary in Infancy and Childhood: Current Guidelines for an Old Dilemma

Ovarian torsion is a rare but critical gynaecological emergency. This manuscript aims to provide a review of the current understanding of ovarian torsion, its clinical presentation, diagnostic modalities, management strategies, and outcomes. This review aims to enhance awareness among healthcare providers and improve the timely diagnosis and management of this potentially devastating condition. A torsed ovary poses significant diagnostic and therapeutic challenges, particularly in infants and young children. It requires prompt recognition and intervention in order to prevent irreversible damage to the ovary and subsequent implications for fertility and overall reproductive health. The ovary twists on its ligamentous support, obstructing blood supply to the organ which potentially results in ischaemia and necrosis of ovarian tissue. While simple ovarian cysts are common, true ovarian neoplasms are definitely rare in infancy and unusual in childhood. A variety of treatment options are available like pre-natal or post-natal cyst aspiration, observation and surgery. Both open surgical and laparoscopic approaches are feasible. Laparoscopy has emerged as a gold standard for the diagnosis of ovarian torsion and masses. The surgical choices vary from ovary-sparing procedures like detorsion alone or detorsion combined with an oophoropexy; ovarian cystectomy; fenestration and de-roofing of cyst to more radical approaches like salpingo-oophorectomy, which obviously entails loss of the organ. The treating surgeon or the gynaecologist is faced with the following three questions: is the organ viable? can it be a malignancy? and which treatment option will be best suited for the individual case. This makes the topic not only interesting for discussion but valuable for future scientific research.