Leave the Uterus Alone: Uterine Torsion in Children.

BACKGROUND: Uterine torsion is an extremely rare condition in pediatric patients and is most often associated with an ovarian mass. When acute symptoms occur, uterine blood supply may be compromised, occasionally leading to ischemia or necrosis. Because of its rarity and nonspecific presentation, pediatric uterine torsion may be misdiagnosed, and no clear recommendations currently exist regarding its management.

CASE: We report the case of a 21-month-old girl who presented with acute abdominal pain and vomiting caused by torsion of a large ovarian mature teratoma. Surgical exploration revealed a 270°-360° uterine torsion with signs of severe ischemia and a necrotic appearance of the uterus. A right salpingo-oophorectomy was performed, but a conservative approach was chosen for the uterus despite the absence of immediate macroscopic recovery after detorsion. The postoperative course was uneventful. Mid-term follow-up of 5.5 years demonstrated normal uterine morphology and vascularization on imaging, with the patient remaining asymptomatic.

SIGNIFICANCE: This case highlights uterine torsion as a rare but possible complication of ovarian masses in children and a potential cause of acute abdominal pain. Our experience, supported by a review of the literature, suggests that conservative uterine management should be considered whenever possible, even in the presence of a necrotic appearance. Long-term follow-up is essential to assess uterine recovery and potential functional outcomes.