Acute Appendicitis Presenting as Right Ovarian Torsion in a Teenage Girl - A Case Study

Abstract

Background: Acute appendicitis is the most common abdominal surgical emergency in the pediatric population. In adolescent females, its diagnosis can be challenging as gynecological pathologies, particularly ovarian torsion, can present with similar symptoms. While both conditions are recognized, the phenomenon of appendicitis perfectly mimicking the clinical and radiological features of ovarian torsion is unusual and can lead to significant diagnostic and management delays.

Case Presentation: A 16-year-old female presented to the emergency department with a 24-hour history of acute, severe right lower quadrant pain, nausea, and vomiting. Physical examination revealed localized tenderness and guarding. A pelvic ultrasound, ordered to rule out gynecological pathology, showed a peripherally located, hypoechoic right adnexal mass with absent Doppler flow, highly suggestive of ovarian torsion. No clear, non-compressible appendix was identified. Based on these findings, the patient was taken for an emergent diagnostic laparoscopy with a presumptive diagnosis of right ovarian torsion. Intraoperatively, the right ovary and fallopian tube were found to be viable and normally positioned. Instead, a severely inflamed, retrocecal appendix was identified, which was adherent to the right pelvic sidewall, causing secondary inflammatory changes in the right adnexa. A laparoscopic appendectomy was performed. The patient recovered uneventfully.

Conclusions: This case highlights a critical diagnostic pitfall where acute appendicitis, especially in a retrocecal position, can clinically and radiologically mimic ovarian torsion. It underscores the limitations of ultrasonography and the importance of maintaining a broad differential diagnosis in adolescent females with acute abdominal pain. A low threshold for diagnostic laparoscopy is essential in such ambiguous cases to ensure correct identification and treatment of the underlying pathology, preventing unnecessary oophorectomy and managing the true surgical cause promptly.