Polycystic Ovary, Recurrent Torsions vs. Midpain , Ovulation
Left picture: The operative diagnosis is a polycystic ovary which led to recurrent torsions and spontaneous reductions. Due to severe discomfort, treatment is urgent, e.g. an ovariopexy. With an earlier ovariopexy, such a severe and irreversible torsion as is visible on the right side of the patient could have been prevented. Today, in cases like these, ultrasound and diagnostic laparoscopy make it possible to avoid an open revision with the purpose of excluding an acute episode of a chronic-recurrent appendicitis. Right picture: The lower abdominal pain is caused by physiological processes of the mature ovary as midpain (ovulation) or premenstrual syndrome. Some of the teenagers have such severe pain that the clinical presentation is an abdominal emergency. A precise history, knowledge of the state of sexual development in the individual girl, and a careful abdominal examination allow a differentiation from operative causes of the discomfort; if necessary, combined with ultrasound, and, in case of extraordinary pains, as well as for the morphological assignment of the possible ovarian pathologies, a diagnostic laparoscopy.
Left picture: Schoolgirl with recurrent lower abdominal pain which became apparent as an acute abdominal emergency. An elongated mass 5 cm in size and having an irregular structure is visible in the left lower abdomen of the patient. Right picture: Teenager with regular episodes of lower abdominal pain which led to repeated emergency consultations. In the right lower abdomen a large oval structure with a size of up to 2 cm is visible which has some uneven areas on its surface.