Background:
Polycystic ovarian syndrome (PCOS) is a multifactorial disorder that becomes apparent during adolescence with a variety of hormonal and metabolic symptoms. The cause of PCOS is unknown but studies suggest a strong genetic component that is affected by the gestational environment and lifestyle factors. Prepubertal metabolic dysfunction may be one of the first phenotypic traits observed in adolescent girls likely to develop PCOS. Polycystic ovaries are usually enlarged and are therefore at greater risk of ovarian torsion. Ovarian torsion is a rare presentation in a recently pubertal girl but it is important to establish the diagnosis early in order to preserve the affected ovary. A number of surgical techniques have been used to try to prevent retorsion with variable success.

Case: a 14 yo girl presented to the A&E department with acute lower abdominal pain. She had a history of recurrent lower abdominal pain since the age of 7. She had been investigated by a paediatric endocrinologist and an ultrasound showed enlarged ovaries. All hormonal investigations were found to be normal. She commenced pubertal development at the age of 11 and experienced menarche at 13 years. She had a second period 3 months prior to her presentation with acute lower abdominal pain. An ultrasound showed enlarged ovaries and probably torsion of the right ovary. At laparoscopy she was found to have markedly enlarged polycystic ovaries and the right ovary was torted twice on its pedicle. The ovary was viable and no definite cyst was seen. She had a markedly elongated right ovarian ligament and the ovary was detorted. An ovariopexy was performed by fixing the proximal end of the ovary to the uterus resulting in significant shortening of the ovarian ligament. The uterus and both fallopian tubes were normal.
Conclusion; We will discuss a number of laparoscopic surgical techniques for the treatment of torsion involving enlarged polycystic ovaries in adolescent girls.