Introduction This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients.

Methods Retrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019

Results The proportion of patients presented with acute onset pain, persistent or recurrent pain, and duration of pain less than 3 months was significantly higher in the TO group than in the non-TO group (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). The symptom of nausea and vomiting was more common among girls with torsion (P < 0.0001). 88.5% of girls with torsion had an ovarian cyst/mass ≥5 cm, compared with 75.0% in girls without torsion (P =0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm, acute onset pain, persistent or recurrent pain were significantly associated with increased risk of torsion.

Conclusion/Implications Most pediatric or adolescent patients with adnexal torsion present with acute onset of persistent, recurrent pain and had fixed pain sites. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL), particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain, may improve ovarian salvage.