The role of preoperative D-dimer levels in diagnosing adnexal torsion in children and adolescents: a prospective monocentric pilot analysis.

Introduction: The diagnosis of adnexal torsion in children remains nonspecific. In some studies, D-dimer was shown to be a promising biochemical marker, especially in animals. This analysis aimed to preliminarily evaluate the specificity and sensitivity of D-dimer levels in predicting the diagnosis of adnexal torsion at our institution. Methods: All female patients who presented at the emergency department from January 2022 to December 2024 with symptoms suggestive of adnexal torsion were prospectively enrolled in the study. Preoperative D-dimer levels were obtained for all patients undergoing surgical exploration. Descriptive analysis was computed, and a receiver operating characteristic curve was constructed via univariate logistic regression. Results: Of the 27 eligible patients, 15 (aged 7-17 years) participated in the study. Torsion was found on the left side in six patients (40%) and on the right side in nine patients (60%). Almost all patients (80%) were treated laparoscopically. No postoperative complications were encountered. None of the examined variables were significantly correlated with adnexal torsion. Notably, D-dimer levels were higher in patients with adnexal torsion (odds ratio = 1, Conclusion: No association was observed between D-dimer levels and ovarian torsion in our cohort. Nonetheless, the sensitivity and specificity results lead us to believe that preoperative D-dimer levels could help surgeons in more accurately predicting the possibility of an adnexal torsion in children and adolescents, but this should not replace imaging studies and diagnostic laparoscopy especially in doubtful cases.