Adnexal torsion is an acute abdominal condition often confused with other diseases in children. The objective of this study is to evaluate the diagnosis and characteristics of adnexal torsion in children.We reviewed the medical records of all cases of children whose adnexal torsion diagnosis was proven by surgery from 1992 to 2005. Neonatal cases were excluded.A total of 49 cases were included in this study, with a mean age of 12.5 years. Sixteen (32.6%) cases were premenarchal girls, who were more likely to have adnexal torsion missed at first clinical diagnosis when compared with postmenarchal girls (P = 0.032). Presenting symptoms included severe abdominal pain (32%) and a history of recurrent pain of more than 2 weeks (14.2%). Abdominal gray-scale ultrasound (US) in 43 patients revealed 41 cases that were suggestive of ovarian pathology and identified 3 torsions. Seventeen patients had both US and abdominal computed tomography, but no definitive adnexal torsion was diagnosed with the combined studies. When multiple radiographic studies were used, there was a significantly longer time from studies to operation as compared with US alone.Ultrasound usually plays an important, but not definitive, role in diagnosis. Multiple radiographic studies with combined computed tomography and US did not provide a diagnostic advantage over US alone. Most pediatric adnexal torsion occurs in postmenarchal patients, but the potential exists for this diagnosis in premenarchal girls. Adnexal torsion should be considered in any girl with an abdominal mass and any degree of abdominal pain.