Ovarian torsion (OT) in the pediatric patient is an uncommon event and a challenging diagnosis. Clinicians caring for children in the acute setting should be aware of the symptoms and the diagnostic findings of OT. All patients suspected to have OT require consultation with gynecology; however, there is some controversy regarding the best operative intervention. In this article, case discussions will serve as a platform for discussing the epidemiology and clinical manifestations of pediatric OT, as well as reviewing the latest evidence related to the diagnosis and treatment.