75. Ovarian Function in Paediatric and Adolescent Ovarian Torsion- Effect of immediate cystectomy

Abstract

<h3>Background</h3> Adnexal torsion is a rare diagnosis in patients under 18, accounting for approximately 2.7% of all cases of acute abdominal pain presenting to the emergency department in children. Current guidelines have proposed early diagnosis and detorsion as the optimal management at the time of torsion. However, the role of concurrent cystectomy at the time of initial surgery is less clear with the potential of increased ovarian dysfunction postoperatively. Our primary aim is to determine if cystectomy at the time of detorsion is associated with higher rates of impaired ovarian function compared to detorsion alone. <h3>Methods</h3> REB approval was obtained. This is a retrospective cohort study in a single large tertiary referral centre with a dedicated paediatric and adolescent gynaecological service. Confirmed cases of adnexal torsion in patients under 18 from January 1st 2004 to December 31st 2018 were identified from surgical logs and electronic chart database. Data was collected on demographics, surgical procedure and intraoperative findings, pathology data and postoperative ultrasonographic findings. We excluded cases which required oophorectomy or of isolated tubal torsion. Ovarian function on ultrasound was defined as the presence of any of the following: follicles present, normal blood flow or radiologist impression of normal ovary for patient age. <h3>Results</h3> Our initial search highlighted 598 potential cases of adnexal torsion. At the time of submission, 150 of these have been examined, with 20 cases of adnexal torsion identified. Patients ranged in age from 7 years to 17 years (mean age 12 years). 80% (n=16) had at least one co-existing ovarian cyst, and all of these patients underwent immediate cystectomy at detorsion. 50% (n=8) of these cysts were mature teratomas on subsequent histological analysis. Two patients had a subsequent adnexal torsion at a later date, and one patient underwent oophoropexy at the time of their initial adnexal torsion. 75% (n=12) of the cases, which involved an ovarian cystectomy, had subsequent ultrasound imaging and all of these confirmed normal ovaries. <h3>Conclusions</h3> Our initial results suggest that ovarian cystectomy at the time of adnexal detorsion may not be harmful. 100% of cases with postoperative imaging after an ovarian cystectomy at the time of detorsion had a subsequent reassuring ultrasound. Our research has been delayed due to the current global pandemic. We will have full results of this study ready for presentation at NASPAG in March 2021. Thus far, we feel our results above show great potential and we look forward to sharing our full findings.