Ovarian Torsion In Children Research Articles

The Role of Neutrophyl-to-Lymphocyte Ratio as a Predictor of Ovarian Torsion in Children: Results of a Multicentric Study.

Pediatric ovarian torsion (OT) is an emergency condition that remains challenging to diagnose because of its overall unspecific clinical presentation. The aim of this study was to determine the diagnostic value of clinical, ultrasound, and inflammatory laboratory markers in pediatric OT. We performed a retrospective multicentric case-control study in patients with clinical and ultrasound suspicion of OT, in whom surgical examination was performed between 2016-2022 in seven pediatric hospitals. Patients were divided into two groups according to intraoperative findings: OT group (ovarian torsion), defined as torsion of the ovarian axis at least 360°, and non-OT group (no torsion). Demographics, clinical, ultrasound, and laboratory features at admission were analyzed. The diagnostic yield analysis was performed using logistic regression models, and the results were represented by ROC curves. We included a total of 110 patients (75 in OT group; 35 in non-OT group), with no demographic or clinical differences between them. OT-group patients had shorter time from symptom onset (8 vs. 12 h; p = 0.023), higher ultrasound median ovarian volume (63 vs. 51 mL; p = 0.013), and a significant increase in inflammatory markers (leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, C-reactive protein) when compared to the non-OT group. In the ROC curve analysis, the neutrophil-to-lymphocyte ratio (NLR) presented the highest AUC (0.918), with maximum sensitivity (92.4%) and specificity (90.1%) at the cut-off point NLR = 2.57. NLR can be considered as a useful predictor of pediatric OT in cases with clinical and ultrasound suspicion. Values above 2.57 may help to anticipate urgent surgical treatment in these patients.

Ovarian cyst mimicking acute appendicitis in children: a case report

Pediatric acute appendicitis is common; however, it is different from torsion ovarian cysts. The estimated incidence of ovarian torsion in children is 5 per 100,000 girls. Herein, we report two cases of ovarian torsion mimicking pediatric acute appendicitis mimicking ovarian cyst. In the first case, a girl who was being assessed for acute appendicitis was identified to have torsion of the ovarian cyst during the surgery. In the second case, a girl experienced a ruptured ovarian cyst but then got severe appendicitis following the surgical procedure. The simultaneous occurrence of appendicitis and ovarian cysts is rare. These two patients' acute gastrointestinal complaints and symptoms exhibit similarities and may coincide. Both patients underwent salpingo-oopherectomy and appendectomy. Both patients were healthy on hospital discharge in a healthy condition. Female patients with severe abdominal pain and amenorrhea should be evaluated for ovarian torsion. Diagnosing the condition may be challenging due to non-specific clinical signs.

Ovarian torsion in a 4-year-old girl: case report

Introduction: Ovarian torsion, a rare surgical emergency in children, is one of the uncommon causes of acute abdominal pain. In this study, a case of ovarian torsion in a 4-year-old female patient was reported. Case Presentation: A four-year-old female came to Bent al-Huda Hospital in Bojnurd, Iran with a complaint of abdominal pain that had started the day before the visit and was colicky. Abdominal examination showed tenderness in the right lower quadrant. The complete blood count (CBC) test was normal. In the Doppler ultrasound of the abdomen and pelvis, partial right ovarian torsion was observed. The patient underwent torsion under laparotomy and the ovary was preserved. Due to the length of the right utero vaginal ligament, the utero vaginal ligament was shortened with 8 stitches and fixed to the pelvic wall. The ovary was placed in its normal anatomical position and the abdominal wall was repaired. In the examination of the complete serial blood cell count, the test results were normal, and the patient was discharged 72 h after surgery in good general condition. Conclusion: Considering the non-specificity of ovarian torsion symptoms, the possibility of ovarian torsion should be considered in all female children with abdominal pain. However, ovarian torsion in children is a rare emergency that requires early and timely evaluation, diagnosis, and intervention to prevent subsequent catastrophic consequences.

128 Recurrent ipsilateral ovarian torsion in a premenarchal girl: What to do? A case report

Ovarian torsion is the complete or partial rotation of the adnexal supporting organ. This affects females of all ages. In premenarchal girls, the incidence is rare, being 4.9 in 100.000 [ [1] Ashwal E. Krissi H. Hiersch L. Less S. Eitan R. Peled Y. Presentation, diagnosis, and treatment of ovarian torsion in premenarchal girls. J Pediatr Adolesc Gynecol. 2015; 28: 526-529 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar ]. Ovarian torsion can be caused by ovarian cysts. Ovarian cysts are common in children with an incidence of 5% [ [2] Millar D.M. Blake J.M. Stringer D.A. Hara H. Babiak C. Prepubertal ovarian cyst formation: 5 years' experience. Obstet Gynecol. 1993; 81: 434-438 PubMed Google Scholar ]. Ovarian torsion can also occur in girls with normal ovaries. This happens particularly in premenarchal girls due to the elongated utero-ovarian ligaments [ [3] Nur Azurah A.G. Zainol Z.W. Lim A.A. Zainuddin P.S. Sulaiman A.S. Ng B.K. Update on the management of ovarian torsion in children and adolescents. World J Pediatr. 2014; 11: 35-40 Crossref PubMed Scopus (20) Google Scholar ]. Ovarian torsion is frequently misdiagnosed because symptoms are often nonspecific [ [3] Nur Azurah A.G. Zainol Z.W. Lim A.A. Zainuddin P.S. Sulaiman A.S. Ng B.K. Update on the management of ovarian torsion in children and adolescents. World J Pediatr. 2014; 11: 35-40 Crossref PubMed Scopus (20) Google Scholar ]. Hence, early diagnosis and surgery are essential to preserve fertility and prevent morbidity [ 3 Nur Azurah A.G. Zainol Z.W. Lim A.A. Zainuddin P.S. Sulaiman A.S. Ng B.K. Update on the management of ovarian torsion in children and adolescents. World J Pediatr. 2014; 11: 35-40 Crossref PubMed Scopus (20) Google Scholar , 4 Dasgupta R. Renaud E. Goldin A.B. et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J of Ped Surg. 2018; 53: 1387-1391 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 5 Comeau I.M. Hubner N. Kives S.L. Allen L.M. Rates and technique for oophoropexy in pediatric ovarian torsion: a single-institution case series. J Pediatr Adolesc Gynecol. 2017; 30: 418-421 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ].

Comparative Values of B-Mode Ultrasound and Contrast-Enhanced Ultrasonography in Diagnosing Ovarian Torsion in Children

Comparative Values of B-Mode Ultrasound and Contrast-Enhanced Ultrasonography in Diagnosing Ovarian Torsion in Children

'Conservative' organ-sparing approach for ovarian torsion in children

To improve the outcomes in children with ovarian torsion. Three clinical observations of patients with ovarian torsion are presented. Duration of the disease was 3-4 days. All children underwent organ-sparing surgery including untwisting followed by ovariopexy. All children were examined in early and late postoperative period (up to 5 years) after organ-sparing procedures. Ultrasonic picture of the ovaries including structure and dimensions corresponded to age, the follicles were determined. 'Conservative' approach allows to preserve anatomical structure and potential for reproductive function.

Ovarian torsion in children: Development of a predictive score.

The aim of this study was to identify clinical signs and symptoms of ovarian torsion (OT) in children and to develop a simple predictive score.A chart review of patients with acute adnexal pathologies treated at the University Children's Hospital Basel, Switzerland, between March 2006 and June 2015 was performed. Medical records were screened for demographic and clinical data. These included clinical symptoms, laboratory studies, imaging, and type of treatment. The diagnosis OT was defined as intraoperative visualization of the torsed ovary around its pedicle at least 360 degrees. Variables predictive for OT were identified and the following score for the likelihood of having OT was developed: age (points = number of years) minus 3 points (if vomitus = “yes”) and plus 1 point (if “pain duration >12 hours”).A total of 80 patients with acute adnexal pathologies were identified. OT was recorded in 17 (21%) cases and ovarian cysts (OC) only in 63 (79%) cases. Patients who presented with OT were significantly younger than patients with OC only (P = .001). Correspondingly, 11 (65%) of the patients with OT had no menarche compared to 3 (5%) patients with OC only (P = .001). Vomiting (P = .001), a shorter pain duration (P = .01), and an elevated C-reactive protein (CRP) (P = .01) were observed significantly more often in patients with OT. The sensitivity of a positive OT score was 0.81 and increased to 1.00 if restricted to girls between 2 to 12 years of age.The presence of vomiting, short duration of abdominal pain, and elevated CRP level have a predictive value for the diagnosis of OT. In these patients, an exploratory laparoscopy should be conducted without delay. The presented OT score appears to be a helpful tool in diagnosing OT in children.

Case report-ovarian torsion in a child: a painful twist in the tale

Ovarian torsion in children is a rare cause of acute abdominal pain and is a true surgical emergency. The clinical presentation closely resembles other pathologies such as urinary tract infections, gastroenteritis and more common surgical emergencies such as appendicitis. We present a case of previously healthy 6 year old female child who presented with abdominal pain, intermittent fever and vomiting. Ultrasonography of the abdomen and pelvis revealed features suggestive of ovarian torsion for which Subacute Laparoscopic Oophorectomy was performed. The authors would like to sensitize readers to the possibility of ovarian torsion in the paediatric populace and reiterate that timely diagnosis and management can prevent catastrophic sequelae.

National Trends in the Surgical Treatment of Ovarian Torsion in Children: An Analysis of 2041 Pediatric Patients Utilizing the Nationwide Inpatient Sample

The aim of this study was to evaluate the national trends in surgical management of ovarian torsion (OT) in children. The Nationwide Inpatient Sample was queried from 1998 to 2011 for females less than 18 years of age with OT. Patients were stratified into three treatment groups: oophorectomy (OO), oophoropexy, or release of torsion (RT) alone. There were 2041 patients with OT, of which 1598 (78%) underwent OO, 126 (6%) oophoropexy, and 317 (15%) RT. RT significantly increased from 1998 to 2011 (9% vs 25%; P < 0.05). At nonteaching hospitals, there were higher rates of OO (89.3% vs 79.5%; P < 0.05) and lower rates of RT (10.7% vs 20.5%; P < 0.05) compared with teaching hospitals. RT was performed at a higher rate in Northeast United States compared with the South (22.7% vs 14.2%; P < 0.05). Girls presenting at nonteaching hospitals and the South had increased odds of undergoing OO compared with those presenting at teaching hospitals and the Northeast (P < 0.05). Although ovarian conservation for OT in children is more often performed in the Northeast United States and at teaching hospitals, this large population-based study demonstrates OO remains the most common surgical management for OT in the United States.

Update on the management of ovarian torsion in children and adolescents.

Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specific symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion. We reviewed original reports on the management of ovarian torsion in young girls published from 1984 till 2014. A literature search was conducted by electronic scanning of five electronic database: MEDLINE, EMBASE, SCI, SSCI and CINAHL. In addition, relevant papers and review articles were hand-searched. The search was limited to English language and human studies. The search was conducted by combining the textwords "ovarian torsion", "adnexal torsion", "adolescents" and "oophoropexy". There are no specific symptoms that can be identified as a pathognomonic feature of ovarian torsion. Ultrasound is a useful diagnostic tool, but it is not always reliable in absence of an enlarged ovary. Laparoscopic detorsion is recognized as the mainstay of treatment regardless the condition of the ovaries. Reports have shown favorable ovarian function after detorsion. The role of oopheropexy remains controversial. Clinicians should be aware of ovarian torsion in girls presenting with abdominal pain. A timely management in this young population can help preserve their ovaries and fertility.

Surgical Approach to Ovarian Torsion in Children

Study ObjectiveOvarian torsion in children is a relatively rare cause of acute abdominal pain. This study evaluates the diagnosis and treatment of ovarian torsion with an emphasis on conservative treatment approaches including the long-term follow-up results. Design and ParticipantsPatients with surgically treated ovarian torsions between December 2006 and February 2014 were included in this retrospective study. The patient population consisted of 41 patients with 42 ovaries involved. The mean age was 11 ± 3.9 (range, 1-17) years. The most common presenting symptom was abdominal pain. InterventionAll patients underwent preoperative pelvic color Doppler ultrasonography that identified torsion in 34 (81%) ovaries. ResultsDuring surgery, a right-sided torsion was detected in 25 (59.5%), and a left-sided one was detected in 17 (40.5%) ovaries. An excisional surgery was used for 16 (38%) ovaries, and detorsion with conservation of the ovary was used for 26 (62%). A trend toward conservative management was seen over the years. Regular follow-up for those patients who underwent conservative surgery was done in 22 patients for a mean of 25 months (range, 1.5-83 months). Control color Doppler ultrasonographic results were within normal limits in terms of ovarian size and blood supply in 17 (77%) patients. Despite normal parenchymal echogenicity, an involved ovary was smaller in size compared to the other ovary in five patients. Ovarian follicles were present in three of them. ConclusionThe ovary-sparing, conservative surgery is found to be highly successful in the presented series. Although malignancies are rarely encountered in torsed ovaries with associated masses, biopsy samples should be obtained in suspicious cases.

Successful laparoscopic surgery for 14-month-old infant with ovarian torsion

The prevalence of ovarian torsion is 4.9 among 100,000 females between ages 1 to 20 years. The diagnosis of ovarian torsion in children, especially in infants, is very difficult. Since they cannot explain related symptoms accurately, and reproductive organs lie high in the abdomen, physical examination shows unclear findings. For these reasons, we use imaging studies, such as ultrasonography and magnetic resonance imaging, to diagnose ovarian torsion. However, it is of limited value to diagnose by using these modalities alone. Therefore, clinical suspicion is important for diagnosis. Though pediatric laparoscopic surgery was introduced 20 years ago, it has been widely performed since the mid 1990s with the development of 3-mm instruments. In addition, usually the pediatric operation is done in the pediatric surgery office, even though it is a gynecologic procedure. In addition, laparotomy is still more frequently conducted in current clinical practice, although the frequency of laparoscopic surgery has increased. However, it is thought that expert gynecologic surgeons can perform pediatric laparoscopic operations if they pay attention to some precautions. We report herein the case of a 14-month-old infant who underwent emergency laparoscopic untwisting of ovarian torsion successfully without complications by a gynecologic surgeon, with a brief review of the literature.

Should the ovary always be conserved in torsion? A tertiary care institute experience

AimThe aim of this study was to analyze our experience in conserving ovarian tissue in cases of ovarian torsion, irrespective of grade of necrosis at exploration. Materials and methodsAll children with a diagnosis of ovarian torsion admitted to our hospital from January 2009 to January 2013 were included. Patients with underlying ovarian pathology were excluded. ResultsThere were 13 torsions in 12 children (one bilateral). All underwent detorsion with or without evacuation of hematoma. Follow-up ultrasonography (USG) with color Doppler was done for all 13 ovaries, which showed an ovary with good vascularity and follicular development in 12 ovaries (92%). In 76% (10 of 13) of cases, intraoperatively, the ovary was judged to be moderately to severely ischemic/necrotic. Yet, follow-up sonograms showed the ovary with follicular development in all cases except one (7%). There were no major complications in our series. ConclusionSimple detorsion, instead of traditionally advocated oophorectomy, was not accompanied by an increase in morbidity. On follow-up, almost all patients studied had functioning ovarian tissue despite the grave ischemia observed intraoperatively. Detorsion should be the procedure of choice for all cases of simple ovarian torsion in children.

Ovarian torsion in children: Management and outcomes

BackgroundThe purpose of this study is to evaluate the clinical symptoms, diagnosis, management, and outcomes in children with ovarian torsion. MethodsThe charts of 50 patients with 53 cases of ovarian torsion treated between January 1989 and March 2012 were reviewed retrospectively. Long term follow up was available for 20 girls who had their ovaries left in the abdominal cavity after detorsion. ResultsIn 22 cases ovaries were removed, and in 31 cases the torsion was relieved and the ovaries left in the abdominal cavity. Twenty-five of the salvaged ovaries were black-bluish and 10 bluish in color. Since 2005, after a change in preferred treatment, all ovaries treated by detorsion were left in the abdominal cavity. The long term results were observed clinically and by ultrasound in 20 girls. Multifollicular ovaries were found in 17 girls. One girl had a normal size paucifollicular ovary, a one-year-old girl had a normal size ovary with microfollicles, and one girl had no ovarian material detectable by ultrasound. ConclusionsLong term analysis of the treatment of ovarian torsion revealed that ovaries treated by detorsion and left in the abdominal cavity preserved their normal anatomy and function. Conservative surgical treatment proved to be safe. None of the girls had thromboembolism or peritonitis, and no malignant tumors were found in the operated ovaries.

Pediatric ovarian torsion: case series and review of the literature

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. We sought to more completely characterize ovarian torsion with respect to pain and ancillary studies, such as urinalysis. We performed a retrospective review of hospital charts of all patients aged 0-18 years with a diagnosis of ovarian torsion at the Children's Hospital at London Health Sciences Centre, in London, Ont., from 1993 to 2008. We analyzed 13 charts of patients aged 7 months to 18 years. Most patients presented with peripheral leukocytosis, vomiting and right lower quadrant pain that did not radiate or migrate. On urinalysis, about half the patients demonstrated pyuria without bacteruria. Pelvic ultrasound revealed an ovarian cyst on the same side of the pain in 11 of 13 patients. Most were found to have a hemorrhagic cyst or ovary and underwent salpingo-oophorectomy or cystectomy within 48 hours of presentation. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Adnexal torsion in children and adolescents: new trends to conservative surgical approach – Our experience and review of literature

The purpose of this study is to discuss the surgical treatment for ovarian torsion in children and adolescents with a focus on the procedures of adnexal conservation surgery and its frequency in the literature of the last 10 years. We retrospectively reviewed the medical charts of 127 operative ovarian lesions including 30 ovarian torsions (23.6%) treated in two pediatric centers over a 10-year period. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathological findings were analyzed. Mean age was 13.7 years. Conservative surgery has been performed in 46.7% of the cases and laparoscopic approach in 40%. Ovarian torsion occurred in 56.7% on ovaries with functional lesion, in 23.3% on normal adnexa and in 20% on ovaries with benign neoplasm. The article includes a literature review (2000–2010) and a statistical analysis which shows a slow increase in conservative surgery from 28 to 45%. Laparoscopic surgery accounts for 23.5%. Literature review shows 40.5% normal adnexa, 33.2% non-neoplastic lesions, 25.3% benign neoplasms and 1% malignant neoplasms. The surgical treatment of children and adolescents presenting adnexal torsion should be practiced as an emergency and it should be more conservative as possible in order to maximize the future reproductive potential.

Risk Factors, Symptoms, and Treatment of Ovarian Torsion in Children: The Twelve-Year Experience of One Center

Objective To assess risk factors, clinical findings and mode of diagnosis and treatment in premenarchal children with surgically verified ovarian torsion (OT). Study Design A retrospective case review (Canadian Task Force Classification II-2). Setting Teaching and research hospital, a tertiary center. Patients Premenarchal children with surgically verified OT. Interventions Patients underwent either laparoscopy or laparotomy. Results Twenty-two cases of OT in 20 premenarchal girls (median age 12 years) were identified. Three cases involved recurrent torsion after detorsion without cystectomy. The main presenting symptoms were sudden pain and vomiting. Six patients underwent Doppler examinations, and all demonstrated an abnormal flow. Seventeen interventions were by laparoscopy. Conservative management, mainly detorsion with additional cyst drainage or cystectomy, was performed in 19 cases (86.4%). Oophoropexy was performed in 3 cases (13.6%). Pathologic examination demonstrated 5 simple cysts and 1 dermoid cyst. Conclusions Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. Other signs and symptoms are nonspecific. When performed, Doppler imaging may assist in diagnosing ovarian torsion in children. Detorsion followed by cystectomy may prevent recurrence.

Clinical Characteristic of Ovarian Torsion in Children

Clinical Characteristic of Ovarian Torsion in Children

Acute Ovarian Torsion in a 6-year-old Girl: A Diagnostic Pitfall in the Emergency Department

It is still a challenge to investigate and manage acute abdominal pain in the emergency department (ED), especially in children, because physical examination is not as easy as in adults. Acute ovarian torsion in children is an uncommon cause of acute abdominal pain and it is difficult to diagnose in a timely fashion in the ED.1 However, since the diagnostic and surgical urgency after initial examination does appear to have an impact on ovarian salvage2, the emergency physician should remain alert to this clinical entity to avoid irreversible ovarian necrosis. Herein, we report a case of acute ovarian torsion in a 6-year-old girl who presented in our ED with acute abdominal pain, which had initially been diagnosed as constipation at another hospital. Constipation is often confused with this condition in the ED and when making this diagnosis, especially in young girls, a careful re-evaluation and judicious utilization of radiological tools are necessary to rule out possible organ- or life-threatening causes.

Ovarian cyst torsion in a toddler

Acute abdominal pain in children is encountered frequently, and the differential diagnosis is extensive. Acute ovarian torsion in children is rare, especially at a very young age, and a difficult diagnosis to make. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. We presented a case of acute ovarian cyst torsion in a 2-year-old girl who originally presented to the emergency department with abdominal pain and vomiting. Ultimately, she was found to have a 2-cm cyst of the right ovary with concomitant torsion. Because acute ovarian torsion in a very young child is not encountered frequently, timely diagnosis is required to prevent mortality and minimize morbidity. It is important to keep ovarian torsion in the differential of any female children with acute abdominal pain. Emergency physicians should be aware that the potential of acute ovarian torsion in a very young child has a high index of suspicion and seek early operative intervention.