Pediatric Ovarian Torsion Research Articles

Incidence and Trends of Pediatric Ovarian Torsion Hospitalizations in the United States, 2000–2006

Incidence and Trends of Pediatric Ovarian Torsion Hospitalizations in the United States, 2000–2006

Incidence and Trends of Pediatric Ovarian Torsion Hospitalizations in the United States, 2000–2006

There is significant variation in the literature regarding the characteristics that are associated with pediatric ovarian torsion and its management. National data regarding the demographics and management of pediatric ovarian torsion are lacking. Our objective was to describe the epidemiology of pediatric ovarian torsion and the rate of oophorectomy by using nationally representative data. Demographic factors and hospital characteristics that are associated with rates of oophorectomy were also explored. This was a cohort analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) 2000, 2003, and 2006. All females aged 1 to 20 years who were hospitalized with ovarian torsion in states participating in KID 2000, KID 2003, and KID 2006 representing 900, 1224, and 1232 ovarian torsion-related hospitalizations, respectively, were included. Primary outcome measures included the incidence of ovarian torsion and rate of associated oophorectomy. Multivariable regression was used to control for patient and hospital characteristics. Among females aged 1 to 20 years, there were 1232 cases of ovarian torsion in KID 2006, an estimated incidence of 4.9 per 100000. A total of 713 (58%) were treated with oophorectomy. The rate of ovarian torsion-associated oophorectomy remained unchanged from 2000 to 2006. The adjusted odds of having an oophorectomy decreased by 0.95 for every increasing year of age. Residing in a lower quartile of household income by zip code increased the adjusted odds of oophorectomy. A diagnosis of benign neoplasm increased the adjusted odds of oophorectomy by 2.16. Fewer than 0.5% of ovarian torsion hospitalizations were associated with malignant neoplasm. Nationally representative hospital data indicate that ovarian torsion is uncommon but occurs in all ages and is typically associated with normal ovaries or benign lesions. Improved awareness of the epidemiology may help to guide management. Ongoing analysis to identify factors that are associated with successful conservative management is warranted.

Ovarian Torsion in a Three-Year-Old Girl

Ovarian torsion is the fifth most encountered gynecological emergency requiring surgery. Representing only 2.7% of surgical emergencies, it is an entity that is worth being familiar with in the emergency department (ED). Untreated ovarian torsion may result in loss of ovarian function, tissue necrosis, and death from thromboembolism or sepsis. Presenting with vague symptoms and abdominal pain, diagnosing ovarian torsion can be difficult, especially in children. The objective of this article is to present a case of pediatric ovarian torsion and to review its epidemiology, diagnosis, and treatment. A 3-year-old girl presented to the ED with vomiting, fever, anorexia, and abdominal pain. Initially diagnosed with appendicitis by physical examination and computed tomography scan, this patient was taken to the operating room for surgical exploration. The patient was subsequently found to have ovarian torsion, which was treated appropriately. Although a rare phenomenon, this case serves to increase awareness of the clinical presentation of ovarian torsion in the pediatric patient. Abdominal pain in the female child represents a challenging differential diagnosis, for which a physician must consider ovarian torsion.

Case 109: Meigs Syndrome

HomeRadiologyVol. 242, No. 3 PreviousNext Diagnosis PleaseCase 109: Meigs SyndromeGopal R. Vijayaraghavan, Deborah LevineGopal R. Vijayaraghavan, Deborah LevineAuthor Affiliations1From the Departments of Radiology (G.R.V., D.L.) and Obstetrics and Gynecology (D.L.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Received April 29, 2004; revision requested July 12; revision received July 21; accepted August 18; final version accepted September 29.Address correspondence to D.L. (e-mail: [email protected]).Gopal R. VijayaraghavanDeborah LevinePublished Online:Mar 1 2007https://doi.org/10.1148/radiol.2423040775MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Dill-Macky MJ, Atri M. Ovarian sonography. In: Callen PW, ed. Ultrasonography in obstetrics and gynecology. 4th ed. Philadelphia, Pa: Saunders, 2000; 857–896. 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Medline, Google ScholarArticle HistoryPublished in print: 2007 FiguresReferencesRelatedDetailsCited ByAnalysis of magnetic resonance imaging features of ovarian thecomaZhiLi, QingweiHu, ZhiqinLuo, ZaixingDeng, WeiZhou, LinghongXie2020 | Medicine, Vol. 99, No. 21MRI diagnosis of ovarian fibrothecomas: tumour appearances and oestrogenic effect featuresBWu, W JPeng, Y JGu, Y FCheng, JMao2014 | The British Journal of Radiology, Vol. 87, No. 1038Radiopaedia.orgJakeBall, YurangaWeerakkody2011A regressive Meigs syndrome after definitive adnexal torsionPascalRousset, Pierre-FleuryChaillot, Anne-SophieBats, Marie-AudeLe Frère Belda, Jean-NoëlBuy2011 | American Journal of Obstetrics and Gynecology, Vol. 205, No. 4Adnexal Masses: US Characterization and Reporting1Douglas L. Brown, , Kika M. Dudiak, , and Faye C. 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Urgency of Evaluation and Outcome of Acute Ovarian Torsion in Pediatric Patients

To describe the symptoms, diagnostic studies, and rate of ovarian salvage among children and adolescents with ovarian torsion. We reviewed the medical records of all children with acute ovarian torsion treated at a university-affiliated pediatric hospital from 1987 to 2002; prenatal cases were excluded. For each child we recorded the time from onset of symptoms to initial examination and the time from initial examination to operation. We reviewed diagnostic tests used, operative reports, and pathology reports. We identified 22 cases; the mean age was 10.2 years (range, 3-15 years). In 6 cases (27%), the ovary was salvaged. Prolonged duration of symptoms prior to initial examination was not significantly associated with ovarian necrosis. Mean time of symptoms prior to care was 76 hours for both salvaged and nonsalvaged ovaries (range, 7-159 hours). The mean time from initial examination to operation, 11 hours for salvaged ovaries (range, 1-23 hours) and 21 hours for nonsalvaged ovaries (range, 2-71 hours), was not significantly different between groups. Twenty-one patients underwent imaging; 19 of 20 ultrasounds and 4 of 5 computed tomographic scans suggested the diagnosis. Less than half (10 of 22) of the torsed ovaries contained cysts, teratomas, or other masses. These data suggest pediatric ovarian torsion is a more salvageable condition than previously reported. Prolonged time of symptoms prior to initial examination does not preclude ovarian salvage. Ovarian tumor accounts for less than half of cases. Urgent imaging and surgical management may lead to improved outcomes.

Asynchronous bilateral ovarian torsion

Background Pediatric ovarian torsion (OT) is a serious condition, especially in cases of asynchronous bilateral ovarian torsion (ABOT). The authors sought to evaluate the predisposing factors for ABOT and to evaluate the most appropriate treatment for ovarian torsion. Methods The authors retrospectively reviewed the charts of patients with ovarian torsion between 1980 and 2002. Data collected included age at presentation, type and duration of symptoms, ultrasound scan findings, interval to surgery, procedures, pathology report, and follow-up. Results Seventy-six patients had adnexal torsion confirmed at surgery, 4 of whom had ABOT. The mean age was 10 years. The mean duration of complaints before hospitalisation and interval to surgery were 56 and 33 hours, respectively. Thirty-five patients had simple tubo-ovarian torsion (46%), including all the patients with ABOT (11.4%), and 41 had an ovarian pathology (54%). All patients with ABOT underwent salpingo-oophorectomy at the first episode. They presented earlier for the second episode and had a shorter interval to surgery where detorsion with oophoropexy was performed. Follow-up ultrasound scan showed perfusion and follicles in the remaining ovary. Conclusions The diagnosis of ovarian torsion often is delayed, especially when a solid tumor is suspected. Conservative management should be strongly considered when there is no underlying ovarian pathology. Furthermore, oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a potentially devastating recurrence.