Treatment Of Ovarian Torsion Research Articles

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 ].

Successful laparoscopy Management of A 20-cm Mass Causing 1260 Degrees Rotation of Adnexa in the First Trimester of Pregnancy: A Case Report

Diagnosing and managing pelvic pain during pregnancy is often challenging. This pain can be obstetrical, gynecological, or non-obstetrical_non-gynecological. Ovarian torsion, recognized as the consequence of ovarian twisting on its supporting ligaments, causes gynecological pelvic pain. It can occur during pregnancy and cause emergencies. However, early detection can preserve the ovaries and maintain the patient’s current and future fertility. Surgery is the gold standard for the diagnosis and treatment of ovarian torsion. Choosing the best surgical technique (laparoscopy or laparotomy) is essential to reduce possible complications during and after surgery. Our case is a 7-8 weeks’ pregnant woman who underwent laparoscopic surgery with an ovarian mass of 85×152 mm and an acute abdomen. It was found that the mass has caused a 1260-degree rotation in the patient’s left adnexa. The results during and after surgery and the condition of the mother and baby were favorable.

Pediatric Ovarian Torsion: A Diagnostic Challenge in COVID-19 Times

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary.

An ovarian torsion in a 2-year-old girl: a case report

BackgroundAbdominal pain is one of the most common complaints by patients in the emergency department. Diarrhea, constipation, and urinary tract infection are the commonest etiologies among these patients, but there are surgical emergencies, such as appendicitis and volvulus of the intestine, which are less common. Torsion of the ovary is rarer than all of the above conditions. Ovarian torsion occurs following the twisting of the ovary on its ligamentous attachment, possibly with a cyst, leading to the impediment of blood flow. Prompt diagnosis with a high clinical suspicion is essential to salvage the ovaries and to prevent complications, including death.Case presentationHere, we present a case of ovarian torsion in a 2-year-old Sri Lankan girl who presented with nonspecific abdominal symptoms after being symptomatically treated twice by her general practitioners for 3 days. Following biochemical and radiological investigations, she was diagnosed with a twisted necrotic ovarian torsion and underwent laparoscopic right-sided oophorectomy.ConclusionsFinding the etiology of a child with abdominal pain is challenging, especially because of the limited history, examination findings, the difficulty in carrying out radiological investigations, and the poor specificity of the results compared with adults. This is a case presentation and a brief discussion about the dilemmas and difficulties in the diagnosis and treatment of ovarian torsion in young children.

Effect of Pregnancy on the Management and Outcomes of Ovarian Torsion: A Population-Based Matched Cohort Study

Study ObjectiveTo compare the treatment and surgical outcomes of ovarian torsion in pregnant and nonpregnant women. DesignA population-based matched cohort study (Canadian Task Force classification II.1). SettingThe United States Health Care Cost and Utilization Project Nationwide Inpatient Sample from 2003 to 2011. PatientsAll cases of ovarian torsion among pregnant women and nonpregnant women with ovarian torsion (matched by age in a ratio of 1:1). InterventionsOutcomes of interest included the type of treatment received for ovarian torsion and the complications of surgery. Measurements and Main ResultsThere were 1366 women diagnosed with ovarian torsion among 8 532 163 pregnant women for an incidence of 1.6 in 10 000. Surgery was the predominant treatment, with laparotomy being more commonly performed on pregnant women versus nonpregnant women (57.0% vs 51.0%; odds ratio = 1.28; 95% confidence interval, 1.08–1.51; p < .01). Overall conservative management was less likely performed; however, it was more common among pregnant women versus nonpregnant women (odds ratio = 1.85; 95% confidence interval, 1.44–2.37; p < .01). In general, adverse events were uncommon in both groups although ovarian infarction was more commonly reported among nonpregnant women. ConclusionThe diagnosis of ovarian torsion in pregnancy is rare. Compared with nonpregnant women, laparotomy and conservative management are more common among pregnant women. Treatment of ovarian torsion in pregnancy has comparable outcomes with treatment in nonpregnant women.

Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls

Study ObjectiveTo describe the clinical characteristics and treatment of ovarian torsion in premenarchal girls with surgically verified ovarian torsion. Design and ParticipantsA retrospective cohort study design was used. The medical charts of all premenarchal girls with surgically verified ovarian torsion treated in a university-affiliated tertiary medical center from 1997 to 2012 were reviewed for clinical, treatment, and outcome data. ResultsThirty-two premenarchal girls were identified. Their median age was 9 years. There were 7 recurrences during the study period (17.9%), for a total of 39 cases. The main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). Physical examination revealed abdominal tenderness in 25 cases (64.1%). Abdominal ultrasound, performed in 31 patients (38 cases), yielded pathologic findings in 28 (73.7%), mainly an enlarged ovary (11 cases, 28.9%). Doppler flow studies were abnormal in 15 cases. In 26 cases (68.4%), the tentative preoperative working diagnosis was ovarian torsion. Laparoscopy was performed in 26 cases, laparotomy in 10, and laparoscopy converted to laparotomy in 3 cases. Conservative management, mainly with additional cyst drainage or cystectomy, was used in 37 cases (95.2%) with oophoropexy in 5 cases. Two patients required oophorectomy because of a suspected neoplasm and severe ovarian necrosis. Pathologic examination demonstrated 5 simple cysts, 1 necrotic ovary, and 1 mature cystic teratoma. ConclusionsOvarian torsion in premenarchal girls is associated with nonspecific signs and symptoms. Abdominal ultrasound and Doppler imaging may assist in the diagnosis. Laparoscopy with conservative management is preferred. Owing to the high recurrence rate, oophoropexy may be considered.

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.

The Diagnosis and Treatment of Ovarian Torsion in Childhood and Adolescence

The Diagnosis and Treatment of Ovarian Torsion in Childhood and Adolescence

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.

Risk Factors, Symptoms and Treatment of Ovarian Torsion in Premenarchal Girls: The 12-Year Experience of One Center

Risk Factors, Symptoms and Treatment of Ovarian Torsion in Premenarchal Girls: The 12-Year Experience of One Center

Predominant Etiology of Adnexal Torsion and Ovarian Outcome after Detorsion in Premenarchal Girls

Consensus has not been reached regarding the treatment of ovarian torsion in premenarchal girls. If viable adnexa can be salvaged, the future reproductive potential of the girl is maximized. The authors determined the predominant etiology, evaluated the restoration of ovarian function and anatomic structure postoperatively in premenarchal girls with adnexal torsion, and discuss the most appropriate treatment. Sixty-six premenarchal girls with twisted adnexa underwent salpingoophorectomy (27 cases), or detorsion and adnexal conservation surgery (39 cases), according to the extent of adnexal damage found intraoperatively. These patients' data were collected and analyzed. The typical presentation, predominant etiology, surgical outcome, and restoration of ovarian function postoperatively were investigated. Of all torsive ovaries, histopathology verified that 2 (3.0%) cases were malignant, 8 (12.1%) cases were normal, and 56 (84.9%) cases were benign. After operation and menarche, ultrasound showed that the involved ovaries were of normal size with normal follicular development in 33 of the 35 (94.3%) patients who received detorsion and adnexal conservation surgery. In the remaining two (5.7%) of the 35 detorsion patients, the affected ovaries were atrophied (small sized) and there was no ultrasound evidence of follicular development. Premenarchal girls with adnexal torsion more commonly had a benign ovarian tumor or no underlying abnormality as an etiology; ovarian malignancy was rare. In the management of these cases, detorsion and adnexal conservation surgery should be considered in cases with adnexa appearing to be ischemic or hemorrhagic infarction.

Emergency Gynecologic Imaging

Acute pelvic pain in the female patient can have myriad presentations and, depending on the diagnosis, profound consequences. In the pregnant patient with pelvic pain or bleeding, an ectopic pregnancy must be first excluded. Ultrasound is important in determining the size and location of the ectopic pregnancy, and presence of bleeding, which in turn helps guide treatment decisions. Subchorionic or subplacental bleeds in an intrauterine pregnancy may also present with vaginal bleeding with consequences dependent on gestational age and size of bleed. In the postpartum female suspected to have retained products of conception, sonographic findings may vary from a thickened endometrial stripe to an echogenic mass with associated marked vascularity, often mimicking an arterial-venous malformation. In the nonpregnant patient, early diagnosis and treatment of ovarian torsion can preserve ovarian function. Other causes of peritoneal irritation may also cause acute pelvic pain including a ruptured hemorrhagic cyst or ruptured endometrioma. When pelvic inflammatory disease is suspected, imaging is used to evaluate for serious associated complications including the presence of a tuboovarian abscess or peritonitis. While leiomyomas of the uterus are largely asymptomatic, a leiomyoma that undergoes necrosis, torsion or prolapse through the cervix may be associated with acute severe pain or bleeding. The imaging features of these and other important clinical entities in the female pelvis will be presented.

Modern Trends in Diagnosis and Treatment of Ovarian Torsion

Dr. Detti is Clinical Fellow, Division of Reproductive Endocrinology and Infertility, Dr. Diamond is Professor, Vice Chairman, and Chief of Reproductive Endocrinology and Infertility, and Dr. Puscheck is Associate Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 3750 Woodward Avenue., Suite 200-D, Detroit, MI 48201; E-mail: [email protected]. The authors have disclosed that they have no significant relationship with or financial interests in any commercial organizations pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.

Modern Trends in Diagnosis and Treatment of Ovarian Torsion: CME QUIZ: Volume 27, Number 1

Modern Trends in Diagnosis and Treatment of Ovarian Torsion: CME QUIZ: Volume 27, Number 1