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(a) Pelvic axial magnetic resonance imaging of the torsioned left ovary. T2w image showing the well-defined heterogeneous, hyperintense, enlarged left ovary along with a hypointense focus corresponding to the calcification (arrow) on the left upper peripheral border of enlarged ovary. (b) and (c) The microscopic views of dystrophic microcalcifications of the left ovary (b) and the left tuba uterina (c) stained with Hematoxilin-Eosin.
Source publication
Intermittent pelvic pain caused by ovarian cysts in adolescence may be due to torsion or partial torsion of the ovary. We present a case of 18-year old adolescent with symptomatic left ovarian torsion with calcifications demonstrated by pelvic MRI and ultrasonography prior to surgery. The pathologic investigation demonstrated dystrophic calcificati...
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Citations
... Following torsion, venous and lymphatic drainage is obstructed, then arterial blood flow may be hampered because of entrapment in the torsed pedicle, in the absence of surgery tissue becomes ischemic and necrotic, thrombophlebitic and peritonitis and finally calcification and auto amputation may occur in long term thus early diagnosis and immediate treatment are required. 11 Intraoperative findings of right ovarian torsion with necrotic changes observed in adnexa, and the expertise of the surgeon (Fig. 2). Increased emphasis is given over the preservation of ovarian tissue to conserve the future reproductive potential of the girl. ...
... It is therefore important to clarify the clinical and surgical characteristics in adnexal torsion patients who show a chronic disease course. However, the description of such features in the literature is still limited [1,7,9,10]. Based on our accumulated experience, the European Journal of Obstetrics & Gynecology and Reproductive Biology j o u r n a l h o m e p a g e : w w w . ...
... a Blood transfusion was required for pre-existing severe anemia (Hb: 3.3 g/dL) due to concomitant submucosal myoma in 1 patient with chronic adnexal torsion. accessory blood supply from the pelvic collaterals [21], as has been described in a number of cases involving patients with isolated tubal torsion who showed a chronic disease course [10,21,22]. In conclusion, even in the era of modern diagnostic imaging and advanced surgical techniques, chronic adnexal torsion can still represent a diagnostic and therapeutic challenge. ...
Introduction:
Oophorectomy is the treatment of choice in ovarian torsion if after detorsion the ovary looks bluish black. Ovarian preservation is advocated by many studies in the pediatric age group quoting the ability of the ovary to recover despite the appearance after detorsion.
Aims:
This study aims to review the outcome of salvage surgery (detorsion) in the management of pediatric ovarian torsion.
Materials and methods:
This is a retrospective study of girls under 18 years with ovarian torsion treated from January 2016 to June 2021. Data were collated from records and analyzed.
Results:
Ten girls with ovarian torsion were included (mean age of 11 years). Ultrasonography and Doppler confirmed ovarian torsion in all. Emergency laparoscopy with detorsion was done in all with the mean time lapse from onset to surgery being 35 h. All the ovaries were black initially and persisted to be bluish black after detorsion. All were conserved and fixed to the lateral abdominal wall. In one child with an associated ovarian cyst, the cyst excision was also done. All girls were asymptomatic on follow-up. Ultrasonography at 3-month follow-up showed a normal-sized ovary with good blood flow in 9 out of 10 girls (90% cases). Follicular changes were seen in five girls who had attained puberty. In one girl, the ovary was very small sized and flows were not well visualized.
Conclusion:
Detorsion and oophoropexy should be the procedure of choice in pediatric patients with ovarian torsion. The gross appearance of the ovary after detorsion should not be the sole determinant for oophorectomy.
Objectives
To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion.
Study Design A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion.
Results
Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (< 24 hrs) whereas most (67%) had pain >24 h up to 4 weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36 = 39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p= 0.098).
Conclusions
Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.
Background
Abdominal 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 presentation
Here, 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.
Conclusions
Finding 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.
There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures.
A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients’ clinical characteristics, surgical procedures, and postoperative recovery were analyzed.
Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases.
Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.
Adnexal torsion is a surgical emergency, which requires immediate recognition and prompt treatment. This article aims to systematically illustrate the most relevant approach to follow in cases of suspected adnexal torsion in adolescents. We based our evaluation of the role of clinical features, laboratory tests, and imaging on recent literature, till we consider the most appropriate surgical treatment.
The literature describes the conservative treatment for adnexal torsion, consisting of detorsion, as the best surgical approach to guarantee the future reproductive capacity of patients. Recent experimental studies have focused on the consequences of detorsion, which may cause ischemia-reperfusion damage and have speculated about the role of different drugs for its avoidance.
A systematic review of physiopathology, clinical picture, and imaging of adnexal torsion is certainly useful to identify as soon as possible this emergency condition. An early identification and an adequate treatment are indispensable in order to achieve a proper outcome for the patient. The choice of the appropriate surgical approach can be challenging and should be made on the basis of an accurate evaluation of the ovarian lesion. Therefore, it would be useful to perform an intraoperative frozen section analysis in selected cases.
