The aim: To assess the functional state of gonads in female adolescents with a history of intact uterine appendages torsion (IUAT). Materials and methods: A total of 55 adolescent girls aged from 13 to 17 years were examined. 35 patients with a history of IUAT were divided into two groups: group 1 consisted of 21 patients with organ-preserving surgical treatment (detorsion) and group 2 of 14 patients with radical surgical treatment of IUAT. 20 healthy girls formed the control group. Assessment of the ovarian reserve was performed by the determination of serum anti-Müllerian hormone (AMH) level. Ultrasound scan was used to evaluate ovaries volume, number and diameter of antral follicles. Results: The AMH level in control group (2.4 ± 0.29 ng/ml) has no statistically significantly differences compared with group 1 (2.2 ± 0.35 ng/ml, p = 0.12) and differed significantly compared with group 2 (0.96 ± 0.11 ng/ml, p < 0.05). No statistically significant differences in ovary volume were found between group 1 and control group (6.02 ± 0.21 cm3 and 6.14 ± 0.17 cm3, respectively, p = 0.125). The number and diameter of antral follicles in group 1 didn`t significantly differ from the control group (3.85 ± 0.35 and 4.00 ± 0.25, p = 0.116, 3.57 ± 0.42 mm and 3.70 ± 0.31 mm, p = 0.128, respectively). Conclusions: The method of choice for IUAT treatment taking into account upcoming motherhood is laparoscopy with detorsion. Dynamic ultrasound results and determination of AMH level indicate the organ-preserving tactics for surgical treatment of IUAT.
the state of somatic and reproductive health of adolescent girls is an actual problem both throughout the world and in Ukraine. Connective tissue dysplasia, a group of congenital pathologies of connective tissue with insufficient or abnormal development of collagen structures, which leads to disruption of the structure and functional disorders of various organs and tissues, was found to be widespread among patients of the pubertal period. More often there are undifferentiated forms of connective tissue dysplasia, characterized by clinical polymorphism: pathology of the musculoskeletal system, autonomic dysfunction syndrome, gynecological pathology, among which adnexal torsion attracts special attention, and more. The aim of the study was to explore the manifestations of connective tissue dysplasia and neurological disorders as risk factors for adnexal torsion, with the aim of improving the clinical and diagnostic approaches to the management of adolescent girls with this gynecological pathology. Based on informed consent, inclusion and exclusion criteria, 42 adolescent girls aged 14-17 years old with a history of adnexal torsion (the clinical group) and 30 healthy peers (the control group) took part in the study. To achieve the set goals, anthropometric, general clinical, echographic and radiological methods, the study of the neurological status were used. In the course of the study, it was found that signs of connective tissue dysplasia were found in 16 (38.1%) of the examined adolescents of the clinical group and in 3 (10%) of the control groups (p<0.05). In particular, scoliosis of the I-II degree was diagnosed in 14 (33.3%) adolescents of the clinical group, which was more than 3 times higher than the similar indicator in the control group - 3 (10%) (p<0.05). In addition, dolichostenomelia and arachnodactyly were observed in adolescents with connective tissue dysplasia, on average, 1.5 times more often. Flat feet was diagnosed 3 times more often in the clinical group (in 13 patients (30.9%)) compared to the control group (in 3 patients (10%)) (p<0.05). At the same time, some patients had a combination of several pathologies disorders of the musculoskeletal system. Thus, scoliosis and flat feet were simultaneously diagnosed in 9 (21.4%) adolescents of the clinical group and only in 2 (6.6%) adolescents in the control group (p<0.05). External developmental anomalies in connective tissue dysplasia were quite often combined with developmental anomalies of internal organs: gallbladder kink was found in 5 (11.9%) patients, nephroptosis - in 2 (4.7%) patients, mitral valve prolapse - in 3 (7.1%) patients of the clinical group, which is associated with the same origin and laying of a number of systems in embryogenesis. The surveyed adolescents of the clinical group had complaints of an asthenic nature associated with autonomic imbalance, namely: rapid heartbeat - in 16 (38.1%), headache - in 12 (28.5%), poor tolerance of moderate physical activity - in 7 (16.6%), increased fatigue - in 9 (21.4%) , sweating – in 7 (16.6%) patients. All adolescent girls were prescribed complex treatment, taking into account the type of autonomic regulation, the severity of clinical and functional disorders that characterize autonomic dysfunction. Thus, as a result of the study, a high prevalence of undifferentiated forms of connective tissue dysplasia was established in patients with a history of adnexal torsion and in most cases was accompanied by the development of pathology of the musculoskeletal system, structural and functional disorders of the internal organs, and manifestations of autonomic dysfunction syndrome. Connective tissue dysplasia, as one of the established predictors of adnexal torsion, can act as an important prognostic marker and provide an opportunity to prevent and timely diagnose the abdominal pain syndrome and its complications caused by this gynecological pathology.
The article presents the clinical features of the complicated course of tumor-like formations of the uterine adnexa in girls, adolescents and young women. The characteristic symptoms of adnexal torsion are described. Topographic and anatomic features leading to torsion of ovarian cysts and uterine appendages, features of the surgical treatment of patients with complicated adnexal torsion are presented. The aim was to study the frequency of occurrence of ovarian tumor-like formations and their complicated course in girls, adolescents and young women, improve early diagnosis and develop optimal methods of conserving surgical treatment of this pathology. Material and methods. The study included 90 girls, adolescents and young women. Patients were divided into three groups. 1 group included 30 young women; the 2nd group consisted of 35 adolescents 13-17 years; 3 group consisted of 25 girls from 2 to 12 years. Diagnostic complex included clinical, special gynecological, comprehensive laboratory, ultrasound (including doppler ultrasound) research, computer and magnetic resonance imaging (if indicated). Results and discussion. The final diagnosis of “Ovarian cyst” was verified in 46 of 90 patients (51,1 %): group 1 – 26 of 30 (86,6 %), in 2 – 18 of 35 (51,4 %), in 3 - 2 of 25 (8 %). It is established that the torsion of the uterine adnexa was detected in 44 of 90 patients: in 1 group – 13,3% of cases (4 of 30 young women), in 2 group – 48,5 % (17 of 35 adolescents), in 3 group – 92 % (23 of 25 girls). 76 surgeries were performed by laparoscopy with preservation of the ovarian reserve, 12 patients were treated conservatively with final diagnosis “Ovulatory syndrome” and “Retention cyst of the ovary”. Conclusions. Ovarian cyst as the cause of abdominal pain is significantly more often diagnosed in young reproductive age than in patients of prepubertal and pubertal age. In girls and adolescent girls with symptoms of acute abdomen the torsion of intact uterine adnexa was significantly more common than in adult patients, due to anatomical features of the internal reproductive organs and more a mobile lifestyle inherent in this age group. Optimal treatment of functional ovarian cyst is complex conservative therapy, surgical treatment of ovarian cysts at a young age is conducted under strict indications, treatment of choice is laparoscopy.
Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion to the improvement of early diagnosis and development of optimal ways of organ-preserving surgical tactics of treatment have been determined. An analysis was carried out of 71 patients with adnexal torsion (group 1– 30 girls of 2–12 years, group 2 – 41 adolescents of 13–17 years). The main clinical signs of adnexal torsion were nonspecific and similar to the well-known clinic of acute abdomen. Ultrasound examination with color doppler mapping (CDM) allowed to suspect adnexal torsion in 44 (62 %) patients. The main echographic features of adnexal torsion were: ovarian enlargement, non-typical location and a change in the structure of ovary, the presence of a free liquid in the cavity of a small pelvis or in the abdominal cavity, «a symptom of springs» (a twisted vascular leg), a decrease or absence of blood flow in CDM. The torsion of intact uterine appendages is installed in 29 patients (twice as often in group 1). In 42 cases were detected the torsion of the uterine appendages, compromised by the presence of tumors and tumor-like formations (twice as often in group 2). In both groups, 36 (50.7 %) organ-preserving and 35 (49.3 %) radical operations were carried out. According to the results of morphological examination of the removed tissues, the following data were obtained: follicular cysts – 15, paratubal cysts – 8, corpus luteum cysts – 8, teratomas – 5, serous cystadenomas – 2, mucinous cystadenoma – 1, paraovarian cysts – 3. Differential diagnosis of adnexal torsion in girls and adolescents should include a thorough collection of anamnestic data, taking into account the features of the clinical course of the disease, the results of a comprehensive examination with an assessment of ultrasound data from CDM, computer and magnetic resonance imaging, which will contribute to the advanced adequate selection of tactics of urgent gynecological intervention. The method of choice for the treatment of adnexal torsion is a minimally invasive surgical intervention – a laparoscopy with organ-preserving operations. Keywords: adnexal torsion, girls, ultrasound and morphological characteristics.
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