19 10 Years of Tertiary Paediatric Centre Experience of Females Undergoing Surgery for Ovarian Torsions

Abstract

Aim Review role and accuracy of imaging, and subsequent management, of patients with ovarian torsion managed at a tertiary paediatric centre. Method Retrospective review of notes for patients undergoing surgery for ovarian torsion over 10 years (2010-2019). Results 23 patients underwent surgery for ovarian torsion (one excluded due to lack of data). Median age 12 years[range 1-15]. 18/22 patients underwent imaging; 15/18 had USS, 12/15(80%) were diagnostic for ovarian torsion. 3/15 showed ovarian pathology prompting further imaging/surgery. 2/22 had initial MRI, 1 diagnostic for torsion. Time from symptom onset to surgery was assessed, data was incomplete for 4 patients. 10 patients were referred from ED/primary care; 5(50%) underwent theatre within 12 hours, 3(30%) 12-12hours and 2(20%) >24hours. 8 patients were referred from external hospitals; 2(25%) underwent theatre within 12 hours, 4(50%) 12-12hours and 2(25%) >24hours. Those having surgery>24 hours from symptom onset were awaiting imaging or had suspected other pathology. 4/22 underwent oophorectomy (open:laparoscopic=3:1) and 18/22 had detorsion +/- cyst aspiration/excision (open:laparoscopic:converted=2:15:1). Follow up imaging was performed in 13/18 patients who underwent detorsion and 2/5 who underwent oophorectomy. Of 3 patients undergoing oopherectomy who did not have follow up; 2 had benign cysts and 1 had a simple tubo-ovarian torsion. Conclusions We advocate early USS in females with presentation concerning for ovarian torsion, though a high index of suspicion is often required owing to non-specific symptoms. Imaging and transfer should be performed promptly to prevent delays in surgical management.