Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution

Abstract

a b s t r a c tStudy Objective: Adnexal torsion (AT) requires urgent surgical intervention to preserve ovarian function. Historically, treatment for AT was oophorectomy because of concerns related to leaving a nonviable ischemic ovary. No published studies support these theoretical concerns and current literature supports conservative management. The aim of this study was to review the institutional outcomes for AT cases, including salvage rates and complications. Design, Setting, Participants, Interventions, and Main Outcome Measures: This study was approved by the institutional review board at Baylor College of Medicine. A retrospective chart review on cases of AT from 2007 to 2016 at a single Children's hospital was performed on the basis of International Classification of Diseases, 10th revision and Current Procedural Terminology codes. A standardized chart review form was used in data extraction. Statistical analysis was performed using SAS version 9.4 (SAS Institute). Results: Chart review identified 245 torsion cases in 237 patients. The mean age was 12.4 AE 3.29 years. Of the participants, 230 (94%) underwent minimally invasive laparoscopy with ovarian preservation in 233 (95%) of the cases. There were no complications due to detorsion of the affected adnexa. Intraoperatively, the right adnexa was affected in 134 (55%) cases and a lesion was noted in 193 (79%) cases, most commonly paratubal cysts and mature teratomas. The malignancy rate was low, noted only in 4/245 patients at (1.2%). Pediatric gynecology performed most of the cases (n 5 214; 87%). Conclusion: The findings of our study continue to support the conservative management of patients with AT.

Management of ovarian cysts in children and adolescents

“…This trend, however, appears to be reversing. A more recent retrospective review published in 2019 of 245 cases of ovarian torsion showed that 94% had laparoscopic surgery and 95% had ovarian preservation …”

Lesson learned: Don't forget about the ovaries in female toddlers presenting with abdominal pain

“…Although typically occurring in postmenarchal females, ovarian torsion has been documented in younger patients. 1,2 In infants, the ovaries are typically found in the lower abdomen as opposed to the pelvis in adolescents, which is possibly why this pathology was discovered in our patient. 3 Ovarian torsion often occurs due to the presence of benign or malignant masses 5 cm in size or larger, although no mass was identified in our patient.…”

“…3 Ovarian torsion often occurs due to the presence of benign or malignant masses 5 cm in size or larger, although no mass was identified in our patient. 1 No one physical complaint is highly sensitive or specific, and abdominal pain is intermittent only 57% of the time. 1,2 Figure 1 The left ovary (LO) is enlarged to 3.3 Â 1.8 Â 1.5 cm (4.6 mL) and there are multiple follicles present.…”

Surgically treated ovarian lesions in preadolescent girls

“…This is in contrast to previous reports with ovary-sparing procedures performed in 40 to even 95% of the cases with benign conditions. 10,[20][21] The high rate of oophorectomies in this patient group is partly explained by our earlier policy to prefer oophorectomy to avoid tumor rupture also in benign neoplasms. We have started to be more active in performing ovary-sparing procedures nowadays since good long term results have been observed with ovary-sparing surgery in pediatric patients despite black-bluish color in twisted ovary.…”