Adnexal torsion in children and adolescents: new trends to conservative surgical approach – Our experience and review of literature

Abstract

The purpose of this study is to discuss the surgical treatment for ovarian torsion in children and adolescents with a focus on the procedures of adnexal conservation surgery and its frequency in the literature of the last 10 years. We retrospectively reviewed the medical charts of 127 operative ovarian lesions including 30 ovarian torsions (23.6%) treated in two pediatric centers over a 10-year period. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathological findings were analyzed. Mean age was 13.7 years. Conservative surgery has been performed in 46.7% of the cases and laparoscopic approach in 40%. Ovarian torsion occurred in 56.7% on ovaries with functional lesion, in 23.3% on normal adnexa and in 20% on ovaries with benign neoplasm. The article includes a literature review (2000-2010) and a statistical analysis which shows a slow increase in conservative surgery from 28 to 45%. Laparoscopic surgery accounts for 23.5%. Literature review shows 40.5% normal adnexa, 33.2% non-neoplastic lesions, 25.3% benign neoplasms and 1% malignant neoplasms. The surgical treatment of children and adolescents presenting adnexal torsion should be practiced as an emergency and it should be more conservative as possible in order to maximize the future reproductive potential.

Adnexal torsion-five-year retrospective study

“…1 The next common symptom in this study was nausea and vomiting seen in 37 (78.7%) cases similar to other studies. 11,14 In this study palpable mass was seen in 14 (29.7%) cases and tenderness was demonstrated only in 17 (36.1%) cases and was similar to another study. 12 Other symptoms like vaginal bleeding and urinary symptoms reported in other studies were not noted in this study.…”

“…1,14,20 Normal adnexal appearance is common in 69% of premenarchal patients. 21 Some studies 9,20 show enlarged ovary with multiple peripheral follicles as sign of torsion with a sensitivity of 64-74%.…”

“…This could be because of long right ovarian ligament or presence of sigmoid on the left side. 12,14 Isolated tube torsion was seen in three (6.3%) cases. No specific risk factors like hydrosalpinx was seen in our cases.…”

Five Year Retrospective Case Series of Adnexal Torsion

“…There were 50 cases (71.4%) between the sizes of 5-10 cm which had undergone torsion [Table/ Fig-3]. In about Our study Kandasami Vijayalakshmi et al, [7] C Spinelli et al, [14] Vijayaraghavan [15] 34 [48.6%] cases tumours was found to be a risk factor for torsion. 11 cases (15.7%) there was no risk factor for torsion.…”

Adnexal torsion-symptoms, diagnosis and management: a review of literature

“…Ultrasound was done in all the patients, which showed ovarian mass in 29 cases (72.5%), among which 14 cases were of mature teratoma, 10 were cyst adenoma, 2 cases of functional cysts, 2 cases of malignant neoplasm and 1 case had synchronous mature teratoma with carcinoma ovary. 28 presented a review of literature to discuss the management of ovarian torsion in children and adolescents. It was found that 76.7% cases were associated with underlying pathology, of which 56.7% had functional ovarian lesion and 20% had benign neoplasm while in remaining 23.3% cases ovarian torsion was found with normal adnexa.…”