Asynchronous Bilateral Ovarian Torsion: Three Cases, Three Lessons

Abstract

Background Ovarian torsion (OT) is a serious condition, and delay in surgical intervention may result in loss of the ovary. Children and adolescents who have suffered from ovarian torsion may be at risk for asynchronous torsion of the contralateral ovary. Study objective Three cases of asynchronous bilateral ovarian torsion were reported to analyse clinical history of three patients, to review the current literature, and to draw a conclusion for future treatment. Design Case reports and review of the literature. Result When a prepubertal girl presents with an ovarian torsion, several considerations have to be taken in account in order to preserve her future fertility; in particular, the pediatric surgeon/gynecologist has to preserve as much as possible the twisted ovary in addition to considering the fate of the contralateral ovary. Summary and Conclusions Pelvic pain in a young girl has always raised the clinical suspect of an ovarian torsion; the possibility of asynchronous bilateral ovarian torsion is rare, but it is described in the literature and has catastrophic consequences; this condition has to be known and treated in the proper way by pediatric surgeons as well as by gynecologists in order to maximize the future fertility of the young patients.

Oophoropexy to prevent adnexal torsion recurrence in children

“…The guidelines [2] recommend that oophoropexy be considered in situations where the ovarian ligaments are congenitally long, patients have repeat torsion, or when no obvious cause for the torsion can be found; however, the technical details of oophoropexy in pediatric population was no mentioned. Lucchetti et al [8] also stated thatoophoropexy should be performed with permanent sutures because absorbable sutures may completely disappear without any residual scar, which was observed in our study in case 5. Fuchs et al [4] reported one case of torsion recurrence 14 months after suturing of the ovary to the lateral pelvic sidewall with an absorbable suture.…”

An Insidious Cause of Abdominal Pain in a Preschooler Girl

“…3 Asynchronous bilateral OT is defined as torsion of both ovaries at different settings. 5 At our knowledge, in literature, as reported by Lucchetti et al, 3 29 asynchronous OTs have been described.…”

“…3,4 Although the adnexal torsion is most frequently unilateral, cases of bilateral synchronous or asynchronous have been reported. 3 Asynchronous bilateral OT is defined as torsion of both ovaries at different settings. 5 At our knowledge, in literature, as reported by Lucchetti et al, 3 29 asynchronous OTs have been described.…”

“…In 50% of cases, in pediatric age, normal ovaries have been demonstrated in patients with OT. 3,4 Although the adnexal torsion is most frequently unilateral, cases of bilateral synchronous or asynchronous have been reported. 3 Asynchronous bilateral OT is defined as torsion of both ovaries at different settings.…”

Adnexal Torsion in Pediatric Age: Does Bolli’s Score Work? Report of Two Cases

“…In premenarchal girls utero-ovarian ligaments are normally elongated. Hypermobility due to an elongated utero-ovarian ligament and hyperlaxity of mesosalpinx could represent risk factors for torsion [8].…”