Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights

Abstract

Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.

Improving Pediatric Ovarian Torsion Evaluation in the Pediatric Emergency Department: A Quality Improvement Initiative

“…Although TPUS has relatively low sensitivity (43%-70%), it is currently the first-line diagnostic test for children. [5][6][7] A patient's subjective bladder fullness, while easy to obtain, is often inaccurate. 8 In addition to its use as a bedside diagnostic tool in the ED, point-of-care US evaluations of the bladder have been shown to decrease time to TPUS and increase first-time success in the visualization of the ovaries in other pediatric ED settings.…”

Improving Turnaround Time of Transabdominal Pelvic Ultrasounds with Ovarian Doppler in a Pediatric Emergency Department

“…[3][4][5] Due to variable clinical presentations, preoperative imaging confirmation is desired. 6,15 Radiology performed transabdominal pelvic ultrasound with ovarian Doppler (pelvic US) is the imaging modality of choice for pediatric female patients with concerns of pelvic pathology as it is noninvasive, painless, and radiation-free. 7,8,15 Problem Description A patient's bladder is used as an acoustic window during pelvic US to evaluate the adnexa and needs to be sufficiently full.…”

“…6,15 Radiology performed transabdominal pelvic ultrasound with ovarian Doppler (pelvic US) is the imaging modality of choice for pediatric female patients with concerns of pelvic pathology as it is noninvasive, painless, and radiation-free. 7,8,15 Problem Description A patient's bladder is used as an acoustic window during pelvic US to evaluate the adnexa and needs to be sufficiently full. 9,10 The sensation of bladder fullness or arbitrary target volumes were used to identify pelvic US readiness.…”

“…3–5 Due to variable clinical presentations, preoperative imaging confirmation is desired. 6,15 Radiology performed transabdominal pelvic ultrasound with ovarian Doppler (pelvic US) is the imaging modality of choice for pediatric female patients with concerns of pelvic pathology as it is noninvasive, painless, and radiation-free. 7,8,15…”

Estratégias Para O Manejo Clínico E Diagnóstico Diferencial Da Paciente Com Torção Anexial Na Urgência E Emergência

“…A taxa de ooforectomias para a correção desse tipo de torção reduziu consideravelmente no último século, entretanto, mesmo que a incidência da torção anexial pediátrica seja similar com a torção testicular pediátrica, a taxa de ooforectomias para esse caso é 50% maior que a de orquiectomias. Assim, a avaliação física de qualquer paciente com os sintomas de torção nas gônadas requer cautela, agilidade e entendimento adequado do manejo clínico, a fim de preservar sua integridade (Scheier, 2022).…”