Evolution in the Management of Pediatric and Adolescent Ovarian Torsion as a Result of Quality Improvement Measures

Hubner, Nicole; Langer, Jacob C.; Kives, Sari; Allen, Lisa

doi:10.1016/j.jpag.2016.06.008

Cited by 31 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adnexal torsion is one of the most common causes of acute pelvic pain in non-pregnant women, preceded by corpus luteum rupture with hemorrhage, and followed by pelvic inflammatory disease, malpositioned intrauterine device and degenerating fibroids 1 . It is most common in women of reproductive age [2][3][4] , but can occur in children 5,6 and rarely in postmenopausal women 2,7,8 . A national population-based study from Korea reported an incidence of adnexal torsion of nine per 100 000 women per year 9 , whereas a population-based matched cohort study in 8 532 163 pregnant women reported an incidence of adnexal torsion of 16 per 100 000 during 8 years 10 .…”

Section: Epidemiologymentioning

confidence: 99%

See 1 more Smart Citation

Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion

Moro

Bolomini

Sibal

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objectives To describe the clinical and ultrasound characteristics of adnexal torsion. Methods This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ. Results A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1–88) years. Most patients were premenopausal (284/314; 90.4%) and presented with acute or subacute pelvic pain (305/315; 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30–349) mm. Free fluid in the pouch of Douglas was detected in 196/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167/241 (69.3%) patients, the whirlpool sign in 178/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119/269 (44.2%) patients and the follicular ring sign in 51/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201/254; 79.1%) and the whirlpool sign (139/153; 90.8%) were the most commonly detected features of adnexal torsion. Conclusion Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright © 2020 ISUOG. Published by John Wiley &...

show abstract

Section: Epidemiologymentioning

confidence: 99%

“…An important risk factor for adnexal torsion is previous adnexal torsion. Some studies reported that 11-19% of patients with adnexal torsion had previous adnexal torsion 6,18,19 . Patients who have had torsion of a normal adnexa have a higher risk of recurrent torsion than do patients who have had torsion of an adnexal cyst 11,19 .…”

Section: Epidemiologymentioning

confidence: 99%

Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion

Moro

Bolomini

Sibal

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…In recent years, the mainstay of the treatment for ovarian torsion has been surgical evaluation and preserving ovarian function. There are many ways to perform the surgery and detorsion and ovarian conservation are almost always recommended now rather than salpingo-oophorectomy [ 69 ]. An ovarian cystectomy is often performed for a benign ovarian mass.…”

Section: Anagementmentioning

confidence: 99%

A review of ovary torsion

2017

View full text Add to dashboard Cite

Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.

show abstract

“…They can be defined broadly as purposeful efforts to secure positive change. There have been studies highlighting unsatisfactory outcomes of the treatment of pediatric masses in children where implementation of quality improvement projects led to positive effects [3,[32][33][34].…”

Section: Discussionmentioning

confidence: 99%

What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?—Results of a Multicenter Retrospective Study and a Scoping Literature Review

et al. 2022

View full text Add to dashboard Cite

Purpose: to determine management problems of ovarian masses in girls in order to form a baseline for prospective randomized studies of the established topics and quality improvement of our management. Materials and Methods: We performed a national analysis of clinical aspects of ovarian masses in girls operated on in Poland, analyzed retrospectively medical files of all consecutive patients aged 0–18 who underwent surgeries for ovarian lesions between 2012 and 2017 at 17 pediatric surgical departments and complemented the analysis with a scoping review of a recent primary research related to ovarian masses in children. Results: The study group comprised 595 patients. Forty-four (7.39%) girls were diagnosed with malignant tumors. The overall preservation rate was 64.54%. The analysis revealed that positive tumor markers (OR = 10.3), lesions larger than 6 cm (OR = 4.17) and solid mass on ultrasound examination (OR = 5.34) are interdependent variables differentiating malignant tumors from non-malignant lesions (X42= 79.1; p = 0.00000). Our scoping review revealed 10 major branches of research within the topic of ovarian masses in pediatric population. Conclusions: We have developed an overview of the field with the emphasis on the local environment. Our next step is a multi-institutional prospective study of a quality improvement project implementation based on the obtained knowledge.

show abstract

Evolution in the Management of Pediatric and Adolescent Ovarian Torsion as a Result of Quality Improvement Measures

Cited by 31 publications

References 26 publications

Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion

Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion

A review of ovary torsion

What Should Be the Topics of a Prospective Study on Ovarian Masses in Children?—Results of a Multicenter Retrospective Study and a Scoping Literature Review

Contact Info

Product

Resources

About