No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults

Kives, Sari; Gascon, Suzy; Dubuc, Élise; Eyk, Nancy Van

doi:10.1016/j.jogc.2016.10.001

Cited by 63 publications

(52 citation statements)

References 65 publications

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“…21,23 Findings on ultrasound examination suggestive of AT include: increased ovarian size, peripheral distribution of follicles, abnormal location of the adnexa compared with the uterus, and the presence of free fluid. 19,23,24 In our study, 69% of preoperative ultrasound examinations were suggestive of AT. Ultrasound is a useful tool, however, the diagnosis of AT is ultimately clinical.…”

Section: Discussionsupporting

confidence: 46%

“…33e35 In our With adnexal pathology, recurrence rates of up to 12% have been reported; it appears to be even higher among premenarchal girls found to have otherwise normal ovaries and fallopian tubes. 13,19,38,40,41 In our cohort, there was a recurrence rate of 3.4% and although no association could be made regarding pubertal status, it was noted that none had pathologic lesions with the initial torsion.…”

contrasting

confidence: 58%

“…Elevated WBC was not a frequent finding in our study, consistent with previous studies. 4,13,19 Ultrasound is the gold standard imaging choice for AT because of the ability to directly and rapidly evaluate ovarian anatomy and perfusion in a noninvasive manner. 20 On ultrasound examination, absent Doppler arterial flow and ovarian enlargement are reported to be the most helpful hallmarks of torsion, but these findings are not always present.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, experienced surgeons suggest that oophoropexy can be offered in the setting of recurrent torsion, absent contralateral ovary presence, elongated ovarian ligament, and torsion of normal adnexa. 19,40,43 In our cohort, 5 of the 8 recurrences (62.5%) received an oophoropexy during their second presentation, none of which had associated pathology during the initial or subsequent surgery.…”

mentioning

confidence: 80%

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

Adeyemi‐Fowode

Lin

Syed

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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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.

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Section: Discussionsupporting

confidence: 46%

contrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 80%

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

Adeyemi‐Fowode

Lin

Syed

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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“…Based on the descriptions in the surgical records in the present study, physicians preferred to perform USO if the color of the adnexa was still blue-black for ten minutes after detorsion. However, some studies have proven that it is not accurate to determine the activity of the ovary based on the color during the surgery [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, treatment and outcome of adnexal torsion in pregnant women: 10-year experience

Wang¹,

Deng²

2020

Preprint

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Background Adnexal torsion during pregnancy is a gynecological emergency. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women. Methods A retrospective study was conducted at a tertiary center between January 2008 and January 2018. Eighty-two pregnant women with surgically confirmed adnexal torsion were included. The clinical characteristics, ultrasound data, surgical interventions and pregnancy outcomes were analyzed. Results The median age of the patients was 28 (range, 18–38) years. The median gestational age was 11 (range, 6–31) weeks: 53 (64.6%) were in the first trimester, 21 (25.6%) were in the second trimester, and 8 (9.8%) were in the third trimester. The most common symptoms and signs were sudden pelvic pain (100%) and adnexal or pelvic masses (97.6%), followed by nausea and vomiting (61%). The Doppler blood flow signal disappeared in 62.5% of the patients. Sixty-three (76.8%) patients underwent laparoscopy, and 29 (24.2%) underwent laparotomy. The median gestational age in patients undergoing laparotomy was higher than that in those undergoing laparoscopy (26 weeks vs 10 weeks, p < 0.001). Fifty-three (64.6%) patients underwent conservative surgery, with 48 detorsions and cystectomies, 2 detorsions and cyst fenestrations, 1 detorsion only and 2 salpingectomies only. Twenty-nine (25.4%) patients underwent unilateral salpingo-oophorectomy. There were no cases of postoperative thrombosis, spontaneous abortion or recurrence. Seven patients underwent simultaneous artificial abortion. One patient experienced intrauterine fetal death, and 74 patients had live births. Conclusion Surgical intervention was required as soon as possible. Laparoscopic conservative surgery is safe and may be appropriate to preserve ovarian function. Cystectomy could reduce the risk of recurrence.

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Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion

Meyer

Meller

Mohr–Sasson

et al. 2021

Intl J Gynecology & Obste

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Adnexal torsion (AT), the 5th most common gynecologic emergency, is present in 2.5%-14.8% of women undergoing emergency surgery for acute pelvic pain and adnexal mass. 1-3 A timely diagnosis of AT is of utmost importance as surgery is performed to untwist the adnexa and preserve the ovary when appropriate. Recurrence of AT (rAT) is not uncommon, and is reported to occur in 2%-12% of women, reaching a rate of more than 60% in some series. [4][5][6][7] Higher rAT rates were reported in normally appearing adnexa and among pregnant women, while oophoropexy and the surgical technique applied during the primary AT were reported to affect the rate of rAT as well. 7 Some studies have developed a scoring system to improve the accuracy of the preoperative diagnosis of AT. 8,9 However, no scoring system has been developed for the subset of women presenting with acute pelvic pain and a previously proven AT. As the risk

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No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults

Cited by 63 publications

References 65 publications

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

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

Clinical characteristics, treatment and outcome of adnexal torsion in pregnant women: 10-year experience

Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion

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