Paediatric Ovarian Torsion- Salvaging the Unsalvageable

Abstract

BACKGROUND Ovariectomy used to be the conventional treatment for ovarian torsion in the paediatric age group. A paradigm shift in the management of paediatric ovarian torsion was reported in recent years, with ovarian recovery documented with simple detorsion, even for cases which macroscopically appeared necrotic or gangrenous. Our study was undertaken to analyse the management and outcome after detorsion of twisted ovaries in children. METHODSA prospective study of 20 consecutive cases of paediatric ovarian torsions that presented in a tertiary level Paediatric Surgery Dept. from 2010 to 2014 was done. Neonatal and infantile cases were excluded. Pre-operative parameters (age, symptoms and duration, menarchal status, sonographic features, doppler assessment of flow, tumour markers, time to surgery from presentation at hospital) and per-operative parameters (site, size, appearance, colour and response to detorsion) were assessed. The cases were categorized into 3 groups-Group A-Detorsion with or without aspiration. Group B-Detorsion with immediate ovarian sparing cystectomy. Group C-Ovariectomy. Post-operatively, patients were followed up clinically and with sonograms. RESULTSIn all cases of Group A and B, the ovary could be salvaged as documented with sonograms, irrespective of the initial macroscopic appearance of the ovary. All cases in group B, where cystectomy was done along with the initial detorsion, had smaller ovaries in follow up sonograms. There were no cases of ovarian malignancy undergoing torsion. 55% of cases were that of normal ovary undergoing torsion. In ovarian torsions, where the size was more than 5 cms and/or volume of the involved side was more than 20 times that of the opposite normal ovary, 82% had an associated cyst/benign lesion at the time of torsion. CONCLUSIONSOvarian preservation should be the basic tenet of surgical approach irrespective of the pre-operative Doppler findings and intra-operative color of the twisted ovary.