Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases.

Department of Pediatric Surgery, Hopital Necker-Enfants Malades, Paris, France.
Journal of pediatric and adolescent gynecology (Impact Factor: 1.81). 08/2008; 21(4):201-6. DOI: 10.1016/j.jpag.2007.11.003
Source: PubMed

ABSTRACT The authors describe and discuss the clinical and therapeutic features of 40 ovarian torsions (OT) in children with its urgent treatment that has advanced in recent years.
A retrospective study of 40 cases of OT in 38 children under 16 years of age, excluding adnexal torsions in neonates.
Abdominal and/or pelvic pain was the presenting symptom ; 8 of these children had pain between 2 to 9 months prior to surgery and 27/40 (67.5%) had associated vomiting. Before the procedure, ultrasound (US) diagnosed 29 ovarian lesions, related to 14 mature teratomas (MTE) and 10 cystadenomas (CA), one association of MTE and CA in the same ovary, 2 functional cysts and 2 malignant neoplasms. 19/40 torsions could benefit from conservative management. Eleven torsions occurred, 10/11 of these ovaries had an increased volume, and 5/11 had US evidence of small subcortical cysts. Three detorsions with incomplete removal of CA were followed by enlargement of the tumor and re-torsion in 2 of them. Five children had bilateral ovarian pathology which led to unilateral ovariectomy, while the other benefited from conservative treatment.
In any girl presenting with abdominal pain, the diagnosis of an ovarian torsion must be considered. US is performed emergently, but only surgery, most often a laparoscopic procedure, assures diagnosis. The treatment of the torsion is an emergency and must be as conservative as possible in order to preserve the ovarian function. Bilateral torsions are not unusual.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The germinal tumors belong to a group of non epithelial neoplasias which can have a gonadal or extragonadal localization. Teratomas are tumors which can have two or more embrionary layers its presentation is unilateral, but in 10% of the cases are bilateral. Ovary rescue is a feasible and useful technique in pediatric patients who present the bilateral form of the disease. In this paper we report two cases of pediatric patients, who developed a methacronic bilateral teratomas, one case of a 12 years old patient and the second one of a 15 years old girl, in both cases we performed ovarian tissue rescue. At the present time they have normal hormonal levels, and in the future they can probably be fertile thanks to the residual ovary tissue.
    Perinatología y reproducción humana / INPer 03/2012; 26(1):35-42.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Adnexal torsion is a rare gynaecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage .Our study is about clinical presentation and management approach of adnexal torsion in a tertiary care centre. Retrospective study. Review of case records during the five years of 2008 November -2013 November in Amrita Institute of Medical Sciences, Kochi, India. Adnexal torsion was found mainly in the reproductive age. Ultrasound was the most commonly used imaging modality. Benign tumours predispose to torsion. Torsion occurred during postovulatory period in many cases. Polycystic ovaries were a risk factor for unexplained torsion in younger age groups. Diagnosis of adnexal torsion was mostly intra operative by direct visualisation of the rotated adnexa. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was tried in majority of the child bearing age groups. Adnexal torsion is a rare emergency which requires a high index of clinical suspicion for diagnosis as the symptoms are non specific. Imaging helps in diagnosis but most of them are diagnosed intra operatively. Laparoscopic conservative surgery is the preferred surgical approach especially in younger age groups. An early surgical intervention helps in salvaging the adnexa and prevents further complications.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Ovarian torsion (OT) is a true surgical emergency that requires prompt diagnosis and therapy. There are conflicting reports on the accuracy of different imaging modalities for OT. In this study, we performed a meta-analysis of all the published studies on B-mode ultrasound (US, morphological criteria), Doppler US (DUS, flow criteria), and computed tomography (CT) for the diagnosis of OT. Methods The medical literature from 1987 to 2013 was searched for studies that evaluated US, DUS, CT, or combination of these techniques to diagnose OT in children using PubMed/MEDLINE database. The studies were screened and included if the quality criteria were met. Data were extracted using a standardized form. Reported sensitivities and specificities were pooled with 95% confidence intervals using a RevMan version 5.1 software (The Cochrane Collaboration, Oxford, United Kingdom). Results A total of 18 US studies with 716 combined patients were included, along with 15 DUS studies comprising of 1,021 patients, and 5 CT studies with a total of 107 patients. All studies reported sensitivities, while only few selected studies also reported specificities. Using morphological criteria on B-mode US (including absolute or relative ovarian size, echotexture, location, and configuration) yielded high sensitivity and specificity (average 92 and 96%, respectively); DUS was highly specific, but lacked sensitivity, while CT was the least sensitive test. CT specificities could not be calculated from the available data. Conclusion This study found considerable variability of the reported sensitivities and specificities for the diagnosis of OT across all evaluated imaging modalities. Interestingly, B-mode US was the most sensitive and specific examination to detect OT. Some authors reported high diagnostic accuracy of DUS as well, but these findings have not been universally reproduced. CT had low overall sensitivity and is not recommended for the workup of suspected OT.
    European Journal of Pediatric Surgery 08/2014; 25(01). DOI:10.1055/s-0034-1387946 · 0.98 Impact Factor