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Recurrent ovarian torsion: risk factors and predictors for outcome of oophoropexy. J Minim Invasive Gynecol 2022; 29:1011-1018. [DOI: 10.1016/j.jmig.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
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Meller N, Levin G, Cohen A, Abu-Bandora E, Amitai Komem D, Mashiach R, Meyer R. Surgically confirmed adnexal torsion during pregnancy: Does the trimester make a difference? J Obstet Gynaecol Res 2021; 47:4216-4223. [PMID: 34605118 DOI: 10.1111/jog.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. METHODS This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. RESULTS The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p = 0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p = 0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p = 0.023). CONCLUSIONS Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.
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Affiliation(s)
- Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adiel Cohen
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Meyer R, Meller N, Mohr-Sasson A, Abu-Bandora E, Cohen A, Tamir M, Mashiach R, Levin G. Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion. Int J Gynaecol Obstet 2021; 155:411-416. [PMID: 33629355 DOI: 10.1002/ijgo.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a risk score for preoperative prediction of recurrent adnexal torsion (rAT) among women with a history of previous adnexal torsion (AT). METHODS A retrospective cohort study. We included women with a history of AT, presenting with suspected rAT who underwent diagnostic laparoscopy between March 2011 and March 2020. We compared women with rAT to those without. We constructed a prediction score and validated it in a prospectively collected cohort between April 2020 and June 2020. RESULTS One hundred and fifteen women composed the study cohort. Recurrent AT was confirmed laparoscopically in 86 (74.8%) cases. A risk score for rAT was developed, based on three associated factors: enlarged ovary, no previous oophoropexy and current IVF treatment. In the construction cohort, the rate of torsion was 44.4%, 67.9%, 82.9% and 100% if none, one, two, or three risk factors were present, respectively. In the prospective validation of the risk score, the prediction of one and two risk factors was 60.0% and 100% respectively. CONCLUSION Enlarged ovary is independently associated with preoperative rAT diagnosis. Coupled with information regarding the previous surgical approach in previous AT and current IVF use, these factors could be used to efficiently predict rAT among women with a previous AT.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Mordechai Tamir
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of medicine, Hebrew University, Jerusalem, Israel
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An Unusual Presentation of Recurrent Ovarian Torsion in an Adolescent Female. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mina E, Fusi G, Angotti R, Nardi N, Vincenti M, Messina M, Molinaro F, Bertozzi M. Mesenteric cystic lymphangioma mimicking an ileo-colic intussusception. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Winton C, Yamoah K. Ovarian torsion and laparoscopy in the paediatric and adolescent population. BMJ Case Rep 2020; 13:e232610. [PMID: 32404320 PMCID: PMC7228144 DOI: 10.1136/bcr-2019-232610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/03/2022] Open
Abstract
A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested which demonstrated a large complex midline mass. The most likely diagnosis was ovarian torsion, for which the patient underwent laparoscopy, detorsion and ovarian cystectomy. Histology revealed a mature cystic teratoma. Although less common than in the adult population, it is important to consider ovarian torsion in children and adolescents. Presentation is usually with pain accompanied by vomiting and fever, although these symptoms are not always present. Current management is organ-sparing, with laparoscopy±cystectomy. We discuss the adaptations for this procedure with regard to the paediatric and adolescent population. Differences in the anatomy and physiology must lead to consideration for alterations in surgical technique and positioning to ensure the safest and best quality care for these young patients.
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Affiliation(s)
- Claire Winton
- Obstetrics and Gynaecology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Kofi Yamoah
- Obstetrics and Gynaecology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Bertozzi M, Noviello C, Molinaro F, Ratta A, Lisi G, Cobellis G, Federici S, Chiesa PL, Martino A, Messina M. Isolated fallopian tube torsion in pediatric age: An Italian multicenter retrospective study. J Pediatr Surg 2020; 55:711-714. [PMID: 31130349 DOI: 10.1016/j.jpedsurg.2019.04.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to quantify the experience of five Italian centers on the diagnosis and management of isolated fallopian tube torsion (IFTT) in children. METHODS We retrospectively reviewed the data of 20 patients aged 1-16 years of age with surgically diagnosed IFTT between 1991 and 2017 from five Italian centers of pediatric surgery. We analyzed common presenting signs, symptoms, and radiographic findings, as well as surgical interventions to describe management offering further insight into the diagnosis and treatment of this rare entity. RESULTS Twenty cases of IFTT were collected. Median age was 13.1 years. Menarche was present in 14 cases. A clinical history of abdominal pain was present in 13 patients, whereas in 7 patients the clinical picture was an acute abdomen. Ultrasonography was the first diagnostic examination in 16 cases. Surgical approach was by laparoscopy in 16 cases and laparotomy in 4 cases. In 11 patients IFTT was associated with another pathologic condition. In 7 of the remaining 9 IFTT without pathologic association, the girls played sports. Salpingectomy was performed in 13 patients and de-torsion in 7. CONCLUSIONS IFTT is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. IFTT should be considered in girls with abdominal pain who practice sports with sudden body movements. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular/cystic structure with adjacent normal ovary. Conservative management is controversial but could be preferred in order to provide the best option for future fertility of these girls. TYPE OF STUDY Treatment Study (Retrospective Study) - Level IV.
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Affiliation(s)
- Mirko Bertozzi
- Pediatric Surgery Unit- University of Perugia - Azienda Ospedaliera di Perugia - S. Maria della Misericordia Hospital -, Perugia, - Italy.
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Francesco Molinaro
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
| | - Alberto Ratta
- Pediatric Surgery Unit - Infermi Hospital -, Rimini, - Italy
| | - Gabriele Lisi
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | | | - Pierluigi Lelli Chiesa
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Mario Messina
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
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Daykan Y, Bogin R, Sharvit M, Yaniv RT, Josephy D, Klein Z, Arbib N, Schonman R. Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better. J Obstet Gynaecol Res 2020; 46:745-751. [PMID: 32077209 DOI: 10.1111/jog.14220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
AIM To investigate characteristics and risk factors for recurrent adnexal torsion (AT). METHODS Retrospective cohort study in a university-affiliated medical center included 320 Women with AT verified by laparoscopy, from January 2005 through January 2017. Demographic data, clinical symptoms, surgical findings and treatment were retrospectively reviewed from patient records. Data from primary and secondary AT of patients in the recurrent torsion group was compared to those with single torsion, to evaluate risk factors for recurrent AT. RESULTS Two hundred and sixty seven (83.4%) patients had a single event of AT and 53 (16.5%) had recurrent AT. Patients with recurrent torsion had significantly fewer previous non-gynecologic surgeries (4.3% and 9.8% of the study groups vs 32.2% of the control group, P = 0.001 for both). Ovarian size was significantly smaller in the recurrent torsion groups (47.5 mm and 48.3 mm vs 63.9 mm, P = 0.045 and P = 0.012, respectively). Polycystic ovary was significantly more common in the recurrent AT group (P = 0.028 and P = 0.005), with risk ratio 4.4 (95% confidence interval, 1.66 to 11.63). Ovaries without any specific findings were also more common among recurrent AT cases (P = 0.001 for both groups). Logistic regression analysis demonstrated that smaller ovarian size is an independent risk factor for recurrent AT. CONCLUSION Recurrent torsion correlated with fewer previous surgeries, small ovarian mass, polycystic ovaries and ovaries without specific findings, which might indicate that additional pathophysiological factors contribute to the recurrent event. Ovarian fixation might be recommended in patients with primary torsion of normal or polycystic ovaries.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rona Bogin
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Sharvit
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Tamir Yaniv
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Josephy
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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A New Technique of Oophoropexy: Folding and Fixating of Utero-Ovarian Ligament to Round Ligament in a Patient with Reccurrent Ovarian Torsion. Case Rep Obstet Gynecol 2019; 2019:7647091. [PMID: 31871803 PMCID: PMC6906817 DOI: 10.1155/2019/7647091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/03/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Most cases of ovarian torsion occur in the reproductive age and many are related to ovarian and paraovarian masses. If it occurs without any subtle anatomic etiology or ovarian and paraovarian masses, recurrence of ovarian torsion is more likely. Recurrent left ovarian torsion is much less common than recurrent right ovarian torsion. The authors describe a rare case with their new ovarian fixation technique. Case and Method A 21-year-old female patient with polycystic ovarian syndrome had a 7th recurrence of left ovarian torsion. Although ovarian fixation was performed in addition to detorsion at the 5th and the 6th laparoscopic surgeries, it had failed. Due to recurrence ovarian torsion after ovarian fixation, the authors performed a different technique:folding the utero-ovarian ligament which folded on itself. The distal part of the utero-ovarian ligament with the ovary was both fixed to the proximal part of the round ligament which was adjacent to the uterus. Conclusion Although a wide range of oophoropexy methods have been described in the literature, the best method remains a matter for debate. This technique can be performed even when the ovarian tissue is necrotic. Because of this, we think that this technique is useful and effective technique.
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Mehmetoğlu F. How can the risk of ovarian retorsion be reduced? J Med Case Rep 2018; 12:200. [PMID: 29970160 PMCID: PMC6031141 DOI: 10.1186/s13256-018-1677-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the current treatment of idiopathic ovarian torsion, the use of oophorectomy has declined in favor of preserving the ovary. This approach brings with it the question of how to reduce the possibility of retorsion of the detorsioned ovary. The aim of this study was to analyze how retorsion can be prevented. METHODS Five patients (a 30-day-old Caucasian girl, a 55-day-old Caucasian girl, an 8-year-old Caucasian girl, a 10-year-old Caucasian girl, and a 16-year-old Caucasian girl) who underwent surgery due to non-neoplastic ovarian torsion were retrospectively analyzed for diagnosis and treatment in terms of reducing the possibility of retorsion. RESULTS In all patients, a precise diagnosis of idiopathic unilateral ovarian torsion was made during laparotomy, and the patients underwent different procedures. The ovary was found to be autoamputated in one patient, and two patients underwent salpingo-oophorectomies due to adnexal necrosis. The ovaries were detorsioned in the remaining two patients. During the operations, patients were evaluated regarding the prevention of retorsion of the ipsilateral and/or contralateral ovary; cyst drainage, cystectomy, ligament fixation, and/or oophoropexy were performed. The median follow-up period of the patients was 2 years (range 1.5-6 years), and they continue to be followed uneventfully. CONCLUSIONS To date, there is no standard approach to protect the ovary from retorsion in patients who undergo surgery due to torsion. The surgical procedure should be tailored on a case-by-case basis.
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Affiliation(s)
- Feride Mehmetoğlu
- Department of Pediatric Surgery, Dörtçelik Children's Hospital, 16140, Bursa, Turkey.
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Bertozzi M, Appignani A. Pediatric Adnexal Torsion. J Emerg Med 2018; 54:131. [PMID: 29329634 DOI: 10.1016/j.jemermed.2017.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/25/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Mirko Bertozzi
- Ospedale S. Maria della Misericordia, Universita degli Studi di Perugia, Perugia, Italy
| | - Antonino Appignani
- Ospedale S. Maria della Misericordia, Universita degli Studi di Perugia, Perugia, Italy
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Bertozzi M, Magrini E, Riccioni S, Giovenali P, Appignani A. Isolated fallopian tube torsion with hydrosalpinx: Review of a debated management in a pediatric population. J Pediatr Surg 2017; 52:1553-1560. [PMID: 28735977 DOI: 10.1016/j.jpedsurg.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify our experience with and assess the literature on diagnosis and management of isolated fallopian tube torsion (IFTT) with hydrosalpinx (HSX) in children. METHODS A PubMed search was performed on pediatric cases of IFTT with HSX to provide a comprehensive review analyzing details and management of this association, focusing on the problem of fertility preservation. RESULTS In addition to our 3 cases, 17 patients of pediatric IFTT associated with HSX were identified, for a total of 21 cases (median age 12.2 years). Menarchal status was present in 10/13 (76.9%); blood tests were reported in 9/20 (42%) showing leucocytosis in 7/9 (75%). Ultrasonography was performed in all cases except one. Laparoscopy was the surgical approach in 84.6% of the reported cases. The torsion was to the right in 36.8%, and to the left in 63.2% of the cases. In one case the torsion was bilateral and asynchronous. Performed procedures were salpingectomy (52.4%) and partial salpingectomy (14.3%); conservative management was reported in 33.3% of the cases. CONCLUSIONS The literature describes different management techniques. Salpingectomy is the most frequently performed procedure but recently conservative management seems to be increasingly applied. A long-term study is necessary to define the most effective treatment for the preservation of future fertility in pediatric patients. TYPE OF STUDY Treatment study (Retrospective Study): LEVEL IV.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy.
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Paolo Giovenali
- S.S. Dipartimentale Citologia ed Istologia Diagnostica, S. Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
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Bertozzi M, Esposito C, Vella C, Briganti V, Zampieri N, Codrich D, Ubertazzi M, Trucchi A, Magrini E, Battaglia S, Bini V, Conighi ML, Gulia C, Farina A, Camoglio FS, Rigamonti W, Gamba P, Riccipetitoni G, Chiarenza SF, Inserra A, Appignani A. Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study. J Pediatr Adolesc Gynecol 2017; 30:413-417. [PMID: 27894860 DOI: 10.1016/j.jpag.2016.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/23/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence. DESIGN Multicenter retrospective cohort study. SETTING Italian Units of Pediatric Surgery. PARTICIPANTS Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014. INTERVENTIONS Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively. MAIN OUTCOME MEASURES A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries. RESULTS Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00). CONCLUSION Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Claudio Vella
- S.C. di Chirurgia Pediatrica, Ospedale dei Bambini "V. Buzzi," Milano, Italy
| | - Vito Briganti
- U.O.C. di Chirurgia e Urologia Pediatrica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy
| | - Nicola Zampieri
- Pediatric Surgical Unit, Department of Surgical Sciences, G.B. Rossi Hospital, Verona, Italy
| | - Daniela Codrich
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo" Via dell'Istria, Trieste, Italy
| | - Michele Ubertazzi
- U.O. di Chirurgia Pediatrica, Azienda Ospedaliero, Universitaria di Sassari Viale S. Pietro, Sassari, Italy
| | - Alessandro Trucchi
- U.O.C. Chirurgia Generale e Toracica Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Sonia Battaglia
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Padua, Italy
| | - Vittorio Bini
- Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
| | | | - Caterina Gulia
- U.O.C. di Chirurgia e Urologia Pediatrica Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy
| | - Alessandra Farina
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Waifro Rigamonti
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo," University of Trieste, Trieste, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Woman and Child Health, University Hospital, Padua, Italy
| | | | | | - Alessandro Inserra
- U.O.C. Chirurgia Generale e Toracica Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Recurrent ovarian torsion in an adolescent after oophoropexy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Smorgick N, Melcer Y, Sarig-Meth T, Maymon R, Vaknin Z, Pansky M. High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa. Fertil Steril 2016; 105:1561-1565.e3. [PMID: 26926251 DOI: 10.1016/j.fertnstert.2016.02.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/23/2015] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare adnexal torsion characteristics and torsion recurrence rates in a pre- and postmenarchal pediatric and adolescent population. DESIGN Retrospective cohort study. SETTING University-affiliated medical center. PATIENT(S) Females <18 years old with surgically diagnosed adnexal torsion. INTERVENTION(S) Adnexal detorsion, cystectomy, salpingectomy, or salpingo-oophorectomy by laparoscopy or laparotomy. Oophoropexy using the utero-ovarian ligament plication technique was performed in cases of recurrent torsion of normal adnexa. MAIN OUTCOME MEASURE(S) The clinical presentation, laboratory and ultrasound characteristics, surgical findings, surgical procedures, pathologic diagnosis, and torsion recurrence rates were analyzed and compared between pre- and postmenarchal patients. RESULT(S) Twenty premenarchal and 24 postmenarchal patients were identified. The clinical presentation, laboratory findings, and ultrasound characteristics were similar between the two groups, except for a higher prevalence of paraovarian cysts on preoperative ultrasound in the postmenarchal compared with in the premenarchal group (20.8% vs. 0%). For the whole cohort, torsion of normal adnexa constituted 25.0% (11/44) of cases, while torsion of "pathologic" adnexa constituted 75.0% (33/44) of torsion cases. Torsion recurrence was significantly more common among girls whose first torsion episode occurred in the premenarchal period compared with in postmenarche (35% vs. 4.2%). On multivariate logistic regression analysis, torsion recurrence was significantly associated with premenarchal status (odds ratio [OR] = 12.7; 95% confidence interval [CI], 1.1-152.0) and with torsion involving normal adnexa (OR = 19.1; 95% CI, 2.3-154.5). CONCLUSION(S) Recurrent torsion is common in patients whose first torsion episode occurred in the premenarchal period and involved otherwise normal adnexa. Ovarian fixation procedures may be considered in patients at risk for torsion recurrence.
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Affiliation(s)
- Noam Smorgick
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Tal Sarig-Meth
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Moty Pansky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
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