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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024; 59:1538-1544. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Marcinkowski K, Saul D, Gould S, Berman L, Schwartz BI. Application of a Composite Score to Predict Adnexal Torsion in Premenarchal and Menarchal Children and Adolescents. J Pediatr Surg 2024; 59:509-514. [PMID: 37875379 DOI: 10.1016/j.jpedsurg.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
STUDY OBJECTIVE The study objective was to apply a previously created composite score for the prediction of adnexal torsion in children and adolescents to a larger group of heterogeneous patients to test its validity and to refine this scoring system to more accurately predict adnexal torsion. METHODS This was a retrospective chart review at a tertiary care children's hospital and its affiliates. Participants were female patients 0-20 years of age who underwent surgery for suspected adnexal torsion from 2016 to 2019. Data were collected from outpatient, emergency department, and inpatient notes, radiographic data, and operative reports. The primary outcome was the accuracy and predictive value of the total composite score (TCS) to identify or exclude adnexal torsion. RESULTS Of the 291 patients with suspected adnexal torsion who went to the operating room during the study period, 168 (57.8 %) had confirmed adnexal torsion. The accuracy of the TCS, which included presence of vomiting, adnexal volume, and adnexal ratio, in predicting or excluding torsion was 83.6 % for all patients, 92.1 % for premenarchal patients, and 81.3 % for menarchal patients. A variation of the TCS that included only vomiting and adnexal volume had an accuracy of 85.8 %. CONCLUSIONS Our study demonstrates the accuracy and reproducibility of a previously published composite score to predict adnexal torsion in children and adolescents. It also further refines this score to a potentially more clinically useful tool. Future studies are needed to prospectively evaluate these composite scores and their implementation in clinical settings. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katrina Marcinkowski
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Saul
- Department of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Sharon Gould
- Department of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA; Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Beth I Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
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Prete S, Abbomerato M, Simon EL. Ovarian torsion masquerading as a ureteral stone. Am J Emerg Med 2024; 76:273.e1-273.e3. [PMID: 38072734 DOI: 10.1016/j.ajem.2023.11.046] [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] [Received: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Abdominal pain is the most common complaint within the emergency department (ED) and has many varied etiologies. Some of these conditions can be medical emergencies, including ovarian torsion. While representing just 3% of gynecologic emergencies, ovarian torsion should be considered in all females presenting to the ED with abdominal or pelvic complaints. CASE A 38-year-old G5P5 female with a past medical history significant for ureterolithiasis presented to a freestanding ED with abdominal pain, nausea, and vomiting. She developed sudden onset of right sided abdominal pain radiating to her right flank upon awakening. The initial differential diagnosis was for ureterolithiasis or appendicitis. Her complete blood count (CBC) was normal, and testing for pregnancy, infection, and hematuria was negative. Computed topography (CT) imaging of the abdomen and pelvis revealed a 9 cm adnexal mass, consistent with a possible dermoid cyst. A pelvic ultrasound was ordered which showed a possible ovarian torsion. She was transferred to a tertiary care hospital where she had a laparoscopy with right-sided oophorectomy and salpingectomy performed. DISCUSSION This patient presented with abdominal pain, nausea, and vomiting and was first suspected to have ureterolithiasis or appendicitis. She was found to have an ovarian torsion with a dermoid cyst, which resulted in the loss of her ovary and fallopian tube. This case demonstrates the importance of including gynecologic emergencies in the differential on all female patients presenting with abdominal pain.
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Affiliation(s)
- Spencer Prete
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron GeneralAve., Akron, OH 44307, USA
| | - Micaela Abbomerato
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron GeneralAve., Akron, OH 44307, USA
| | - Erin L Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron GeneralAve., Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 St. OH-44, Rootstown, OH 44272, USA.
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Yagur Y, Brisker K, Kveler K, Cohen G, Weitzner O, Schreiber H, Schonman R, Klein Z, Biron-Shental T. Can Natural Language Processing Improve Adnexal Torsion Predictions? J Minim Invasive Gynecol 2023; 30:672-677. [PMID: 37119990 DOI: 10.1016/j.jmig.2023.04.010] [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] [Received: 03/24/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
STUDY OBJECTIVE To create a decision support tool based on machine learning algorithms and natural language processing (NLP) technology, to augment clinicians' ability to predict cases of suspected adnexal torsion. DESIGN Retrospective cohort study SETTING: Gynecology department, university-affiliated teaching medical center, 2014-2022. PATIENTS This study assessed risk-factors for adnexal torsion among women managed surgically for suspected adnexal torsion based on clinical and sonographic data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The dataset included demographic, clinical, sonographic, and surgical information obtained from electronic medical records. NLP was used to extract insights from unstructured free text and unlock them for automated reasoning. The machine learning model was a CatBoost classifier that utilizes gradient boosting on decision trees. The study cohort included 433 women who met inclusion criteria and underwent laparoscopy. Among them, 320 (74%) had adnexal torsion diagnosed during laparoscopy, and 113 (26%) did not. The model developed improved prediction of adnexal torsion to 84%, with a recall of 95%. The model ranked several parameters as important for prediction. Age, difference in size between ovaries, and the size of each ovary were the most significant. The precision for the "no torsion" class was 77%, with a recall of 45%. CONCLUSIONS Using machine learning algorithms and NLP technology as a decision-support tool for the diagnosis of adnexal torsion is feasible. It improved true prediction of adnexal torsion to 84% and decreased cases of unnecessary laparoscopy.
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Affiliation(s)
- Yael Yagur
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel.
| | - Karin Brisker
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Ksenya Kveler
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
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Meyer R, Meller N, Amitai Komem D, Abu-Bandora E, Cohen A, Cohen SB, Mashiach R, Levin G. Pregnancy-Associated Ovarian Torsion - a Single-Center Case-Control Study. Reprod Sci 2023; 30:1998-2002. [PMID: 36576712 DOI: 10.1007/s43032-022-01138-z] [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] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/29/2022]
Abstract
The etiology of OT is largely unknown. Any predisposition to rotation of the infundibulopelvic ligament and utero-ovarian ligament should be considered a possible etiology. Information with respect to ovarian torsion (OT) among pregnant is underreported and based on small studies. We aim to compare characteristics of confirmed OT to laparoscopies performed for the indication of suspected OT, in which no OT was found among pregnant women. This is a retrospective case-control study. We included pregnant women who underwent laparoscopy for a suspected OT between March 2011 and August 2020. Pregnant women with confirmed OT (torsion group) were compared to those without (no torsion group). There were 169 women with suspected OT. OT was confirmed in 140 (82.8%) women. There was higher proportion of assisted reproductive technology (ART) gestation in the torsion group [76 (54.3%) vs. 5 (17.2%), p < 0.001]. The rate of pregnant approaching evaluation within 8 h of symptoms onset was higher in the torsion group [57 (40.7%) vs. 2 (6.9%), p < 0.001]. The mean visual analogue score (VAS) was higher in the torsion group (8.5 vs. 7.1, p = 0.002). The mean pulse was lower in the torsion group (79 vs. 88 bpm, p < 0.001). From sonographic characteristics examined, the following was higher in the torsion group; mean maximal size of the ovary (70 mm in the torsion group vs. 54 mm in the no torsion group, p = 0.011). In a multivariable logistic regression analysis, number of hours of symptoms was negatively associated with AT [aOR, 95% CI 0.95 (0.91-0.98)] and pulse was negatively associated with OT [aOR, 95% CI 0.78 (0.63-0.95)]. Among the 29 cases in which no OT was found during laparoscopy, the following findings were noted: 16 (55.2%) no abnormality at all, 5 (17.2%) functional ovarian cyst, 2 (6.9%) mature teratoma and 6 cases of peritoneal adhesions (20.7%). The time from pain onset to approaching evaluation and women's pulse should be considered and acknowledged in the evaluation of OT during pregnancy.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Adiel Cohen
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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An adolescent with adnexal torsion presenting with severe hyponatremia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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7
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Ashmore AA, Blackstock S, Kenny C, Ismail A. Recognition and initial management of ovarian torsion. BMJ 2023; 381:e074514. [PMID: 37116904 DOI: 10.1136/bmj-2022-074514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Ayisha A Ashmore
- Gynaecology Department, University Hospitals Leicester NHS Trust, Leicester, UK
| | | | - Conor Kenny
- The Old Church GP Surgery, Chingford, London, UK
| | - Aemn Ismail
- Gynaecology Department, University Hospitals Leicester NHS Trust, Leicester, UK
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8
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Clinical and radiologic factors associated with adnexal torsion in premenarchal and menarchal children and adolescents. J Pediatr Surg 2023; 58:767-773. [PMID: 36008196 DOI: 10.1016/j.jpedsurg.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adnexal torsion is a gynecologic emergency in children and adolescents but remains a challenging diagnosis, with no consistent clinical or radiologic diagnostic criteria. Our objective was to identify risk factors associated with adnexal torsion in premenarchal and menarchal patients with surgically confirmed torsion compared with those without torsion. METHODS We conducted a retrospective chart review of all patients who underwent surgery between January 2016 and December 2019 for possible adnexal torsion. Data on demographics, clinical characteristics, radiologic variables, and operative findings were compared using descriptive statistics. Independent predictors of torsion were then examined in multivariate logistic regression models. RESULTS Of the 291 patients who underwent surgery, 168 (57.7%) had torsion. Patients with torsion were younger than those without torsion (11.9 vs. 14.2 years, P < .01). Vomiting was significantly associated with torsion for all patients (P < .001). Large adnexal volume and absent arterial Doppler flow were associated with torsion for the total population and menarchal subgroup. A logistic regression model for the total population that controlled for age and menarchal status found that vomiting (adjusted odds ratio [aOR] 5.92, 95% confidence interval [CI] 2.87-12.22), highest adnexal volume category (aOR 4.92, 95% CI 2.25-10.75), and absent arterial Doppler flow (aOR 2.674, 95% CI 1.28-5.60) were associated with torsion. CONCLUSIONS Vomiting, enlarged adnexal volume, and absent arterial Doppler flow were associated with adnexal torsion. However, no single risk factor accurately diagnosed torsion, and multiple factors should be interpreted together. LEVEL OF EVIDENCE Study of Diagnostic Test, Level II.
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George JS, Rosen MW, Curci N, Torres ML, Wasnik AP, Smith YR, Quint EH. Sonographic Predictors of Ovarian Torsion in Premenarchal Girls. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00310-8. [PMID: 36944392 DOI: 10.1016/j.jpag.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/07/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
STUDY OBJECTIVE To identify preoperative transabdominal sonographic predictors of surgically-confirmed ovarian torsion (OT) in premenarchal girls. METHODS Retrospective case-control study of 32 premenarchal girls aged 0-12 undergoing surgery for OT (cases) or a non-torsed ovarian mass (controls) from 2006-2017 at a single academic center. Cases had ICD-9/10 codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube and surgically-confirmed OT; controls had codes for ovarian mass or cyst and surgically-confirmed absence of OT. Preoperative transabdominal ultrasounds were analyzed by three radiologists blinded to final diagnosis. Chi-square, Fisher's exact, and Student's t-test were used for statistical comparisons. RESULTS From 2016-2017, 32 patients presented with acute abdominal pain or symptoms concerning for ovarian mass requiring ultrasound imaging and subsequent diagnostic laparoscopy-24 (75.0%) had confirmed OT by laparoscopy; eight (25.0%) did not. Mean age in both groups was similar (7.3±2.9 years). Preoperative sonographic variables significantly associated with OT included presence of a simple cyst (20.8% vs 12.5%), ovarian heterogeneity (100% vs 12.5%), presence of peripheralized follicles (70.8% vs 0%), and asymmetry of color Doppler (75.0% vs 37.5%)-all p<0.05. Presence of free fluid, arterial color Doppler, and a whirlpool sign were not predictive of OT. CONCLUSION In premenarchal patients, while certain variables on transabdominal sonography predicted surgically-confirmed OT, only the presence of peripheralized follicles was unique to girls with OT. The decision to proceed with diagnostic laparoscopy for suspected OT can be aided by these specific sonographic findings but should ultimately be based on high clinical suspicion.
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Affiliation(s)
- Jenny S George
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI.
| | - Nicole Curci
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
| | | | | | - Yolanda R Smith
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI
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Zhang H, Bai J, Zhang B, Wu D, Fang Y. Characteristics of ovarian necrosis in the neonatal ovarian tumor: a single-center retrospective study and review of literature. Pediatr Surg Int 2022; 39:42. [PMID: 36484856 DOI: 10.1007/s00383-022-05277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 12/13/2022]
Abstract
To analyze the characteristics of ovarian necrosis in the neonatal ovarian tumor, and review treatments for ovarian torsion in neonates. Neonates with ovarian tumors undergoing surgery in Fujian Maternal and Child Health Hospital (Fujian Children's Hospital) from February 2016 to August 2021 were analyzed retrospectively. Patients were divided into the ovarian necrosis group and control group (without necrosis). Demographic characteristics, prenatal and postnatal examination, operation, and pathological findings were compared and the relevant factors of ovarian necrosis were discussed. 26 neonates were included, 12 in necrosis group and 14 in control group. The maximum diameter of the tumor in necrosis group was smaller than that in control group (P < 0.01). The preoperative CRP in necrosis group was significantly higher than that in control group (P < 0.05). There were no significant differences between two groups in the timeliness of surgery, pathological types, and length of postoperative hospital stay. About 26% of neonatal ovarian torsion could be rescued. Neonatal ovarian necrosis is characterized by a smaller tumor size and a higher preoperative CRP level. Timely surgery after birth might not change the ovarian outcome, but ovarian detorsion could be attempted in neonates to save residual ovarian function.
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Affiliation(s)
- Hong Zhang
- Department of General Surgery and Oncology, Fujian Children's Hospital, 966th Hengyu Road, Jin'an District, Fuzhou City, 350000, Fujian, China.,Fujian Branch of Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Jianxi Bai
- Department of General Surgery and Oncology, Fujian Children's Hospital, 966th Hengyu Road, Jin'an District, Fuzhou City, 350000, Fujian, China.,Fujian Branch of Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Bing Zhang
- Department of General Surgery and Oncology, Fujian Children's Hospital, 966th Hengyu Road, Jin'an District, Fuzhou City, 350000, Fujian, China.,Fujian Branch of Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
| | - Dianming Wu
- Department of General Surgery and Oncology, Fujian Children's Hospital, 966th Hengyu Road, Jin'an District, Fuzhou City, 350000, Fujian, China. .,Fujian Branch of Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China. .,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China.
| | - Yifan Fang
- Department of General Surgery and Oncology, Fujian Children's Hospital, 966th Hengyu Road, Jin'an District, Fuzhou City, 350000, Fujian, China.,Fujian Branch of Shanghai Children's Medical Center, Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China
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Cizek SM, Tyson N. Pediatric and Adolescent Gynecologic Emergencies. Obstet Gynecol Clin North Am 2022; 49:521-536. [PMID: 36122983 DOI: 10.1016/j.ogc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of gynecologic emergencies in the pediatric and adolescent population requires a high index of suspicion to avoid delayed or incorrect diagnoses. This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers.
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Affiliation(s)
- Stephanie M Cizek
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA
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12
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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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Tielli A, Scala A, Alison M, Vo Chieu VD, Farkas N, Titomanlio L, Lenglart L. Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population. Eur J Pediatr 2022; 181:1405-1411. [PMID: 35094159 DOI: 10.1007/s00431-021-04352-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
Ovarian torsion is rare in the pediatric population. Delayed diagnosis can significantly impact fertility. The aim of this review is to highlight current knowledge regarding clinical presentation, diagnosis, surgical management, and follow-up in the pediatric population. Whilst the presentation is often very unspecific, most children will present with sudden severe unilateral pelvic pain associated with vomiting. A key diagnostic test is pelvic ultrasonography, which may help demonstrate an asymmetric enlarged ovary with peripherally displaced follicles. In the pediatric population, ovarian torsion may occur in a normal ovary. However, underlying lesions can be found in half of cases. Benign neoplasms (teratomas or cystic lesions) represent the commonest etiology, with the risk of malignancy being less than 2%. Surgical management should be focused on fertility preservation. This is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence. Follow-up studies demonstrate excellent recovery rates of detorsed ovaries including those with ischemic appearances. What is Known: • Ovarian torsion is a rare diagnosis in the pediatric population. • Aspecific symptoms and differential diagnoses lead to missed or delayed diagnosis increasing the risk of oophoprectomy and further infertility. What is New: • Reviewing the latest knowledge about clinical presentation, diagnostic, surgical management, and follow-up of ovarian torsion in the pediatric population. • Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.
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Affiliation(s)
- Alexandra Tielli
- Department of Pediatric Emergency Care, APHP - Hôpital Robert Debré, 48 Boulevard Serurier, 75019, Paris, France
| | - Andrea Scala
- Department of Abdominal Surgery, NHS, Guildford, UK
| | - Marianne Alison
- Department of Pediatric Radiology, APHP - Hôpital Robert Debré, Paris, France.,NeuroDiderot, Inserm U1141, Equipe 5 inDev - Imaging Neurodevelopmental Phenotypes, HU I2D2, 75019, Paris, France
| | - Van Dai Vo Chieu
- Department of Pediatric Radiology, APHP - Hôpital Robert Debré, Paris, France
| | | | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hôpital Robert Debré, 48 Boulevard Serurier, 75019, Paris, France.,Paris University, INSERM U1141, DHU Protect, Paris, France
| | - Léa Lenglart
- Department of Pediatric Emergency Care, APHP - Hôpital Robert Debré, 48 Boulevard Serurier, 75019, Paris, France.
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Meyer R, Meller N, Mohr-Sasson A, Toussia-Cohen S, Komem DA, Mashiach R, Levin G. A clinical prediction model for adnexal torsion in pediatric and adolescent population. J Pediatr Surg 2022; 57:497-501. [PMID: 33902897 DOI: 10.1016/j.jpedsurg.2021.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/27/2021] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical characteristics of children and adolescents that underwent diagnostic laparoscopy for suspected adnexal torsion (AT), and to develop a prediction model for preoperative detection of AT among young women. METHODS A retrospective cohort study. We included all girls ≤18 years old with clinically suspected AT who underwent a diagnostic laparoscopy between 3/2011 and 6/2020. We compared patients with AT to those without AT and constructed a prediction model. RESULTS Overall, 120 children and adolescents with suspected AT were included in the study. Of those, AT was identified in 83 (69.2%). In a multivariate analysis, the following risk factors were independently associated with AT and included in the prediction model: absence of right lower quadrant tenderness upon examination [adjusted odds ratio (aOR) (95% Confidence interval (CI)) 3.23 (1.23-8.47), p = 0.017], platelets level >240 K [aOR (95% CI) 3.15 (1.19-8.36), p = 0.021], and neutrophils level >5.4 [aOR (95% CI) 2.71 (1.02-7.52), p = 0.046]. The rate of AT was 12.5% in cases without risk factors for AT, 56.7% with one, 68.8% with two, and 94.1% with three risk factors present, respectively. CONCLUSIONS We have identified preoperative indicators independently associated with surgically confirmed AT in a large cohort of young women. Level of evidence- III.
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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
| | - Shlomo Toussia-Cohen
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 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
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Hewitt MK. A diagnosis with a twist: Ultrasonographic sensitivity and predictors of pediatric ovarian torsion within a large pediatric hospital. World J Emerg Med 2022; 13:229-231. [DOI: 10.5847/wjem.j.1920-8642.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
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Umasankar N, Howard SM, Tomlin KV. Adnexal Torsion Predictive Tool Maintains Applicability in a Heterogeneous Pediatric Population. J Pediatr Adolesc Gynecol 2021; 34:656-661. [PMID: 33989799 DOI: 10.1016/j.jpag.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE A previously published scoring system showed promise in identifying adnexal torsion in adolescents. However, published patients were homogeneously Caucasian/White. We sought to assess whether this scoring system was generalizable to a more diverse population that is predominantly African American and overweight. DESIGN Retrospective chart review. SETTING Tertiary academic hospital. PARTICIPANTS Female patients 0-21 years of age undergoing surgery for suspected ovarian torsion from 2010 to 2019. INTERVENTIONS Records were reviewed for patients, including laboratory studies, imaging, surgery, and pathology. Significance was determined for clinical and imaging findings, and retrospective composite scores were calculated for each participant as suggested by the scoring system. MAIN OUTCOME MEASURES Determination of whether the previously published composite score was predictive of pediatric adnexal torsion in our population. RESULTS A total of 57 cases of suspected torsion were included. Approximately 60% of patients were African American, 10% Hispanic, and 30% Caucasian/White. The average body mass index (BMI) across ethnicities was 29. Our findings significantly correlated with previously published predictors for all components. The presence of nausea/vomiting, leukocytosis, ovarian volume and ratio were found to be significant. The post hoc calculated composite score was applied to our cohort, and more than 90% of confirmed torsion would have been identified. CONCLUSION Our study suggests that a previously published composite score assessing torsion can successfully be used to predict torsion in a more diverse setting than the original study population, potentially accelerating surgical management of patients with the condition.
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Affiliation(s)
- Nivedita Umasankar
- University of South Carolina School of Medicine, Columbia, South Carolina; Prisma Health - Midlands, Columbia, South Carolina
| | - Shannon M Howard
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Kristl V Tomlin
- University of South Carolina School of Medicine, Columbia, South Carolina; Prisma Health - Midlands, Columbia, South Carolina.
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Rocha RM, Barcelos IDES. Practical Recommendations for the Management of Benign Adnexal Masses. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:569-576. [PMID: 32559804 PMCID: PMC10309218 DOI: 10.1055/s-0040-1714049] [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] [Received: 04/27/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To perform a comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. METHODS A comprehensive review of the literature was performed to identify the most relevant data about this subject. RESULTS In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. CONCLUSIONS Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can be managed with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.
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Affiliation(s)
- Rodrigo Manieri Rocha
- Departament of Gynecology and Obstetrics, Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, PR, Brazil
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Ovarian Torsion in Premenarchal Girls. J Pediatr Adolesc Gynecol 2019; 32:254-258. [PMID: 30367984 DOI: 10.1016/j.jpag.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To investigate characteristics that differentiate premenarchal girls with ovarian torsion (OT) from those without OT at the time of surgery. DESIGN Retrospective chart review of 36 premenarchal girls who underwent 42 surgeries for either OT (n = 33) or a nontorsed ovarian mass (n = 9) from 2006 to 2017. SETTING Large, tertiary care academic institution. PARTICIPANTS We included patients aged 0-12 years with International Classification of Diseases, Ninth Revision codes for torsion of the ovary, adnexa, ovarian pedicle, or fallopian tube. Controls had International Classification of Diseases, Ninth Revision codes for ovarian mass or cyst, who also underwent surgery and did not have OT. INTERVENTIONS Records were reviewed for patient characteristics including laboratory and imaging studies, surgical intervention, and pathologic diagnosis. Fischer exact test and the nonparametric Mann-Whitney U test were used for statistical analysis. MAIN OUTCOME MEASURES Characteristics predictive of OT in premenarchal girls. RESULTS Twenty-nine premenarchal patients were diagnosed with 33 episodes of OT. Nine patients underwent surgery for ovarian masses but did not have OT. All patients with OT reported abdominal pain (compared with 55.6% without OT; P < .001) and most had nausea and/or emesis (81.8% vs 33.3%; P < .009). Ultrasound findings of ovarian enlargement and decreased Doppler flow were significant in the OT group (P < .083, P < .009). There were 2 cases of malignancy in each group. CONCLUSION Patients with OT had significantly more nausea, emesis, and abdominal pain compared with those without OT. Additionally, 2 of 4 malignancies were found in patients with OT, indicating that malignancy should still be considered with large, complex masses.
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Hillard PJA. What is Pediatric and Adolescent Gynecology? J Pediatr Adolesc Gynecol 2018; 31:77-78. [PMID: 29566847 DOI: 10.1016/j.jpag.2018.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paula J Adams Hillard
- Professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Director of Pediatric and Adolescent Gynecology Lucile Packard Stanford Childrens Hospital.
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