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Ayemoba J, Callier K, Johnson K. Rate of oophorectomy in pediatric ovarian torsion: risk factors and change over time. Pediatr Surg Int 2024; 40:160. [PMID: 38910201 PMCID: PMC11194208 DOI: 10.1007/s00383-024-05743-8] [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] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved. METHODS Children with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge. RESULTS A total of 7008 patients, ages 1-20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001). CONCLUSION The rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Joy Ayemoba
- Department of Surgery, Division of Pediatric Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Kylie Callier
- Department of Surgery, Division of Pediatric Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Kevin Johnson
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctor's Office Tower, Vanderbilt University School of Medicine, 2200 Children's Way, Suite 7100, Nashville, TN, USA.
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Cheung CTD, Jayasekara M, Hussain M, Raman N. Synchronous bilateral ovarian torsion followed by recurrent unilateral torsion in a patient undergoing fertility treatment: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2023; 290:60-66. [PMID: 37734139 DOI: 10.1016/j.ejogrb.2023.08.015] [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: 01/18/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Ovarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT. OBJECTIVE The diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management. CASE REPORT A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully. CONCLUSIONS Clinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes.
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Affiliation(s)
- Candice Tien-da Cheung
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea, SS0 0RY, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, PE29 6NT England, UK.
| | - Matthew Jayasekara
- University of Cambridge School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge CB2 0SP, UK.
| | - Munawar Hussain
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea SS0 0RY, UK.
| | - Narayanaswamy Raman
- Department of Obstetrics and Gynaecology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Southend-on-Sea SS0 0RY, UK.
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Ryles HT, Hong CX, Andy UU, Farrow MR. Changing Practices in the Surgical Management of Adnexal Torsion: An Analysis of the National Surgical Quality Improvement Program Database. Obstet Gynecol 2023; 141:888-896. [PMID: 37023448 PMCID: PMC10147583 DOI: 10.1097/aog.0000000000005142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/12/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate trends in the surgical management of adnexal torsion and to evaluate these trends with respect to the updated American College of Obstetricians and Gynecologists (ACOG) guidelines. METHODS We performed a retrospective cohort study using the National Surgical Quality Improvement Program database. Women who underwent surgery for adnexal torsion between 2008 and 2020 were identified on the basis of International Classification of Diseases codes. Surgeries were grouped as either ovarian conservation or oophorectomy with the use of Current Procedural Terminology codes. Patients were also grouped into year cohorts with respect to the publication of the updated ACOG guidelines (2008-2016 compared with 2017-2020). Multivariable logistic regression, weighted by cases per year, was used to assess differences between groups. RESULTS Of the 1,791 surgeries performed for adnexal torsion, 542 (30.3%) involved ovarian conservation and 1,249 (69.7%) involved oophorectomy. Older age, higher body mass index, higher American Society of Anesthesiologists classification, anemia, and diagnosis of hypertension were significantly associated with oophorectomy. There was no significant difference in the proportion of oophorectomies performed before 2017 compared with after 2017 (71.9% vs 69.1%, odds ratio [OR] 0.89, 95% CI 0.69-1.16; adjusted OR 0.94, 95% CI 0.71-1.25). A significant decrease in proportion of oophorectomies performed each year was identified over the entire study period (-1.6%/y, P=.02, 95% CI -3.0% to -0.22%); however, the rates did not differ before and after 2017 (interaction P=.16). CONCLUSION There was a modest decrease in the proportion of oophorectomies for adnexal torsion performed per year over the study period. However, oophorectomy is still commonly performed for adnexal torsion, despite updated guidelines from ACOG recommending ovarian conservation.
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Affiliation(s)
- Hannah T Ryles
- Department of Obstetrics and Gynecology and the Division of Urogynecology, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia; and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Huerta CT, Ramsey WA, Lynn R, Saberi RA, Gilna GP, Parreco JP, Thorson CM, Sola JE, Perez EA. Underutilization of laparoscopy for ovarian surgeries in the pediatric population: A nationwide analysis. J Pediatr Surg 2023; 58:1000-1007. [PMID: 36792420 DOI: 10.1016/j.jpedsurg.2023.01.014] [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: 12/15/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Oophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovarian operations in the pediatric population. METHODS Females less than 21 years old who underwent ovarian operations (oophorectomy, detorsion, and/or drainage) from 2016 to 2017 were identified from the Nationwide Readmissions Database. Patients were stratified by surgical approach (laparoscopic or open). Hospital characteristics and outcomes were compared using standard statistical tests. RESULTS There were 13,202 females (age 17 [14-20] years) who underwent open (59%) or laparoscopic (41%) ovarian operations. The most common indications for surgery were ovarian mass (48%), cyst (36%), and/or torsion (19%) for which oophorectomy (88%), detorsion (26%), and drainage (13%) were performed most frequently. The open approach was utilized more frequently for oophorectomy (95% vs. 77% laparoscopic) and detorsion (33% vs. 16% laparoscopic), both p < 0.001. A greater proportion of laparoscopic procedures were performed at large (67% vs. 61% open), teaching (82% vs. 76% open) hospitals in patients with private insurance (47% vs. 42% open), all p < 0.001. Patients undergoing open procedures had significantly higher index length of stay (LOS) and rates of wound infections. Thirty-day and overall readmission rates, as well as overall readmission costs, were higher in patients who received open surgeries. CONCLUSIONS Despite fewer overall complications, decreased cost, fewer readmissions, and shorter LOS, laparoscopic approaches are underutilized for pediatric ovarian procedures. TYPE OF STUDY Retrospective Comparative. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Royi Lynn
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Parreco
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Jalal M, El Qasseh R, Youssouf N, Sami Z, Benrehal S, Lamrissi A, Fechtali K, Bouhya S. Healthy adnexal torsion in pregnancy: A case report. Int J Surg Case Rep 2022; 100:107633. [PMID: 36327860 PMCID: PMC9637572 DOI: 10.1016/j.ijscr.2022.107633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
•Adnexal torsion during pregnancy is a rare surgical emergency. •The diagnosis of certainty of adnexal torsion can only be made intraoperatively. •In the absence of any contraindication, laparoscopy should be the preferred approach. •Ovariopexy is proposed by certain authors in order to prevent recurrence.
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Affiliation(s)
- M Jalal
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - R El Qasseh
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco.
| | - N Youssouf
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - Z Sami
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - S Benrehal
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - A Lamrissi
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - K Fechtali
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
| | - S Bouhya
- Department of Gynecology - Obstetrics, Ibn Rochd University Hospital of Casablanca, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Casablanca, Morocco
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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Klar M, Matsuo K, Juhasz-Böss I, Hasanov MF. Ovarian conservation in a patient with a large ovarian cyst and adnexal torsion - a confirmatory video with intravenous indocyanine green. Fertil Steril 2022; 118:417-418. [PMID: 35691717 DOI: 10.1016/j.fertnstert.2022.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To share our experience of intravenous indocyanine green (ICG) application during conservative ovarian surgery in a young patient with adnexal torsion, a large ovarian cyst, and apparent ovarian necrosis. DESIGN This confirmatory video of ovarian reperfusion uses footage from the laparoscopic treatment and ICG application in a young patient with adnexal torsion and apparent necrosis. SETTING Academic, multisite medical center. PATIENT(S) A 24-year-old patient with a 12-cm dermoid cyst, adnexal torsion, and apparent tissue necrosis. INTERVENTION(S) Five milligrams intravenous ICG, de-torsion, ovarian cystectomy, and ovarian reconstruction. The patient approved the ICG off-label use. MAIN OUTCOME MEASURE(S) Ovarian preservation and perioperative morbidity. RESULT(S) This video demonstrates the surgical treatment of a patient with adnexal torsion. The perfusion patterns before and after the surgical treatment, i.e., cyst de-torsion and cyst removal are documented using intravenous ICG. The perfusion patterns guided the surgeon to perform ovarian conservation despite apparent initial ischemia. The patient recovered well, and no postoperative 30-day morbidity occurred. CONCLUSION(S) Intraoperative subjective overestimation of the true ovarian ischemia may lead to unnecessary oophorectomy. Per the American College of Obstetrics and Gynecology recommendation, patients with adnexal torsion should be treated surgically with ovarian conservation regardless of the appearance of the ovary. As demonstrated, ovaries reperfuse despite multiple twists along the infundibulopelvic pedicle, apparent necrosis, and large cysts. Unilateral salpingo-oophorectomies are avoidable even in these cases.
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Affiliation(s)
- Maximilian Klar
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Germany.
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gnyecology, University of Southern California, Los Angeles
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Germany
| | - Mir-Fuad Hasanov
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Freiburg, Germany
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Ulusoy O, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Diagnostic failures in ovarian torsion during childhood: The effect of ovarian cyst size on the diagnostic accuracy of Doppler ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:660-665. [PMID: 35235217 DOI: 10.1002/jcu.23167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
| | | | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
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9
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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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10
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Soh PQ, Cheng C, Reddington C, Dior UP, Healey M. Oophorectomy for ovarian torsion - should this be abandoned? Aust N Z J Obstet Gynaecol 2022; 62:548-552. [PMID: 35246837 DOI: 10.1111/ajo.13506] [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: 11/28/2022]
Abstract
BACKGROUND Management of ovarian torsion ranges from de-torsion to oophorectomy and is dependent on various factors. Oophorectomy can have significant implications for fertility and general health, thus requiring careful consideration. AIMS We evaluate the management of ovarian torsion at a tertiary hospital over a ten-year period and identify the predictors of oophorectomy in ovarian torsion cases. MATERIALS AND METHODS Inpatient notes of patients who underwent surgical management for acute ovarian torsion at a tertiary hospital in Victoria, Australia, were reviewed, from January 2008 to June 2018. We reported the incidence and predictors of oophorectomy and ovarian ischaemia and current practices in oophoropexy. RESULTS Our analysis included 159 patients. The incidence of oophorectomy was 47%. After confounders were adjusted, increasing age was the only significant predictor for oophorectomy. The adjusted odds ratio of having an oophorectomy based on age alone was 1.10 for each year increase in age between the ages of 15 and 68 (P = 0.001, 95% confidence interval 1.04-1.16). Of those with oophorectomy, 57% had ischaemia confirmed histologically. There were no significant predictors for ischaemia. CONCLUSION The incidence of oophorectomy in this audit is comparable to reported incidences in current literature. However, with increasing evidence to support ongoing ovarian function even in cases where ischaemia is histologically confirmed, this incidence could be lowered. Age was the only variable that was found to have a significant effect on the incidence of oophorectomy.
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Affiliation(s)
- Pei Qian Soh
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Claudia Cheng
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Charlotte Reddington
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Uri P Dior
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Martin Healey
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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Adnexal torsion in a pediatric population: Acute presentation with question of chronicity. Eur J Obstet Gynecol Reprod Biol 2021; 268:82-86. [PMID: 34883338 DOI: 10.1016/j.ejogrb.2021.11.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 09/24/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To establish the frequency of torsion with multiple twists of the adnexa in girls 19 years old and younger surgically diagnosed with torsion. STUDY DESIGN A retrospective chart review using an institutional tool to review charts of female patients 19 years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion. RESULTS Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain > 24 h up to 4 weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36 = 39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p = 0.098). CONCLUSIONS Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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Mandelbaum RS, Smith MB, Violette CJ, Matsuzaki S, Matsushima K, Klar M, Roman LD, Paulson RJ, Matsuo K. Conservative surgery for ovarian torsion in young women: perioperative complications and national trends. BJOG 2020; 127:957-965. [PMID: 32086987 PMCID: PMC7772940 DOI: 10.1111/1471-0528.16179] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion. DESIGN Population-based retrospective observational study. SETTING Nationwide Inpatient Sample in the USA (2001-2015). POPULATION In all, 89 177 ovarian torsions including 20 597 (23.1%) conservative surgeries and 68 580 (76.9%) oophorectomies. METHODS (1) Trend analysis to assess utilisation of conservative surgery over time, (2) multivariable binary logistic regression to identify independent factors associated with conservative surgery and (3) inverse probability of treatment weighting with a generalised estimating equation to analyze perioperative complications. MAIN OUTCOME MEASURES Trends, characteristics and complications related to conservative surgery. RESULTS Performance of conservative surgery increased from 18.9 to 25.1% between 2001 and 2015 (32.8% relative increase, P = 0.001) but decreased steadily after age 15, and sharply declined after age 35 (P < 0.001). On multivariable analysis, younger age exhibited the largest effect size for conservative surgery among the independent factors (adjusted odds ratios 3.39-7.96, P < 0.001). In the weighted model, conservative surgery was associated with an approximately 30% decreased risk of perioperative complications overall (10.0% versus 13.6%, odds ratio 0.73, 95% confidence interval 0.62-0.85, P < 0.001) and was not associated with venous thromboembolism (0.2 versus 0.3%, P = 0.457) or sepsis (0.4 versus 0.3%, P = 0.638). CONCLUSION There has been an increasing utilisation of conservative surgery for ovarian torsion in the USA in recent years. Our study suggests that conservative surgery for ovarian torsion may not be associated with increased perioperative complications. TWEETABLE ABSTRACT Conservative surgery for ovarian torsion may not be associated with increased perioperative complications.
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Affiliation(s)
- RS Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - MB Smith
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - CJ Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - S Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - K Matsushima
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - M Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - LD Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - RJ Paulson
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - K Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
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Richardson A, Brigic A, Emmett J, Natale J, Baskind NE. Going, gonad, gone. Gender inequalities in the management of gonadal torsion: a cohort study. HUM FERTIL 2020; 25:247-255. [PMID: 32590926 DOI: 10.1080/14647273.2020.1784473] [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: 10/24/2022]
Abstract
Gonadal torsion (when the gonad twists on its ligamentous supports) is a surgical emergency in both men and women. Prompt management is essential to preserve gonadal function. Our aim was to compare the timeliness with which men and women who underwent surgery for suspected gonadal torsion are managed. All adult patients who underwent surgery for suspected gonadal torsion between 1/4/16 and 31/3/18 were reviewed and the following times recorded: symptom onset; hospital presentation; gynaecological/surgical review; decision for theatre; and knife-to-skin (KTS). The surgical procedure(s) and intra-operative findings were also documented. In total, 31 women (mean age 29.4 ± 7.1yrs) and 49 men (mean age 23.2 ± 7.0yrs) were identified. Women waited significantly longer than men at every stage (p < 0.01). Time intervals between hospital presentation and review, review and decision for theatre, and decision and KTS were 1.6 (1.2-2.6 hrs), 0.3 (0.0-0.9 hrs) and 1.7 (1.5-2.5 hrs) for men and 4.3 (3.1-15.3 hrs), 10.3 hrs (2.4-20.7 hrs) and 4.7 (2.3-9.3 hrs) for women, respectively. Torsion was confirmed in 20 (64.5%) women and 25 (51.0%) men. Intraoperatively, 13(65%) ovaries were reportedly necrotic compared to only 6 (24%) testes (p = 0.0076). All necrotic gonads were removed despite conservative surgery being recommended practice during the study period. Women with suspected gonadal torsion received suboptimal care compared to their male counterparts, which has potentially catastrophic consequences for the subsequent fertility of this predominantly young population.
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Affiliation(s)
- Alison Richardson
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Adela Brigic
- Department of Surgery, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Jack Emmett
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - Joseph Natale
- Department of Surgery, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
| | - N Ellissa Baskind
- Department of Gynaecology, Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, UK
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Sun Y, Feng G, Fu Y, You J, Li M, Zhu Y. Emergent complication of assisted reproductive technology: Clinical analysis of 17 pregnant women with adnexal torsion. Am J Emerg Med 2019; 38:305-308. [PMID: 31704061 DOI: 10.1016/j.ajem.2019.158391] [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: 06/27/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical symptoms, surgical management, and outcomes of pregnant women with adnexal torsion due to assisted reproductive technology. METHODS It was a retrospective study that include 17 pregnant women with adnexal torsion, in which the maternal age, type of fertilization, gestational age, clinical symptoms, ultrasonic findings, side affected by the disease, surgical method, and pregnancy outcomes were evaluated. RESULTS A total of 17 patients with adnexal torsion were included in this study, of which 8 patients conceived by in vitro fertilization-embryo transfer (IVF-ET), 1 by artificial insemination (AIH), and the other 8 conceived naturally after ovulation induction. About 14 were reported to have occurred in the first trimester of pregnancy, 1 case in the second trimester, and the other 2 in the third trimester. Clinical symptoms were abdominal pain with or without nausea and vomiting. 14 cases occurred in the right adnexa and the other 3 in the left. 5 of the patients underwent laparoscopy, and the other 12 underwent laparotomy. 8 cases were of full- term delivery, 6 twins gave birth prematurely, and 3 patients had inevitable abortion. CONCLUSIONS Adnexal torsion is an acute onset of lower abdominal pain in women, which seldom occurs during pregnancy. However, because of the wide application of assisted reproductive technology (ART), its incidence has increased. Early diagnosis and treatment can lead to better results.
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Affiliation(s)
- Yu Sun
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guofang Feng
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanling Fu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiali You
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Miao Li
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Halimeh R, Tomassian S, El Hage M, Metri N, Bersaoui M, Daou R, Anastasiadis E. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Case Rep Obstet Gynecol 2019; 2019:1093626. [PMID: 31815026 PMCID: PMC6877964 DOI: 10.1155/2019/1093626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.
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Affiliation(s)
- Rawad Halimeh
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Serge Tomassian
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Maria El Hage
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Nicole Metri
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Marianne Bersaoui
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rafi Daou
- Faculty of Medicine, University of London, St. Georges, Nicosia, Cyprus
| | - Elie Anastasiadis
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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Kives S, Gascon S, Dubuc É, Van Eyk N. No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:82-90. [PMID: 28241927 DOI: 10.1016/j.jogc.2016.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the evidence and provide recommendations on the diagnosis and management of adnexal torsion in children, adolescents, and women. OUTCOMES Elements evaluated include the risk factors, diagnostic accuracy, management options, and outcomes of adnexal torsion. EVIDENCE Published literature was retrieved through searches of MEDLINE, Embase, CINAHL, and the Cochrane Library using appropriate controlled vocabulary and key words ("adnexal torsion," "ovarian torsion"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and new material incorporated in the guideline to December 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence obtained was reviewed and evaluated by the Canadian Paediatric and Adolescent Gynaecology and Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors. Recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS AND COSTS Guideline implementation should assist the practitioner in developing an optimal approach to the diagnosis and management of adnexal torsion while minimizing harm and improving patient outcomes. VALIDATION These guidelines have been reviewed and approved by the Gynaecology Committee of the SOGC and approved by the council of the SOGC. SPONSOR The Society of Obstetricians and Gynaecologists of Canada SUMMARY STATEMENTS: RECOMMENDATIONS.
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Geimanaite L, Trainavicius K. Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue. J Pediatr Surg 2019; 54:1453-1456. [PMID: 30851955 DOI: 10.1016/j.jpedsurg.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficiency of the preservation of ovarian tissue in cases of ovarian torsion. MATERIALS AND METHODS A retrospective study was performed of patients treated at our hospital for ovarian torsion from January 2007 to December 2017. This research does not include patients with antenatal ovarian torsion and 1 girl with an immature teratoma, in whom the twisted ovary was removed during the initial operation. Follow-up ultrasonography of all patients was performed after 4-6 weeks and again after more than 12 weeks. Volume, blood flow and folliculogenesis of the ovary were measured and assessed. RESULTS All 42 ovaries (39 patients) preserved their normal anatomy and folliculogenesis after detorsion. All patients had an enlarged ovary at the time of detorsion. In all cases of ovarian torsion, enlargement of the ovary up to an average of 58.14 ± 52.86 (17.37-86.83) ml was detected. After 4-6 weeks, all untwisted ovaries decreased in volume by an average of 9.01 ± 13.69 (2.33-9.30) times, and 59.5% of them became normal in size. In 3 girls, enlarged ovaries were still observed after 12 weeks. Teratoma was diagnosed for these patients and ovarian sparing operations were performed. CONCLUSIONS It is safe to perform detorsion regardless of the level of ischemia or volume of the affected ovary. The follow-up is essential, especially for the further diagnostics of potential pathological structures or tumors; therefore, the normalization of blood flow and the volume of the ovary must be monitored. TYPE OF STUDY Prognosis retrospective study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lina Geimanaite
- Vilnius University, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius, Lithuania; Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Department of Pediatric Surgery, Vilnius, Lithuania.
| | - Kestutis Trainavicius
- Vilnius University, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius, Lithuania; Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Department of Pediatric Surgery, Vilnius, Lithuania
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Adeyemi-Fowode O, Lin EG, Syed F, Sangi-Haghpeykar H, Zhu H, Dietrich JE. Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution. J Pediatr Adolesc Gynecol 2019; 32:64-69. [PMID: 30012428 DOI: 10.1016/j.jpag.2018.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/18/2022]
Abstract
STUDY 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 ± 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 = 214; 87%). CONCLUSION The findings of our study continue to support the conservative management of patients with AT.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Emily G Lin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Fatima Syed
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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20
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Wang Z, Zhang D, Zhang H, Guo X, Zheng J, Xie H. Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: A retrospective study. Medicine (Baltimore) 2019; 98:e14321. [PMID: 30702612 PMCID: PMC6380708 DOI: 10.1097/md.0000000000014321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures.A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients' clinical characteristics, surgical procedures, and postoperative recovery were analyzed.Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases.Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.
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Affiliation(s)
- Zengyan Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
- Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University
| | - Dan Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
- Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University
| | - Huanxiao Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
| | - Xu Guo
- Medical Examination Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingxuan Zheng
- Deparment of Neurology, People's Hospital of Yangjiang, Guangdong, China
| | - Hongzhe Xie
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
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21
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Wei W, Huang L, Li B, Zou S, Song G. Conservative laparoscopic surgery of adnex torsion for fertility preservation. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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22
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Bassi A, Czuzoj-Shulman N, Abenhaim HA. Effect of Pregnancy on the Management and Outcomes of Ovarian Torsion: A Population-Based Matched Cohort Study. J Minim Invasive Gynecol 2018; 25:1260-1265. [DOI: 10.1016/j.jmig.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/21/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
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Günay T, Yardımcı OD, Hocaoğlu M, Demirçivi Bör E, Erdem G. Over Torsiyonu ve Cerrahi Tedavisi: Tersiyer bir merkezin 5 yıllık deneyimi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2018. [DOI: 10.17517/ksutfd.423102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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24
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Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, Diefenbach KA, Gosain A, Grabowski J, Guner YS, Jancelewicz T, Kawaguchi A, Lal DR, Oyetunji TA, Ricca RL, Shelton J, Somme S, Williams RF, Downard CD. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg 2018; 53:1387-1391. [PMID: 29153467 DOI: 10.1016/j.jpedsurg.2017.10.053] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion. METHODS Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence. RESULTS Ninety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3months postprocedure but sooner if there is a concern for malignancy. CONCLUSION There appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion. TYPE OF STUDY Systematic review of level 3-4 studies. LEVEL OF EVIDENCE 3-4.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH.
| | - Elizabeth Renaud
- Department of Surgery, Division of Pediatric Surgery Albany Medical College, Albany, NY
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QC
| | | | - Meghan A Arnold
- Section of Pediatric Surgery, CS Mott Children's Hospital, Ann Arbor, MI
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Ankush Gosain
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Julia Grabowski
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Yigit S Guner
- Division of Pediatric General and Thoracic Surgery Children's Hospital Orange County, University of California Irvine
| | - Tim Jancelewicz
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Akemi Kawaguchi
- Department of Pediatric Surgery, Mc Govern Medical School at the University of Texas Health Science Center at Houston
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Robert L Ricca
- Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VA
| | - Julia Shelton
- Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Stig Somme
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Regan F Williams
- Division of Pediatric Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY
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Chu K, Zhang Q, Sun N, Ding H, Li W. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up experience. J Int Med Res 2018; 46:1685-1689. [PMID: 29486636 PMCID: PMC6091833 DOI: 10.1177/0300060517754025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Laparoscopic unwinding of adnexal torsion has been proposed for decades. However, this technique is still controversial regarding the concern of thromboembolic events. We present two cases of conservative laparoscopic management of adnexal torsion. In the first case, a 16-year-old adolescent with serous cystadenoma was successfully managed by untwisting and cystectomy. We followed up this patient for 17 years with regular re-examinations in our hospital. To the best of our knowledge, this is the longest follow-up reported of this condition. In the second case, a 32-year-old infertile woman who received oocyte retrieval 3 days before being admitted to hospital was referred to hospital with right ovarian torsion. We treated her successfully based on our long-term follow-up experience, and she is now asymptomatic and in her 7th month of pregnancy.
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Affiliation(s)
- Kun Chu
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qing Zhang
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ningxia Sun
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haixia Ding
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Li
- Reproductive Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Kives S, Gascon S, Dubuc É, Van Eyk N. N° 341-Diagnostic et prise en charge de la torsion annexielle chez les filles, les adolescentes et les femmes adultes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:91-100. [DOI: 10.1016/j.jogc.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Hubner N, Langer JC, Kives S, Allen LM. Evolution in the Management of Pediatric and Adolescent Ovarian Torsion as a Result of Quality Improvement Measures. J Pediatr Adolesc Gynecol 2017; 30:132-137. [PMID: 27381235 DOI: 10.1016/j.jpag.2016.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE The aim of this study was to document the change in ovarian conservation rate after ovarian torsion as a result of continuous quality improvement (CQI) measures, and to determine factors that contribute to this outcome. DESIGN A retrospective, uncontrolled before-and-after study. SETTING An academic children's hospital. PARTICIPANTS Female adolescents younger than 18 years with surgically confirmed ovarian torsion from April 1, 1988 to October 15, 2013; excluding cases from 2003 (intervention period). INTERVENTIONS Implementation of CQI measures including educational programs, collaborative care pathways, and quality review with the goal of improving ovarian conservation. MAIN OUTCOME MEASURES Demographic characteristics, details on presentation, investigations, consultation, surgical intervention, surgical findings, pathology, postoperative course, and follow-up imaging. RESULTS One hundred thirty-nine patients met inclusion criteria (42 pre-CQI cohort and 97 post-CQI cohort). Mean ages were 9.96 and 10.33 years, respectively. Ovarian conservation rates were 47.6% compared with 85.6%, respectively (P < .001). The following factors differed between cohorts: fever (P = .003), ultrasound completed (P = .001), time from first health care provider visit to imaging (P = .025), time from specialist consultation to surgery (P = .002), surgical start time within 1 hour of booking (P < .001), and gynecologist present in operating room (P < .001). A log-binomial regression model showed that gynecology presence in the operating room (relative risk [RR], 2.043) was associated with untwisting. Increasing time from specialist consultation to surgery (RR, 0.986 per hour) was inversely associated with untwisting. Fever at presentation was also inversely associated with untwisting (RR, 0.666). CONCLUSION The implementation of CQI measures was associated with a significant increase in ovarian conservation rate.
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Affiliation(s)
- Nicole Hubner
- Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Charles Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children; and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sari Kives
- Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mary Allen
- Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
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Surgical Management of Benign Adnexal Masses in the Pediatric/Adolescent Population: An 11-Year Review. J Pediatr Adolesc Gynecol 2017; 30:123-127. [PMID: 27639749 DOI: 10.1016/j.jpag.2016.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/27/2016] [Accepted: 09/03/2016] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution. DESIGN A retrospective cohort review. SETTING Children's and adult tertiary care university-based hospital. PARTICIPANTS Patients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013. INTERVENTIONS Patient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy. MAIN OUTCOME MEASURES The primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty. RESULTS Of 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005). CONCLUSION Results of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible.
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Yasa C, Dural O, Bastu E, Zorlu M, Demir O, Ugurlucan FG. Impact of laparoscopic ovarian detorsion on ovarian reserve. J Obstet Gynaecol Res 2016; 43:298-302. [PMID: 27928855 DOI: 10.1111/jog.13195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate ovarian reserve after laparoscopic ovarian detorsion in patients with ovarian torsion. METHODS From February 2014 to September 2015, a total of 11 patients with ovarian torsion underwent laparoscopic detorsion. These 11 patients were eligible for study, and ovarian reserve was assessed on serum anti-Müllerian hormone (AMH) and by antral follicle count preoperatively, and in postoperative months 1 and 3. RESULTS Mean patient age was 25.4 ± 5.5 years. Although mean antral follicle count on the operated side was slightly lower than on the contralateral side at 1 month postoperatively (P > 0.05), at 3 months postoperatively there was no difference in mean antral follicle count between the operated and contralateral sides (P > 0.05). There was no significant change in serum AMH level at 1 and 3 months postoperatively compared with the preoperative level (P > 0.05). CONCLUSIONS Laparoscopic detorsion of twisted ovary is a safe procedure to preserve ovarian function, and does not impair ovarian reserve according to antral follicle count and AMH during the course of follow-up.
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Affiliation(s)
- Cenk Yasa
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ercan Bastu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Masallah Zorlu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Omer Demir
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
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Ruptured Ectopic Pregnancy with Contralateral Ovarian Serous Cyst Adenoma Torsion: Laparoscopic Management of Double Trouble. Case Rep Obstet Gynecol 2016; 2016:2980941. [PMID: 27840755 PMCID: PMC5093254 DOI: 10.1155/2016/2980941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022] Open
Abstract
Adnexal torsion is responsible for 2.7% of all gynecological emergencies. Ectopic pregnancy is relatively common, occurring in 2% of all pregnancies. We report the second case of ruptured right tubal ectopic gestation with torsion of serous cystadenoma of left ovary. This was diagnosed after emergency laparoscopy done for acute abdomen. Right salpingectomy and left ovarian detorsion followed by cystectomy were done laparoscopically.
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Multidetector-row computed tomography (MDCT) findings of adnexal torsion: An analysis of 116 patients. Diagn Interv Imaging 2016; 97:899-905. [DOI: 10.1016/j.diii.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 11/19/2022]
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Jung SI, Park HS, Jeon HJ, Yu MH, Kim YJ, Yim Y, Jeong K. CT predictors for selecting conservative surgery or adnexectomy to treat adnexal torsion. Clin Imaging 2016; 40:816-20. [DOI: 10.1016/j.clinimag.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/19/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
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Laganà AS, Sofo V, Salmeri FM, Palmara VI, Triolo O, Terzić MM, Patrelli TS, Lukanovic A, Bokal EV, Santoro G. Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:416-23. [PMID: 26985329 PMCID: PMC4793162 DOI: 10.22074/ijfs.2015.4598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/01/2015] [Indexed: 12/20/2022]
Abstract
Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group
that must be included in the differential diagnosis of any girl with abdominal pain or
pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility,
although oophoropexy may be considered in case of severe necrosis. Nevertheless,
maintaining the circulation of the ovary after detorsion deteriorates the tissue injury
and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is
characterized by oxidative stress. During the detorsion process, an excess amount of
molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS)
such as superoxide radical (O2-), hydrogen peroxide (H2O2), hydroxyl radical (OH•),
as well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and
their toxic products cause DNA damage and lipid peroxidation in the cellular and
mitochondrial membranes, leading to cell death. In spite of attention on this topic,
currently there is no shared and clear evidence about the use of anti-inflammatory
and antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion.
Considering this element, future research should aim to develop shared protocols for
the clinical use (route of application, dosage and time of application) of antioxidants
after laparoscopic management of this condition.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Vincenza Sofo
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Maria Salmeri
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Vittorio Italo Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Milan Milosav Terzić
- University of Belgrade, School of Medicine, Belgrade, Serbia; Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Adolf Lukanovic
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Eda Vrtcnik Bokal
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Giuseppe Santoro
- Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy
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Selim MF, Haggag MS, Hassan MA. Detorsion or Adnexectomy for Adnexal Torsion and MRI Assessment for Necrosis. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Fouad Selim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Abstract
Imaging is crucial in expediting the diagnosis and guiding definitive therapy in children with ovarian torsion. This article reviews the multimodality spectrum of imaging findings in pediatric ovarian torsion, focusing primarily on US appearances. We describe predisposing conditions that can lead to torsion, the pathological basis of the radiologic findings in ovarian torsion, and the common diagnostic pitfalls.
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Affiliation(s)
- Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA.
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Sola R, Wormer BA, Walters AL, Heniford BT, Schulman AM. National Trends in the Surgical Treatment of Ovarian Torsion in Children: An Analysis of 2041 Pediatric Patients Utilizing the Nationwide Inpatient Sample. Am Surg 2015. [DOI: 10.1177/000313481508100914] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the national trends in surgical management of ovarian torsion (OT) in children. The Nationwide Inpatient Sample was queried from 1998 to 2011 for females less than 18 years of age with OT. Patients were stratified into three treatment groups: oophorectomy (OO), oophoropexy, or release of torsion (RT) alone. There were 2041 patients with OT, of which 1598 (78%) underwent OO, 126 (6%) oophoropexy, and 317 (15%) RT. RT significantly increased from 1998 to 2011 (9% vs 25%; P < 0.05). At nonteaching hospitals, there were higher rates of OO (89.3% vs 79.5%; P < 0.05) and lower rates of RT (10.7% vs 20.5%; P < 0.05) compared with teaching hospitals. RT was performed at a higher rate in Northeast United States compared with the South (22.7% vs 14.2%; P < 0.05). Girls presenting at nonteaching hospitals and the South had increased odds of undergoing OO compared with those presenting at teaching hospitals and the Northeast ( P < 0.05). Although ovarian conservation for OT in children is more often performed in the Northeast United States and at teaching hospitals, this large population-based study demonstrates OO remains the most common surgical management for OT in the United States.
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Affiliation(s)
- Richard Sola
- Carolinas Medical Center, Charlotte, North Carolina
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Sakae C, Sato Y, Taga A, Satake Y, Emoto I, Maruyama S, Kim T. Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic untwisting of ovarian torsion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:243-246. [PMID: 25810122 DOI: 10.1002/uog.14853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/08/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
Hyperreactio luteinalis (HL) is characterized by multicystic bilateral enlargement of the ovaries and is a self-limiting benign condition associated with pregnancy or trophoblastic disease. Since HL regresses spontaneously over time, it should be managed conservatively as long as the patient's condition permits; torsion of the enlarged ovaries is believed to be the only exception that mandates surgical intervention. Here, we describe a case of HL complicated by ovarian torsion that was treated successfully without surgical intervention. A 33-year-old woman was admitted to our hospital owing to acute abdomen. Nine days previously, she had had a stillbirth caused by hydrops fetalis at 24 weeks' gestation. The characteristic findings observed on magnetic resonance imaging (MRI) led to the diagnosis of HL complicated by torsion of the enlarged left ovary. Emergency laparoscopic detorsion of the ischemic left ovary was planned. Aiming to reduce the risk of cystic injury and bleeding at the trocar insertion site, volume reduction of the left ovarian cyst was performed by percutaneous aspiration. The patient's pain diminished rapidly and laparoscopic surgery was deferred. Subsequent MRI revealed that gadolinium enhancement of the left ovarian tumor had been restored, indicating spontaneous detorsion of the left ovary. The patient remained asymptomatic and was discharged from the hospital 12 days after aspiration of the cyst. From this experience, we propose that, in cases of ovarian torsion occurring in large functional cysts, including HL, volume reduction by percutaneous cyst aspiration should be considered before performing emergency laparoscopic surgery.
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Affiliation(s)
- C Sakae
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - Y Sato
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - A Taga
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - Y Satake
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - I Emoto
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - S Maruyama
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
| | - T Kim
- Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Nagara, Otsu, Shiga, Japan
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Yildirim N, Yigitturk G, Sahingoz Yildirim AG, Akdemir A, İlgen O, Yeniel O, Ergenoglu M, Erbas O. Octreotide protects ovary against ischemia-reperfusion injury in rats: Evaluation of histological and biochemical parameters. J Obstet Gynaecol Res 2015. [DOI: 10.1111/jog.12770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nuri Yildirim
- Department of Obstetrics and Gynecology; Ege University; Izmir Turkey
| | - Gurkan Yigitturk
- Department of Histology and Embryology; Ege University; Izmir Turkey
| | | | - Ali Akdemir
- Department of Obstetrics and Gynecology; Ege University; Izmir Turkey
| | - Orkun İlgen
- Department of Obstetrics and Gynecology; Ege University; Izmir Turkey
| | - Ozgur Yeniel
- Department of Obstetrics and Gynecology; Ege University; Izmir Turkey
| | - Mete Ergenoglu
- Department of Obstetrics and Gynecology; Ege University; Izmir Turkey
| | - Oytun Erbas
- Department of Physiology; Bilim University; Istanbul Turkey
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Santos XM, Cass DL, Dietrich JE. Outcome Following Detorsion of Torsed Adnexa in Children. J Pediatr Adolesc Gynecol 2015; 28:136-8. [PMID: 26046601 DOI: 10.1016/j.jpag.2014.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/31/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To examine the postoperative course and outcomes of young females with ovarian torsion treated with detorsion and ovarian preservation. The secondary objective was to determine which operative findings correlated with higher follicular counts following detorsion. DESIGN Retrospective chart review. SETTING Tertiary academic center. PARTICIPANTS 29 females (mean age 10.3 ± 4.9 y) who underwent surgery for ovarian torsion with detorsion and ovarian preservation at our institution between July 2007 and July 2010 and who had follow-up pelvic ultrasonography available for review. INTERVENTIONS None. MAIN OUTCOME MEASURES Surgical findings, postoperative complications, and follicular counts on follow-up ultrasonography. RESULTS Mean duration of abdominal pain on presentation was 77.5 ± 78.8 h. The detorsed ovary was described as "dusky/purple" in 21 cases (72.4%), "normal" in 1 (3.4%), "necrotic" in 1 (3.4%), and not described in 6 (20.7%). All pubertal patients resumed menstrual function. No patients required reoperation for removal of the salvaged ovary. There were no instances of postoperative fever or concern for ovarian venous thrombosis. Average timing of follow-up ultrasonography was 8.1 ± 6.7 months, with 28 patients (96.6%) showing ovarian follicles on the affected side (mean 4.6 ± 1.9 and 4.7 ± 3.3 follicles on the right and left ovary, respectively). No correlation was found between the side affected, gross appearance of the torsed ovary or the number of follicles found on follow-up ultrasonography. CONCLUSIONS Detorsion with ovarian preservation is a safe and effective treatment, and should be considered the primary treatment for girls with ovarian torsion, even for those with ovaries that appear necrotic.
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Affiliation(s)
- Xiomara M Santos
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Darrell L Cass
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Hyttel TEW, Bak GS, Larsen SB, Løkkegaard ECL. Re-torsion of the ovaries. Acta Obstet Gynecol Scand 2014; 94:236-44. [PMID: 25412114 DOI: 10.1111/aogs.12542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/12/2014] [Indexed: 12/01/2022]
Abstract
The increasing use of de-torsion of the ovaries may result in re-torsion. This review addresses risk of re-torsion and describes preventive strategies to avoid re-torsion in pre-menarcheal girls, and fertile and pregnant women. We clinically reviewed PubMed, Embase, Trip and Cochrane databases. The main outcome measures were re-torsion and viability of ovary with fixation measures. A total of 38 publications including 71 girls, 363 fertile women, and 69 pregnant women were found to be relevant. All studies were case reports or case series, sometimes with non-randomized controls. The studies show considerable heterogeneity in design, population, management and outcome. Only four studies included more than 50 cases. In pregnancy the risk of re-torsion was as high as 19.5-37.5%; among fertile women it was 28.6%. Most articles concluded that fixation of the ovaries to the pelvic sidewall or plication of the ovarian ligament after torsion may prevent re-torsion. In one case a girl experienced re-torsion after ovariopexy. Based on observational studies it seems that de-torsion and fixation of the ovary is a safe procedure that usually ensures maintenance of ovarian function and reduces the risk of recurrence, especially when there are no ovarian cysts or adnexal masses.
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Affiliation(s)
- Trine E W Hyttel
- Department of Anesthesiology, Vendsyssel Hospital, Hjørring, Denmark
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Huang HJ, Huang YC, Kuo HC, Chang CY. A rare cause of acute abdomen after a sport-related blunt abdominal trauma – Torsion of a normal ovary in a pre-pubertal girl. J Acute Med 2014. [DOI: 10.1016/j.jacme.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fujishita A, Araki H, Yoshida S, Hamaguchi D, Nakayama D, Tsuda N, Khan KN. Outcome of conservative laparoscopic surgery for adnexal torsion through one-stage or two-stage operation. J Obstet Gynaecol Res 2014; 41:411-7. [DOI: 10.1111/jog.12534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Akira Fujishita
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Hiroyuki Araki
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Shiko Yoshida
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Daisuke Hamaguchi
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Daisuke Nakayama
- Department of Gynecology; Saiseikai Nagasaki Hospital; Nagasaki Japan
| | - Nobuo Tsuda
- Department of Pathology; Nagasaki Health Promotion Corporation; Nagasaki Japan
| | - Khaleque Newaz Khan
- Department of Obstetrics and Gynecology; Graduate School of Biomedical Sciences, Nagasaki University; Nagasaki Japan
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Akdemir A, Erbas O, Gode F, Ergenoglu M, Yeniel O, Oltulu F, Yavasoglu A, Taskiran D. Protective effect of oxytocin on ovarian ischemia-reperfusion injury in rats. Peptides 2014; 55:126-30. [PMID: 24630974 DOI: 10.1016/j.peptides.2014.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 01/14/2023]
Abstract
Oxytocin (OT), a neurohypophysial nonapeptide, plays dual role as a neurotransmitter/neuromodulator and a hormone. It has also well known protective properties against ischemia/reperfusion organ damage. This study investigated the effect of OT on experimentally induced ovarian torsion/de-torsion ischemia/reperfusion (I/R) injury in rats. Sprague-Dawley rats were assigned to five treatment groups (n=7/group): Group 1, sham-operated; Group 2, torsion; Group 3, 80 IU/kg of OT administration 30 min prior to torsion; Group 4, torsion/de-torsion; and Group 5, torsion followed by 80 IU/kg of OT administration 30 min prior to de-torsion. OT administration significantly decreased the tissue malondialdehyde (MDA) levels in both the torsion and OT group (Group 3), and torsion/de-torsion OT group (Group 5) in comparison with the torsion-only group (Group 2) and torsion/de-torsion group (Group 4). Histopathological finding scores including follicular degeneration, edema, hemorrhage, vascular congestion, and infiltration by inflammatory cells were found to be significantly decreased in the torsion and OT group (Group 3), and torsion/de-torsion OT group (Group 5) when compared with the torsion-only group (Group 2) and torsion/de-torsion group (Group 4). In conclusion, these results, verified with histopathologic evaluation and biochemical assays, suggest a probable protective role for OT in ischemia and I/R injury in rat ovaries.
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Affiliation(s)
- Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Oytun Erbas
- Department of Physiology, Ege University School of Medicine, Izmir, Turkey
| | - Funda Gode
- Department of Obstetrics and Gynecology, Kent Hospital, Izmir, Turkey.
| | - Mete Ergenoglu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Ozgur Yeniel
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Fatih Oltulu
- Department of Histology and Embryology, Ege University School of Medicine, Izmir, Turkey
| | - Altug Yavasoglu
- Department of Histology and Embryology, Ege University School of Medicine, Izmir, Turkey
| | - Dilek Taskiran
- Department of Physiology, Ege University School of Medicine, Izmir, Turkey
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Yucel B, Usta TA, Kaya E, Turgut H, Ates U. Folicular reserve changes in torsion-detorsion of the ovary: an experimental study. Eur J Obstet Gynecol Reprod Biol 2014; 177:126-9. [PMID: 24774035 DOI: 10.1016/j.ejogrb.2014.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We assess follicular reserve changes by follicle count in torsion-detorsion rat model. STUDY DESIGN 30 albino rats were randomly divided into 3 groups: sham group (SG), detorsion after 24-hour torsion group (24hTG) and detorsion after 72-hour torsion group (72hTG). Ovaries were torsioned and fixed. They were untwisted 24 and 72 h later. Oophorectomies were performed at 14th day after detorsion. Tissue damage scoring and follicle counts were evaluated microscopically. RESULTS Tissue damage scores (TDSs) were higher in 72hTG and 24hTG compared to SG. In addition, as we increase torsion duration, TDSs also increased. There was no statistically significant difference in follicle numbers (primordial, primary, secondary and tertiary). CONCLUSION Duration of torsion and intensity of ovarian damage do not affect follicular reserve in a rat model. Regardless of their macroscopic appearance, ovaries maintain their follicle reserves after torsion. Thus, surgeons should be reassured and encouraged to untwist torsioned ovaries rather than removing them.
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Affiliation(s)
- Burak Yucel
- Department of Obstetrics and Gynecology, Acıbadem Hospital, Kayseri, Turkey
| | - Taner A Usta
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey.
| | - Erdal Kaya
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, Bagcilar, Istanbul, Turkey
| | - Hurriyet Turgut
- Department of Pathology, Bakirkoy Sadi Konuk Training and Research Hospital, Bakirkoy, Turkey
| | - Ugur Ates
- Department of Obstetrics and Gynecology, Haseki Training and Research Hospital, Bagcilar, Istanbul, Turkey
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Parelkar SV, Mundada D, Sanghvi BV, Joshi PB, Oak SN, Kapadnis SP, Shetty S, Athawale H, Multani P. Should the ovary always be conserved in torsion? A tertiary care institute experience. J Pediatr Surg 2014; 49:465-8. [PMID: 24650479 DOI: 10.1016/j.jpedsurg.2013.11.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 10/28/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
Abstract
AIM The aim of this study was to analyze our experience in conserving ovarian tissue in cases of ovarian torsion, irrespective of grade of necrosis at exploration. MATERIALS AND METHODS All children with a diagnosis of ovarian torsion admitted to our hospital from January 2009 to January 2013 were included. Patients with underlying ovarian pathology were excluded. RESULTS There were 13 torsions in 12 children (one bilateral). All underwent detorsion with or without evacuation of hematoma. Follow-up ultrasonography (USG) with color Doppler was done for all 13 ovaries, which showed an ovary with good vascularity and follicular development in 12 ovaries (92%). In 76% (10 of 13) of cases, intraoperatively, the ovary was judged to be moderately to severely ischemic/necrotic. Yet, follow-up sonograms showed the ovary with follicular development in all cases except one (7%). There were no major complications in our series. CONCLUSION Simple detorsion, instead of traditionally advocated oophorectomy, was not accompanied by an increase in morbidity. On follow-up, almost all patients studied had functioning ovarian tissue despite the grave ischemia observed intraoperatively. Detorsion should be the procedure of choice for all cases of simple ovarian torsion in children.
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Affiliation(s)
- Sandesh V Parelkar
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India.
| | - Dinesh Mundada
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Beejal V Sanghvi
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Prashant B Joshi
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Sanjay N Oak
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Satish P Kapadnis
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Shishira Shetty
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Hemangi Athawale
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
| | - Pooja Multani
- Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai, India
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Sasaki KJ, Miller CE. Adnexal Torsion: Review of the Literature. J Minim Invasive Gynecol 2014; 21:196-202. [DOI: 10.1016/j.jmig.2013.09.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
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Ovarian torsion in children: management and outcomes. J Pediatr Surg 2013; 48:1946-53. [PMID: 24074673 DOI: 10.1016/j.jpedsurg.2013.04.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 03/31/2013] [Accepted: 04/13/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the clinical symptoms, diagnosis, management, and outcomes in children with ovarian torsion. METHODS The charts of 50 patients with 53 cases of ovarian torsion treated between January 1989 and March 2012 were reviewed retrospectively. Long term follow up was available for 20 girls who had their ovaries left in the abdominal cavity after detorsion. RESULTS In 22 cases ovaries were removed, and in 31 cases the torsion was relieved and the ovaries left in the abdominal cavity. Twenty-five of the salvaged ovaries were black-bluish and 10 bluish in color. Since 2005, after a change in preferred treatment, all ovaries treated by detorsion were left in the abdominal cavity. The long term results were observed clinically and by ultrasound in 20 girls. Multifollicular ovaries were found in 17 girls. One girl had a normal size paucifollicular ovary, a one-year-old girl had a normal size ovary with microfollicles, and one girl had no ovarian material detectable by ultrasound. CONCLUSIONS Long term analysis of the treatment of ovarian torsion revealed that ovaries treated by detorsion and left in the abdominal cavity preserved their normal anatomy and function. Conservative surgical treatment proved to be safe. None of the girls had thromboembolism or peritonitis, and no malignant tumors were found in the operated ovaries.
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Spinelli C, Buti I, Pucci V, Liserre J, Alberti E, Nencini L, Alessandra M, Lo Piccolo R, Messineo A. Adnexal torsion in children and adolescents: new trends to conservative surgical approach -- our experience and review of literature. Gynecol Endocrinol 2013; 29:54-8. [PMID: 22817767 DOI: 10.3109/09513590.2012.705377] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study is to discuss the surgical treatment for ovarian torsion in children and adolescents with a focus on the procedures of adnexal conservation surgery and its frequency in the literature of the last 10 years. We retrospectively reviewed the medical charts of 127 operative ovarian lesions including 30 ovarian torsions (23.6%) treated in two pediatric centers over a 10-year period. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathological findings were analyzed. Mean age was 13.7 years. Conservative surgery has been performed in 46.7% of the cases and laparoscopic approach in 40%. Ovarian torsion occurred in 56.7% on ovaries with functional lesion, in 23.3% on normal adnexa and in 20% on ovaries with benign neoplasm. The article includes a literature review (2000-2010) and a statistical analysis which shows a slow increase in conservative surgery from 28 to 45%. Laparoscopic surgery accounts for 23.5%. Literature review shows 40.5% normal adnexa, 33.2% non-neoplastic lesions, 25.3% benign neoplasms and 1% malignant neoplasms. The surgical treatment of children and adolescents presenting adnexal torsion should be practiced as an emergency and it should be more conservative as possible in order to maximize the future reproductive potential.
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Affiliation(s)
- Claudio Spinelli
- Department of Surgery, Chair of Pediatric Surgery, University of Pisa, Italy.
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Gaied F, Emil S, Lo A, Baird R, Laberge JM. Laparoscopic treatment of isolated salpingeal torsion in children: case series and a 20-year review of the literature. J Laparoendosc Adv Surg Tech A 2012; 22:941-7. [PMID: 23067066 DOI: 10.1089/lap.2011.0530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Isolated torsion of the Fallopian tube, without ovarian torsion, is a rare cause of lower abdominal pain. We report our experience with 4 recent cases, along with data from a 20-year review of the pediatric literature. SUBJECTS AND METHODS The records of 4 cases encountered during a 3-year period were reviewed. A literature review was completed by searching Medline, Medline in Process, Embase, Current Contents, and BIOSIS from 1990 to 2010. RESULTS All 4 patients were diagnosed on laparoscopy. Laparoscopic salpingectomy was performed in 3 cases and laparoscopic detorsion in 1. All three resected specimens revealed hemorrhage and gangrene of the salpinx, with an associated cyst in one. The pediatric literature review, including our report, revealed 33 case reports and case series with 45 patients. Fifty-six percent of cases represented primary torsion, and 44% were secondary to underlying tubal pathology. Thirty percent of girls were premenarchal. The mean age at presentation and symptom duration were 13.2±2.1 years and 5.8±12.5 days, respectively. Fever and leukocytosis were present in 27% and 63%, respectively. Ultrasound, computed tomography scan, and magnetic resonance imaging showed a sensitivity of 22% (8/36), 14% (1/7), and 40% (2/5), respectively. A correct preoperative diagnosis was considered in only 13%. Eighty-eight percent of cases were treated by salpingectomy, and 12% were treated by tubal detorsion. Long-term outcomes of detorsion were not reported. CONCLUSIONS Isolated salpingeal torsion in girls is rarely diagnosed preoperatively, regardless of imaging technique. Laparoscopy is the intervention of choice for definitive diagnosis and management. Salpingectomy is the most frequent treatment. Detorsion without resection may be considered for selected cases, but the long-term outcomes of this approach are unknown.
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Affiliation(s)
- Fady Gaied
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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50
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Bharathan R, Ramsawak L, Kelly A. Ovarian torsion: Opportunities to improve clinical management. J OBSTET GYNAECOL 2012; 32:683-6. [DOI: 10.3109/01443615.2012.698331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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