Adnexal torsion in childhood and adolescence

Czech version

Authors: R. Chmel Jr. ^1,2 ; N. Chubanovová ¹ ; R. Kelčík ^1,2 ; M. Nováčková ¹
Authors‘ workplace: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha ¹; LF UK v Plzni ²
Published in: Ceska Gynekol 2023; 88(2): 120-125
Category: Review Article
doi: https://doi.org/10.48095/cccg2023120

Overview

The incidence of adnexal torsion in childhood and adolescence is 4.9 per 100,000 girls. Torsion of the adnexa is caused by rotation of the ovary usually with the fallopian tube around the infundibulopelvic ligament. The torsion leads primarily to the interruption of both venous outflow and lymphatic drainage. It causes enlargement of the ovary due its edema with occurrence of hemorrhagic infarctions. Interruption of the arterial inflow leads finally to the necrosis of ovarian tissue. Torsion of the adnexa in childhood occurs usually in enlarged ovary, particularly by a cyst, or when the non-enlarged ovary is excessively mobile due to the extended infundibulopelvic ligament. The characteristic clinical symptoms of adnexal torsion are sudden pain in the lower abdomen with nausea and vomiting. The diagnosis of adnexal torsion is based on the typical symptoms, clinical course, and the results of physical and ultrasound examinations. Torsion of the adnexa should be considered in every girl with sudden abdominal pain. To preserve reproductive functions, an early surgery with detorsion of the adnexa should be performed.

Keywords:

puberty – laparoscopy – adnexal torsion – ovarian torsion – acute abnominal pain

Sources

1. Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000–2006. Pediatrics 2010; 125 (3): 532–538. doi: 10.1542/peds.2009-1360.

2. Childress KJ, Dietrich JE. Pediatric ovarian torsion. Surg Clin North Am 2017; 97 (1): 209–221. doi: 10.1016/j.suc.2016.08.008.

3. Kim HS, Yoo SY, Cha MJ et el. Diagnosis of neonatal ovarian torsion: emphasis on prenatal and postnatal sonographic findings. J Clin Ultrasound 2016; 44 (5): 290–297. doi: 10.1002/jcu.22327.

4. Breech LL, Adams Hillard PJ. Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol 2005; 17 (5): 483–489. doi: 10.1097/01.gco.0000179666.39548.78.

5. Descargues G, Tinlot-Mauger F, Gravier A et al. Adnexal torsion: a report on forty-five cases. Eur J Obstet Gynecol Reprod Biol 2001; 98 (1): 91–96. doi: 10.1016/s0301-2115 (00) 00555-8.

6. Karaca SY, İleri A. Ovarian torsion in adolescents with and without ovarian mass: a cross--sectional study. J Pediatr Adolesc Gynecol 2021; 34 (6): 857–861. doi: 10.1016/j.jpag.2021.05. 007.

7. Yaniv RT, Schonmann R, Agizim R et el. Correlation between the length of ovarian ligament and ovarian torsion: a prospective study. Gynecol Obstet Invest 2019; 84 (1): 45–49. doi: 10.1159/000490664.

8. Celik A, Ergün O, Aldemir H et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg 2005; 40 (4): 704–708. doi: 10.1016/j.jpedsurg.2005.01.008.

9. Geimanaite L, Trainavicius K. Ovarian torsion in children: management and outcomes. J Pediatr Surg 2013; 48 (9): 1946–1953. doi: 10.1016/j.jpedsurg.2013.04.026.

10. Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg 2000; 180 (6): 462–465. doi: 10.1016/s0002-9610 (00) 00503-1.

11. Lawrence AE, Fallat ME, Hewitt G et el. Factors associated with torsion in pediatric patients with ovarian masses. J Surg Resc 2021; 263: 110–115. doi: 10.1016/j.jss.2020.12.058.

12. Pansky M, Smorgick N, Herman A et al. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol 2007; 109 (2 Pt 1): 355–359. doi: 10.1097/01.AOG.0000250969.15438.17.

13. Prieto JM, Kling KM, Ignacio RC et al. Premenarchal patients present differently: a twist on the typical patient presenting with ovarian torsion. J Pediatr Surg 2019; 54 (12): 2614–2616. doi: 10.1016/j.jpedsurg.2019.08.020.

14. Rousseau V, Massicot R, Darwish AA et al. Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol 2008; 21 (4): 201–206. doi: 10.1016/j.jpag.2007.11.003.

15. Meyer R, Meller N, Komem DA et al. Pediatric and adolescent females are at higher risk of adnexal torsion recurrence – a large-scale retrospective study. J Obstet Gynaecol Res 2022; 48 (3): 838–842. doi: 10.1111/jog.15 159.

16. Fuchs N, Smorgick N, Tovbin Y et al. Oophoropexy to prevent adnexal torsion: how, when, and for whom? J Minim Invasive Gynecol 2010; 17 (2): 205–208. doi: 10.1016/j.jmig.2009.12.011.

17. Tobiume T, Shiota M, Umemoto M et al. Predictive factors for ovarian necrosis in torsion of ovarian tumor. Tohoku J Exp Med 2011; 225 (3): 211–214. doi: 10.1620/tjem.225.211.

18. Bertozzi M, Noviello C, Molinaro F. Isolated fallopian tube torsion in pediatric age: an Italian multicenter retrospective study. J Pediatr Surg 2020; 55 (4): 711–714. doi: 10.1016/ j.jpedsurg.2019.04.032.

19. Yancey LM. Intermittent torsion of a normal ovary in a child associated with use of a trampoline. J Emerg Med 2012; 42 (4): 409–412. doi: 0.1016/j.jemermed.2010.11.046.

20. Servaes S, Zurakowski D, Laufer MR et al. Sonographic findings of ovarian torsion in children. Pediatr Radiol 2007; 37 (5): 446–451. doi: 10.1007/s00247-007-0429-x.

21. Jarošová R, Mašata J. Torze ovaria v prvním trimestru gravidity po stimulaci v IVF-ET programu – kazuistika. Ceska Gynekol 2009; 74 (6): 437–439.

22. Ondrová D, Hamplová-Běhávková K, Ondrová S. Bolesti břicha u dívek v dětském a pubertálním období. Čes-slov Pediat 2020; 75 (3): 125–130.

23. Nissen M, Sander V, Rogge P et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio might predict pediatric ovarian torsion: a single-institution experience and review of the literature. J Pediatr Adolesc Gynecol 2021; 34 (3): 334–340. doi: 10.1016/j.jpag.2020.12.003.

24. Grunau GL, Harris A, Buckley J et al. Diagnosis of ovarian torsion: is it time to forget about doppler? J Obstet Gynaecol Can 2018; 40 (7): 871–875. doi: 10.1016/j.jogc.2017.09.013.

25. Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 2004; 23 (12): 1643–1649. doi: 10.7863/jum. 2004.23.12.1643.

26. Alberto EC, Tashiro J, Zheng Y et al. Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway. Pediatr Surg Int 2021; 37 (1): 129–135. doi: 10.1007/s00383-020- 04782-1.

27. Wilkinson C, Sanderson A. Adnexal torsion – a multimodality imaging review. Clin Radiol 2012; 67 (5): 476–483. doi: 10.1016/j.crad.2011.10.018.

28. Adu-Bredu TK, Arkorful J, Appiah-Denkyira K et al. Diagnostic value of the sonographic whirlpool sign in the diagnosis of ovarian torsion: a systematic review and meta-analysis. J Clin Ultrasound 2021; 49 (7): 746–753. doi: 10.1002/jcu.23021.

29. Fischerová D, Zikán M, Pinkavová I et al. Racionální předoperační diagnostika benigních a maligních ovariálních nádorů – zobrazovací metody, nádorové markery (přehledový článek). Ceska Gynekol 2012; 77 (4): 272–287.

30. Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2021; 27 (1): 236–242. doi: 10.1016/j.radi.2020.07. 006.

31. Kaplanoglu D, Bulbul M, Odemis G et al. Can various complete blood count parameters helpful in preoperative diagnosis of adnexal torsion? Rev Assoc Med Bras 2021; 67 (6): 873–877. doi: 10.1590/1806-9282.20210201.

32. Bolli P, Schädelin S, Holland-Cunz S et al. Ovarian torsion in children: development of a predictive score. Medicine (Baltimore) 2017; 96 (43): e8299. doi: 10.1097/MD.00000000 00008299.

33. Kinay T, Akgul MA, Altinbas SK et al. Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases. J Obstet Gynaecol Res 2021; 47 (5): 1846–1853. doi: 10.1111/jog.14715.

34. Adams K, Ballard E, Amoako A et al. When is it too late? Ovarian preservation and duration of symptoms in ovarian torsion. J Obstet Gynaecol 2022; 42 (4): 675–679. doi: 10.1080/01443615.2021.1929114.

35. Nichols DH, Julian PJ. Torsion of the adnexa. Clin Obstet Gynecol 1985; 28 (2): 375–380. doi: 10.1097/00003081-198528020-00015.

36. Mandelbaum RS, Smith MB, Violette CJ et al. Conservative surgery for ovarian torsion in young women: perioperative complications and national trends. BJOG 2020; 127 (8): 957–965. doi: 10.1111/1471-0528.16179.

37. Taskin O, Birincioglu M, Aydin A et al. The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: an ischaemia-reperfusion rodent model. Hum Reprod 1998; 13 (10): 2823–2827. doi: 10.1093/humrep/13.10.2823.

38. Walker SK, Lal DR, Boyd KP et al. Management of pediatric ovarian torsion: evidence of follicular development after ovarian preservation. Surgery 2018; 163 (3): 547–552. doi: 10.1016/j.surg.2017.11.019.

39. Obut M, Değer U. A new technique ofoophoropexy: folding and fixating of utero-ovarian ligament to round ligament in a patient with reccurrent ovarian torsion. Case Rep Obstet Gynecol 2019; 2019: 7647091. doi: 10.1155/2019/7647091.