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Obstetrics and Gynecology May 2023
Topics: Female; Humans; Ovarian Torsion; Torsion Abnormality
PubMed: 37023460
DOI: 10.1097/AOG.0000000000005177 -
International Journal of Gynaecology... Mar 2022To investigate the clinical features and computed tomography (CT) findings of pediatric ovarian torsion.
OBJECTIVE
To investigate the clinical features and computed tomography (CT) findings of pediatric ovarian torsion.
METHODS
A retrospective analysis of the clinical and CT data of 61 newborns, infants, children, and adolescents with ovarian torsion confirmed by histopathology was performed.
RESULTS
Clinical features included abdominal mass, abdominal pain, nausea and vomiting, and fever. The tumor marker α-fetoprotein was increased in five cases. Ovarian enlargement was found in 26 cases, and follicles were detected in the peripheral region of the ovary in 21 cases. Twenty-one cases presented as solid mixed-density masses on CT images. A total of 30 cases of ovarian torsion were associated with a benign ovarian mass. Among 27 cases of cystic or predominantly cystic masses, the mass had a thickened wall in 26 cases and showed an uneven density in 23 cases. Among all 61 patients, a torsed pedicle was detected in 47 cases. A torsed ovary or mass exhibited mild contrast enhancement in seven cases. Uterine deviation toward the involved side, blurred fat space around lesions, and pelvic free fluid were also found.
CONCLUSION
Pediatric ovarian torsion presents a relatively characteristic CT appearance. Correct diagnosis can be established based on clinical and imaging features.
Topics: Adolescent; Child; Female; Humans; Infant; Infant, Newborn; Ovarian Diseases; Ovarian Torsion; Retrospective Studies; Tomography, X-Ray Computed; Torsion Abnormality
PubMed: 33621364
DOI: 10.1002/ijgo.13657 -
Journal of Pediatric and Adolescent... Dec 2021The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT).
STUDY OBJECTIVE
The aim of this study was to compare the characteristics of adolescents with and without adnexal mass who were diagnosed with ovarian torsion (OT).
DESIGN
Retrospective cross-sectional study.
SETTING
Gynecology Department at Tepecik Education and Reseach Hospital, Izmir, Turkey.
PARTICIPANTS
Adolescent girls who received surgery for OT between March 2012 and October 2020 in our institution.
INTERVENTIONS AND MAIN OUTCOME MEASURES
The patients were divided into 2 groups according to the presence or absence of an ovarian mass and compared. Demographic and clinical characteristics, imaging findings, surgery, and pathology reports of the patients were obtained. Differences in initial symptoms, ultrasound findings, the diagnostic process, and the degree of torsion in patients with and without ovarian mass.
RESULTS
Seventy-six patients were diagnosed with OT. Of the 76 patients, 41/76 (53.9%) had an ovarian mass (OTwM), and 35/76 (46.1%) had no pathology (OTnP). The admission to surgery interval was longer in the OTnP group (P = .03). Ultrasound findings of ovarian edema and the appearance of free fluid were significant in the OTnP group (P = .001). The largest dimension of the nontorsion ovary in the OTnP group was greater than in the OTwM group (P = .03). In addition, it was found that torsion more than 360° was more common in the OTnP group than in the OTwM group (24/35, 68.5% vs 41/18, 43.9%; P = .03).
CONCLUSION
In symptomatic adolescents without an ovarian mass, the presence of follicle peripheralization suggesting ovarian edema on ultrasound and the presence of free fluid in the abdomen are important in terms of suspicion of torsion for clinicians. In addition, the degree of torsion was increased in these patients.
Topics: Adnexal Diseases; Adolescent; Cross-Sectional Studies; Female; Humans; Ovarian Neoplasms; Ovarian Torsion; Retrospective Studies; Torsion Abnormality
PubMed: 34044177
DOI: 10.1016/j.jpag.2021.05.007 -
Radiology Case Reports Jul 2021Ovarian torsion (OT) is a medical emergency which can have significant clinical consequences. It is surgically treated by either detorsion with or without oophoropexy,...
Ovarian torsion (OT) is a medical emergency which can have significant clinical consequences. It is surgically treated by either detorsion with or without oophoropexy, or oophorectomy. In this report, a case of left OT is described after prior hysterectomy and bilateral prophylactic oophoropexy three years prior. The patient presented with progressive left flank and abdominal pain. The diagnosis of torsion was made using a combination of CT and MR imaging with confirmation at surgery and pathology. At laparoscopic surgery, the left ovary was found at the level of iliac crest posterior to the descending colon. The ovary was torsed with hemorrhagic infarction. It was successfully removed. The patient was discharged postoperative day one and is now free of symptoms and complaints. OT is rarely reported after hysterectomy and oophoropexy. This case demonstrates that OT should be kept in the differential even in patients post hysterectomy and/or oophoropexy.
PubMed: 34007376
DOI: 10.1016/j.radcr.2021.03.040 -
Fertility and Sterility Dec 2023To analyze characteristics of acute and chronic ovarian torsion, review treatment recommendations, and present possible surgical techniques for fertility preservation in...
OBJECTIVE
To analyze characteristics of acute and chronic ovarian torsion, review treatment recommendations, and present possible surgical techniques for fertility preservation in young women.
DESIGN
Literature review and demonstration of perioperative management of ovarian torsion using radiologic images and intraoperative video footage. Ovarian torsion is mostly mentioned in context of gynecologic emergencies, where acute ovarian torsion with arterial obstruction leads to ovarian ischemia and necrosis. However, ovarian torsion can also occur as a partial or intermittent torsion with venous and lymphatic obstruction, followed by ovarian swelling. In both cases, surgical management of ovarian torsion commonly includes oophorectomy, although leading guidelines recommend preservation of the ovary. We here aimed to raise awareness for the clinical features of ovarian torsion and demonstrate adequate perioperative management, thereby avoiding surgical overtreatment in young women.
SETTING
Medical University of Vienna, Department of Obstetrics and Gynecology.
PATIENT(S)
We present a case of acute ovarian torsion with a consequently ischemic ovary as well as a case of chronic ovarian torsion with related massive ovarian edema. The patients included in this video gave consent for publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.), and other applicable sites.
INTERVENTION(S)
Laparoscopic management with detorsion of the torquated ovaries, cystectomy on an ischemic ovary and oophoropexy to the pelvic side wall and utero-ovarian ligament to prevent recurrence.
MAIN OUTCOME MEASURES
Postoperative relief of pain and normalization of ovarian size and morphology on ultrasound imaging.
RESULTS
The current cases show successful conservative surgical management of ovarian torsion, hence preserving hormonal function and fertility in young women.
CONCLUSION
Although it is recommended to preserve fertility in young women affected by ovarian torsion, surgical overtreatment by means of oophorectomy is still common in clinical routine. Increasing awareness for the clinical characteristics of acute and chronic ovarian torsion, as well as for the importance of preservation of the ovary, is crucial. We therefore believe that ovarian torsion and its surgical management deserve increased attention in the future.
Topics: Female; Humans; Ovarian Torsion; Torsion Abnormality; Ovarian Diseases; Ovariectomy
PubMed: 37574000
DOI: 10.1016/j.fertnstert.2023.08.012 -
Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights.Open Access Emergency Medicine : OAEM 2022Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and... (Review)
Review
Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.
PubMed: 35770141
DOI: 10.2147/OAEM.S342725 -
Journal of Minimally Invasive Gynecology Aug 2022To identify risk factors for recurrent ovarian torsion and evaluation of the efficacy of oophoropexy techniques.
STUDY OBJECTIVE
To identify risk factors for recurrent ovarian torsion and evaluation of the efficacy of oophoropexy techniques.
DESIGN
Case control study.
SETTING
Tertiary university-affiliated medical center.
PATIENTS
A total of 79 women with recurrent ovarian torsion (study group) were matched with 158 women with a single episode of ovarian torsion (control group).
INTERVENTIONS
Laparoscopic detorsion and oophoropexy.
MEASUREMENTS AND MAIN RESULTS
Demographic data, clinical characteristics, ultrasound characteristics, surgical findings, surgical procedures, and torsion recurrence rates were analyzed and compared between the 2 groups between 2001 to 2020.
RESULTS
There was an inverse association between women's age and the risk of recurrent torsion (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.83-0.96, p = .003). Moreover, in women younger than 20 years, the risk of recurrent event was substantially higher (aOR, 5.0; 95% CI, 1.56-6.15, p = .007). In addition, the absence of ovarian pathology was associated with increased risk for recurrent torsion (aOR, 14.3; 95% CI, 6.15-33.42; p <.001). Oophoropexy was performed in 46 women in the study group. The risk of recurrent torsion after oophoropexy was 30%. A long duration of pain before admission was associated with oophoropexy failure (37.5 ± 6.3 hours vs 11.7 ± 6.0 hours, p = .003). No single fixation procedure was superior to the others in terms of therapeutic success.
CONCLUSION
Recurrent ovarian torsion is more common in young women with a normal-appearing ovary. Oophoropexy is a safe procedure with a risk of retorsion in 30% of the patients. We found no advantage for one fixation technique over the others.
Topics: Case-Control Studies; Female; Humans; Ovarian Diseases; Ovarian Torsion; Recurrence; Risk Factors; Torsion Abnormality
PubMed: 35577246
DOI: 10.1016/j.jmig.2022.05.007 -
Reproductive Sciences (Thousand Oaks,... Jun 2023The etiology of OT is largely unknown. Any predisposition to rotation of the infundibulopelvic ligament and utero-ovarian ligament should be considered a possible...
The etiology of OT is largely unknown. Any predisposition to rotation of the infundibulopelvic ligament and utero-ovarian ligament should be considered a possible etiology. Information with respect to ovarian torsion (OT) among pregnant is underreported and based on small studies. We aim to compare characteristics of confirmed OT to laparoscopies performed for the indication of suspected OT, in which no OT was found among pregnant women. This is a retrospective case-control study. We included pregnant women who underwent laparoscopy for a suspected OT between March 2011 and August 2020. Pregnant women with confirmed OT (torsion group) were compared to those without (no torsion group). There were 169 women with suspected OT. OT was confirmed in 140 (82.8%) women. There was higher proportion of assisted reproductive technology (ART) gestation in the torsion group [76 (54.3%) vs. 5 (17.2%), p < 0.001]. The rate of pregnant approaching evaluation within 8 h of symptoms onset was higher in the torsion group [57 (40.7%) vs. 2 (6.9%), p < 0.001]. The mean visual analogue score (VAS) was higher in the torsion group (8.5 vs. 7.1, p = 0.002). The mean pulse was lower in the torsion group (79 vs. 88 bpm, p < 0.001). From sonographic characteristics examined, the following was higher in the torsion group; mean maximal size of the ovary (70 mm in the torsion group vs. 54 mm in the no torsion group, p = 0.011). In a multivariable logistic regression analysis, number of hours of symptoms was negatively associated with AT [aOR, 95% CI 0.95 (0.91-0.98)] and pulse was negatively associated with OT [aOR, 95% CI 0.78 (0.63-0.95)]. Among the 29 cases in which no OT was found during laparoscopy, the following findings were noted: 16 (55.2%) no abnormality at all, 5 (17.2%) functional ovarian cyst, 2 (6.9%) mature teratoma and 6 cases of peritoneal adhesions (20.7%). The time from pain onset to approaching evaluation and women's pulse should be considered and acknowledged in the evaluation of OT during pregnancy.
Topics: Female; Humans; Pregnancy; Case-Control Studies; Ovarian Torsion; Retrospective Studies; Torsion Abnormality; Ovarian Cysts; Laparoscopy
PubMed: 36576712
DOI: 10.1007/s43032-022-01138-z -
International Journal of Surgery Case... Mar 2022Indirect inguinal hernia is one of the most common congenital anomaly common in males, but not uncommon in females. In females, inguinal hernia mostly indirect,...
INTRODUCTION
Indirect inguinal hernia is one of the most common congenital anomaly common in males, but not uncommon in females. In females, inguinal hernia mostly indirect, containing ovary presenting as a palpable labial mass is common, resulting in strangulation, torsion, and infertility if left untreated.
IMPORTANCE
The bell clapper deformity (BCD) is an important anatomical risk factor for intra vaginal testicular torsion, its presence in females is hardly been speculated.
CASE PRESENTATION
A 6 months female baby presenting with tender labial mass, its management has been discussed here.
CLINICAL DISCUSSION
The bell clapper deformity, in which the tunica vaginalis inserts high on the spermatic cord, leaving the testis free to rotate and get torted, however its presence in females has never been explored.
CONCLUSION
Bell clapper deformity's existence in females yet to be speculated before exploration.
PubMed: 35240485
DOI: 10.1016/j.ijscr.2022.106879 -
Innovative Surgical Sciences Dec 2021Ovarian lesions are rare but frequent in children. Patients could present with abdominal pain, but ovarian lesions could also be incidentally found on ultrasound....
OBJECTIVES
Ovarian lesions are rare but frequent in children. Patients could present with abdominal pain, but ovarian lesions could also be incidentally found on ultrasound. Awareness is required in cases with acute, severe lower abdominal pain, as ovarian torsion could be the cause. Other lesions can be cysts or benign or malignant ovarian tumors. Thus, the aim of this paper is to review typical ovarian lesions according to age, imaging and laboratory findings, and surgical management.
METHODS
We retrospectively analysed the patient charts of 39 patients aged 10.4 ± 6.1 years (from 3 months to 18 years) with ovarian lesions treated in our institution between 01/2009 and 08/2020. All clinical and pathological findings of infants and children operated on for ovarian lesions were included.
RESULTS
Ovarian lesions in children younger than 2 years of age were typically ovarian cysts, and ovarian tumors were not observed in this age group. In older children over 10 years of age, tumors were more common - with mostly teratoma or other germ cell tumors, followed by epithelial tumors. Moreover, acute or chronic ovarian torsion was observed in all age groups. In general, ovarian tumors were much larger in size than ovarian cysts or twisted ovaries and eventually showed tumor marker expression of AFP or ß-HCG. Simple ovarian cysts or twisted ovaries were smaller in size. Surgery for all ovarian lesions should aim to preserve healthy ovarian tissue by performing partial ovariectomy.
CONCLUSIONS
In adolescent girls with acute abdominal pain, immediate laparoscopy should be performed to rule out ovarian torsion. Careful imaging evaluation and the assessment of tumor markers should be performed in painless ovarian lesions to indicate an adequate surgical ovarian-sparing approach.
PubMed: 35937851
DOI: 10.1515/iss-2021-0006