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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 -
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 -
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 -
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 -
Revista de La Facultad de Ciencias... Dec 2023The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging...
The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging since both symptoms and physical examination are nonspecific. In most cases, the patient presents abdominal pain, followed by nausea and vomiting. Imaging tests, such as ultrasound, are very useful to elucidate the cause of the symptoms in those patients.
Topics: Female; Humans; Ovarian Torsion; Cysts; Abdominal Pain
PubMed: 38150207
DOI: 10.31053/1853.0605.v80.n4.40830 -
International Journal of Surgery Case... Jul 2022Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and...
INTRODUCTION AND IMPORTANCE
Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and pulmonary type (SCCOPT).
CASE PRESENTATION
A 23 years old girl was admitted to the emergency room with the presentation of acute abdomen. The ultrasound and Magnetic resonance imaging revealed a right adnexal huge mass with adnexal torsion. In laparotomy, she underwent unilateral salpingo-oophorectomy due to ovarian torsion and possible malignancy. The histopathological evaluation was challenging and was finalized by a team of pathologists as hypercalcemic small cell carcinoma. She refused reoperation and unfortunately relapsed during chemotherapy and died 6 months after the initial diagnosis.
CLINICAL DISCUSSION
Conclusion: We do not yet have comprehensive information on small cell ovarian cancer. Cytopathology diagnosis is still challenging and the treatments are not usually effective. Further clinical trials and studies are recommended to find appropriate treatments for these patients.
PubMed: 35797874
DOI: 10.1016/j.ijscr.2022.107337 -
Biomedicines Sep 2023Polycystic ovary syndrome (PCOS) constitutes the most prevalent endocrine disorder in women of reproductive age worldwide. Given the increased risk of ovarian torsion in... (Review)
Review
Polycystic ovary syndrome (PCOS) constitutes the most prevalent endocrine disorder in women of reproductive age worldwide. Given the increased risk of ovarian torsion in the presence of large ovarian cysts, polycystic ovarian syndrome could be regarded as one of the most significant risk factors for ovarian and/or adnexal torsion in cases of significantly enlarged ovaries. The aim of the present review is to investigate, for the first time, the association between polycystic ovarian syndrome and ovarian torsion. We performed a review of the literature using the MEDLINE and LIVIVO databases in order to find relevant studies. By using the search terms "polycystic ovarian syndrome" and "ovarian torsion", we were able to identify 14 studies published between 1995 and 2019. The present work constitutes the most up-to-date, comprehensive literature review focusing on the risk of ovarian/adnexal torsion in patients with polycystic ovaries. Ovarian/adnexal torsion seems to be a feared complication in patients with polycystic ovary syndrome. Acute lower abdominal pain in patients with known polycystic ovaries represents the most common symptom, while diagnostic assessment almost always incorporates transvaginal ultrasound and computer tomography or magnetic resonance tomography scans. In case of suspected torsion, emergency laparoscopy with ovarian or adnexal detorsion seems to be the standard therapeutic approach with a view to restitute the interrupted blood supply. In cases of repeated ovarian/adnexal torsions, ovariopexy or ovariectomy/adnexectomy had to be discussed with the patient in the context of risk recurrence minimization.
PubMed: 37760944
DOI: 10.3390/biomedicines11092503 -
Journal of Minimally Invasive Gynecology Feb 2022To quantitatively evaluate the blood flow in ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess the use of ICGA as...
STUDY OBJECTIVE
To quantitatively evaluate the blood flow in ovaries (ischemic ovaries) that underwent torsion using indocyanine green angiography (ICGA) and assess the use of ICGA as an indicator for functional preservation of the ovaries.
DESIGN
In vivo animal study.
SETTING
The University of Yamanashi Animal Experimentation Center.
SUBJECTS
Eighteen female Wistar albino rats.
INTERVENTIONS
As an alternative to ovarian torsion, we occluded an ovary in each rat for 24 hours, after which we performed ICGA before and after releasing ischemia and extracted the following 8 parameters: F (maximum F value before releasing ischemia); T (time taken from the onset of an increase in F to reaching F); T (time taken from the onset of an increase in F to reaching half of F); slope (F/T); time ratio (T/T); F' (maximum F value after releasing ischemia); reperfusion rate (F'/F); and reperfusion gap (F' - F). Four weeks later, we counted the total number of primordial and primary follicles and classified the rats into functional and nonfunctional groups.
MEASUREMENTS AND MAIN RESULTS
On the basis of the total number of primordial and primary follicles, 13 rats had "functional" ovaries on the clamped side, and 5 rats had "nonfunctional" ovaries. The area under the curve values for each parameter were as follows: F, 0.908; T, 0.569; T, 0.546; time ratio, 0.746; slope, 0.877; F', 0.723; reperfusion rate, 0.938; and reperfusion gap, 0.862.
CONCLUSION
ICGA can be used to quantitatively evaluate ovaries that have been subjected to ischemia, and the magnitude of fluorescence intensity can be an excellent predictor of ovarian necrosis. Quantifying the degree of reperfusion immediately after the release of ischemia can be an equally excellent predictor of necrosis.
Topics: Angiography; Animals; Female; Humans; Indocyanine Green; Ovarian Diseases; Ovarian Torsion; Rats; Rats, Wistar; Reperfusion Injury; Torsion Abnormality
PubMed: 34375741
DOI: 10.1016/j.jmig.2021.08.003 -
Journal of Ovarian Research Jan 2023Ovarian absence is an uncommon condition that most frequently presents unilaterally. Several etiologies for the condition have been proposed, including torsion, vascular... (Review)
Review
Ovarian absence is an uncommon condition that most frequently presents unilaterally. Several etiologies for the condition have been proposed, including torsion, vascular accident, and embryological defect. A systematic review was conducted to describe the clinical presentation of ovarian absence, as well as its associations with other congenital anomalies, through a systematic search of Cochrane Library, ClinicalTrials.gov, Google Scholar, Ovid Embase, Ovid Medline, PubMed, Scopus, and Web of Science. Exclusion criteria included cases with suspicion for Differences of Sex Development, lack of surgically-confirmed ovarian absence, and karyotypes other than 46XX. Our search yielded 12,120 citations, of which 79 studies were included. 10 additional studies were found by citation chasing resulting in a total 113 cases including two unpublished cases presented in this review. Abdominal/pelvic pain (30%) and infertility/subfertility (19%) were the most frequent presentations. Ovarian abnormalities were not noted in 28% of cases with pre-operative ovarian imaging results. Approximately 17% of cases had concomitant uterine abnormalities, while 22% had renal abnormalities. Renal abnormalities were more likely in patients with uterine abnormalities (p < 0.005). Torsion or vascular etiology was the most frequently suspected etiology of ovarian absence (52%), followed by indeterminate (27%) and embryologic etiology (21%). Most cases of ovarian absence are likely attributable to torsion or vascular accidents, despite many references to the condition as "agenesis" in the literature. Imaging may fail to correctly diagnose ovarian absence, and diagnostic laparoscopy may be preferable in many cases as genitourinary anatomy and fertility considerations can be assessed during the procedure. Fertility is likely minimally or not affected in women with unilateral ovarian absence.
Topics: Humans; Female; Urogenital Abnormalities; Ovary; Uterus
PubMed: 36642704
DOI: 10.1186/s13048-022-01090-1 -
Cureus Dec 2022Ovarian torsion is a rare, emergent occurrence seen in the premenarchal population. If detected promptly, ovarian torsion can be treated via detorsion. We present a case...
Ovarian torsion is a rare, emergent occurrence seen in the premenarchal population. If detected promptly, ovarian torsion can be treated via detorsion. We present a case of a three-year-old girl whose ovary spontaneously torsed and was corrected via ovarian detorsion. The patient presented with sudden-onset abdominal pain and emesis; a transabdominal ultrasound with Doppler was performed, which led to the diagnosis of ovarian torsion. The patient was directly taken into surgery for correction, after which she quickly recovered and was subsequently discharged. The choice of ovarian detorsion to protect fertility in pediatric patients is supported by this case and by the related literature. The key to safeguarding fertility in these patients lies in rapid detection, which remains a challenge in the pediatric population. By raising widespread awareness of the use of Doppler ultrasound as well as symptom presentation, the protection of fertility in cases of pediatric ovarian torsion can be improved.
PubMed: 36601187
DOI: 10.7759/cureus.32132