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BMJ Case Reports May 2020A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested... (Review)
Review
A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested which demonstrated a large complex midline mass. The most likely diagnosis was ovarian torsion, for which the patient underwent laparoscopy, detorsion and ovarian cystectomy. Histology revealed a mature cystic teratoma. Although less common than in the adult population, it is important to consider ovarian torsion in children and adolescents. Presentation is usually with pain accompanied by vomiting and fever, although these symptoms are not always present. Current management is organ-sparing, with laparoscopy±cystectomy. We discuss the adaptations for this procedure with regard to the paediatric and adolescent population. Differences in the anatomy and physiology must lead to consideration for alterations in surgical technique and positioning to ensure the safest and best quality care for these young patients.
Topics: Child; Diagnosis, Differential; Female; Humans; Laparoscopy; Ovarian Neoplasms; Ovarian Torsion; Teratoma
PubMed: 32404320
DOI: 10.1136/bcr-2019-232610 -
Children (Basel, Switzerland) Jun 2023Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and... (Review)
Review
Most abdominal masses in the pediatric population derive from the ovaries. Ovarian masses can occur in all ages, although their incidence, clinical presentation and histological distribution vary among different age groups. Children and adolescents may develop non-neoplastic ovarian lesions, such as functional cysts, endometrioma, torsion, abscess and lymphangioma as well as neoplasms, which are divided into germ cell, epithelial, sex-cord stromal and miscellaneous tumors. Germ cell tumors account for the majority of ovarian neoplasms in the pediatric population, while adults most frequently present with epithelial tumors. Mature teratoma is the most common ovarian neoplasm in children and adolescents, whereas dysgerminoma constitutes the most frequent ovarian malignancy. Clinical manifestations generally include abdominal pain, palpable mass, nausea/vomiting and endocrine alterations, such as menstrual abnormalities, precocious puberty and virilization. During the investigation of pediatric ovarian masses, the most important objective is to evaluate the likelihood of malignancy since the management of benign and malignant lesions is fundamentally different. The presence of solid components, large size and heterogenous appearance on transabdominal ultrasonography, magnetic resonance imaging and computed tomography indicate an increased risk of malignancy. Useful tumor markers that raise concern for ovarian cancer in children and adolescents include alpha-fetoprotein, lactate dehydrogenase, beta subunit of human chorionic gonadotropin, cancer antigen 125 and inhibin. However, their serum levels can neither confirm nor exclude malignancy. Management of pediatric ovarian masses needs to be curative and, when feasible, function-preserving and minimally invasive. Children and adolescents with an ovarian mass should be treated in specialized centers to avoid unnecessary oophorectomies and ensure the best possible outcome.
PubMed: 37508611
DOI: 10.3390/children10071114 -
BMC Pediatrics Aug 2023Prader-Willi syndrome (PWS) is a genetic disorder involving multiple systems, with an incidence of about 1/10000-25000. Ovarian torsion (OT) is not commonly found in...
BACKGROUND
Prader-Willi syndrome (PWS) is a genetic disorder involving multiple systems, with an incidence of about 1/10000-25000. Ovarian torsion (OT) is not commonly found in children. Ovarian cyst acts as one of the primary factors resulting in OT. While ovarian cyst torsion with Prader-Willi Syndrome has not been reported before.
CASE PRESENTATION
A 12-years old female was admitted to Emergency Department of our hospital with the chief complaint of abdominal pain. The outcomes of physical examination revealed the height of 150 cm, weight of 103 kg, BMI of 45.77 kg/m. The patient manifested the special facial features, an obese body, with the abdomen distended into a spherical shape. The fat accumulation in the abdomen significantly embarrassed the palpation. The abdominal CT scan indicated a huge cystic mass in the abdominal cavity, sized about 138 mm × 118 mm. According to medical history, the patient was born with low crying and hypotonia, who has developed the uncontrollable eating behavior since 3-years old. These abnormalities led to a speculation of PWS syndrome, so a genetic test was performed and finally confirmed it, concluding a torsion of ovarian cyst with PWS. With the multidisciplinary consultation, a careful treatment strategy containing the control of blood pressure and blood sugar, coenzyme Q10 was administrated to nourish the myocardium and the application of Growth Hormone was developed. All the above preoperative treatments have brought great benefits to patients. Thus promising the successful completion of operation. The postoperative follow-up till now indicated that the abdominal incision was well healed, without operative complications.
CONCLUSIONS
This may be the first case report. In the treatment of ovarian cyst torsion, PWS syndrome requires fully consideration, as the latter can lead to multisystem abnormalities, especially the relation to perioperative management, and even fatalities. Genetic testing should be conducted early when PWS was suspected, accompanied with adequate preparation for the perioperative period, the follow-ups of patients should be maintained for a long time after surgery.
Topics: Humans; Female; Child; Ovarian Cysts; Prader-Willi Syndrome; Abdominal Pain; Muscle Hypotonia; Obesity; Human Growth Hormone
PubMed: 37553631
DOI: 10.1186/s12887-023-04223-7 -
Ginekologia Polska 2020This study aims to analyze the conditions of ovarian preservation during adnexal torsion surgery, and safety of ovarian preservation.
OBJECTIVES
This study aims to analyze the conditions of ovarian preservation during adnexal torsion surgery, and safety of ovarian preservation.
MATERIAL AND METHODS
A retrospective analysis of 130 patients, who underwent surgery for ovarian benign tumor pedicle torsion in Fujian Provincial Maternal and Child Health Hospital from June 2013 to June 2018, was conducted. This study analyses the possible risk factors affecting the operation method using multiple logistic regression and analyses the complications and the recovery of ovarian function after the treatment of the ovarian preservation.
RESULTS
Among these patients, 58 received ovarian cystectomy, while 72 received ovariectomy. There was no significant difference in terms of age, preoperative blood, operation time and surgical bleeding volume between the two groups (p > 0.05). However, there was a significant difference in preoperative adnexal blood flow, abdominal pain to the surgical interval, and a collection of torsion cycles (p < 0.05). There was an increased risk of ovarian resection in patients whose blood flow of the annex disappeared, whose time of abdominal pain was long, and whose number of twists were significant. For the preservation group, there were no increases in postoperative complications.
CONCLUSIONS
According to clinical indicators, such as preoperative adnexal blood flow, abdominal pain to the interval of surgery and the number of torsion cycles, it was determined whether it was feasible to keep the ovary. Retaining the ovary is safe, effective and feasible in adnexal torsion.
Topics: Adnexal Diseases; Adolescent; Adult; Child; Female; Fertility Preservation; Humans; Japan; Middle Aged; Ovarian Torsion; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Young Adult
PubMed: 32495934
DOI: 10.5603/GP.2020.0066 -
Wideochirurgia I Inne Techniki... Sep 2020Paediatric and adolescent gynaecology is a narrow field of medicine dealing with the diagnosis of and treatment of gynaecological diseases from the neonatal period to... (Review)
Review
Paediatric and adolescent gynaecology is a narrow field of medicine dealing with the diagnosis of and treatment of gynaecological diseases from the neonatal period to sexual maturity. The current trend in surgical gynaecology in the paediatric population is to minimise the degree of invasiveness of diagnostic and therapeutic procedures. This contributes to reducing the number of complications and the risk of infertility. Laparoscopic procedures are a challenge for paediatric surgeons and gynaecologists, not only because of the age of treated patients, and anatomical and physiological differences between different age groups but also because of the complexity of the pathology, the differentiation of cancer tumours, and the presence of congenital developmental defects.
PubMed: 32904632
DOI: 10.5114/wiitm.2020.97817 -
Journal of Minimally Invasive Gynecology Feb 2022To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of...
STUDY OBJECTIVE
To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery.
DESIGN
Retrospective nested case-control study.
SETTING
Large urban medical system.
PATIENTS
Eighty-nine female patients ages 17 to 51.
INTERVENTIONS
Patients underwent ovarian-sparing hysterectomy.
MEASUREMENTS AND MAIN RESULTS
The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic or laparoscopic-assisted approach to hysterectomy vs any other approach (odds ratio [OR], 3.36; 95% confidence interval [CI], 0.86-13.23); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR, 3.45; 95% CI, 1.33-8.97); and a gynecologic history significant for endometriosis (OR, 4.07; 95% CI, 1.04-15.88).
CONCLUSION
There is an association between laparoscopic approach to hysterectomy, younger age at time of hysterectomy, and a history of endometriosis with subsequent risk of adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.
Topics: Adnexal Diseases; Adolescent; Adult; Case-Control Studies; Female; Humans; Hysterectomy; Laparoscopy; Middle Aged; Ovarian Torsion; Retrospective Studies; Risk Factors; Young Adult
PubMed: 34400354
DOI: 10.1016/j.jmig.2021.08.006 -
Cureus Feb 2024Uterine torsion is defined as torsion of the uterus along its longitudinal axis greater than 45 degrees. It is observed in all age groups of the reproductive period, in... (Review)
Review
Uterine torsion is defined as torsion of the uterus along its longitudinal axis greater than 45 degrees. It is observed in all age groups of the reproductive period, in all parity groups, and at all stages of pregnancy. Torsion from 60 degrees to 720 degrees has been described. It is not possible to clarify why it occurs, but numerous abnormalities have appeared with uterine torsion. It is a rare complication that can result in placental abruption and intrauterine foetal death. Pregnancy, giant fibroids, and ovarian cysts are among the most common causes. Vague clinical attributes make diagnosis challenging pre-operatively and can be missed on routine ultrasound. Being a rare life-threatening condition, it necessitates a high level of concern for diagnosis and prompt intervention to optimise results. This review will help the healthcare worker to understand the various presentation of uterine torsion and their management by appropriately and timely diagnosing it.
PubMed: 38533137
DOI: 10.7759/cureus.54839 -
Radiologia Brasileira 2019Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular...
Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic "whirlpool sign". The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.
PubMed: 32047334
DOI: 10.1590/0100-3984.2018.0079 -
Revista Da Associacao Medica Brasileira... May 2022This study aimed to evaluate the feasibility of texture analysis on T2-weighted axial images in differentiating affected and nonaffected ovaries in ovarian torsion.
OBJECTIVE
This study aimed to evaluate the feasibility of texture analysis on T2-weighted axial images in differentiating affected and nonaffected ovaries in ovarian torsion.
METHODS
We included 22 torsioned ovaries and 19 healthy ovaries. All patients were surgically proven ovarian torsion cases. On T2-weighted axial images, ovarian borders were delineated by the consensus of two radiologists for magnetic resonance imaging-based texture analysis. Statistical differences between texture features of affected and nonaffected ovaries were assessed.
RESULTS
A total of 44 texture features were extracted from each ovary using LIFEx software. Of these, 17 features were significantly different between affected and nonaffected ovaries in ovarian torsion. NGLDM_Coarseness and NGLDM_Contrast, which are the neighborhood gray-level difference matrix parameters, had the largest area under the curve: 0.923. The best cutoff values for the NGLDM_Contrast and NGLDM_Coarseness were 0.45 and 0.01, respectively. With these cutoff levels, NGLDM_Contrast had the best accuracy (85.37%).
CONCLUSION
Magnetic resonance imaging-based texture analysis on axial T2-weighted images may help differentiate affected and nonaffected ovaries in ovarian torsion.
Topics: Female; Humans; Magnetic Resonance Imaging; Ovarian Torsion; Retrospective Studies
PubMed: 35584489
DOI: 10.1590/1806-9282.20211369 -
Clinical Case Reports Nov 2023Isolated utero-ovarian torsion poses a challenge to diagnosing adnexal torsion, as it may not present with imaging findings. Clinicians with high suspicion for torsion...
KEY CLINICAL MESSAGE
Isolated utero-ovarian torsion poses a challenge to diagnosing adnexal torsion, as it may not present with imaging findings. Clinicians with high suspicion for torsion but lack of evidence on ultrasonography should proceed to diagnostic laparoscopy.
ABSTRACT
Adnexal torsion occurs when the ovary rotates around its supporting ligaments, the infundibulopelvic and utero-ovarian (UO) ligaments, often causing disruption of blood supply. This pathology often presents with acute pelvic pain and is a gynecologic surgical emergency. Diagnosis is typically made with Doppler ultrasound, although dual blood supply to the ovary poses additional diagnostic challenges and sensitivity of this tool is debated. In this case study, we present a case of missed torsion due to isolated compromise of UO ligament.
PubMed: 37908789
DOI: 10.1002/ccr3.8114