Predominant Etiology of Adnexal Torsion and Ovarian Outcome after Detorsion in Premenarchal Girls

Abstract

Background/Purpose: Consensus has not been reached regarding the treatment of ovarian torsion in premenarchal girls. If viable adnexa can be salvaged, the future reproductive potential of the girl is maximized. The authors determined the predominant etiology, evaluated the restoration of ovarian function and anatomic structure postoperatively in premenarchal girls with adnexal torsion, and discuss the most appropriate treatment.

Methods: Sixty-six premenarchal girls with twisted adnexa underwent salpingoophorectomy (27 cases), or detorsion and adnexal conservation surgery (39 cases), according to the extent of adnexal damage found intraoperatively. These patients’ data were collected and analyzed. The typical presentation, predominant etiology, surgical outcome, and restoration of ovarian function postoperatively were investigated.

Results: Of all torsive ovaries, histopathology verified that 2 (3.0%) cases were malignant, 8 (12.1%) cases were normal, and 56 (84.9%) cases were benign. After operation and menarche, ultrasound showed that the involved ovaries were of normal size with normal follicular development in 33 of the 35 (94.3%) patients who received detorsion and adnexal conservation surgery. In the remaining two (5.7%) of the 35 detorsion patients, the affected ovaries were atrophied (small sized) and there was no ultrasound evidence of follicular development.

Conclusions: Premenarchal girls with adnexal torsion more commonly had a benign ovarian tumor or no underlying abnormality as an etiology; ovarian malignancy was rare. In the management of these cases, detorsion and adnexal conservation surgery should be considered in cases with adnexa appearing to be ischemic or hemorrhagic infarction.

Key words

adnexal torsion - prepubertal girls - ovarian neoplasms

References

• 1 Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children.  Am J Surg. 2000;  180 462-465
• 2 Oelsner G, Bider D, Goldenberg M. et al . Long-term follow-up of the twisted ischemic adnexa managed by detorsion.  Fenil Steril. 1993;  60 976-979
• 3 Aziz D, Davis V, Allen L. et al . Ovarian torsion in children: is oophorectomy necessary?.  J Pediatr Surg. 2004;  39 750-753
• 4 Ghezzi F, Cromi A, Uccella S. et al . Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer.  Gynecol Oncol. 2007;  105 409-413
• 5 Shalev E, Bustan M, Yarom I. et al . Recovery of ovarian function after laparoscopic Detorsion.  Hum Reprod. 1995;  10 2965-2966
• 6 Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion.  J Ultras Med. 2004;  23 1643-1649
• 7 Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients.  Arch Pediatr Adolesc Med. 2005;  159 532-535
• 8 Stenchever MA, Drogemueller W, Herbst AL. et al . Comprehensive Gynecology.  4th ed. St Louis, MO: Mosby, Inc. 2001;  520-521
• 9 Özcan C, Celık A, özok G. et al . Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion.  J Pediatr Surg. 2002;  37 1617-1620
• 10 Grunewald B, Keating J, Brown S. Asynchronous ovarian torsion – the case for prophylactic oophoropexy.  Postgrad Med J. 1993;  69 318-319
• 11 Nagel TC, Sebashan J, malo JW. Oophoropexy to prevent sequential or recurrent torsion.  J Am Assoc Gynecol Laparosc. 1997;  4 495-498
• 12 Colhen Z, Shinhar D, Kopernik G. et al . The laparoscopic approach to uterine adnexal torsion in childhood.  J Pediatr Surg. 1996;  31 1557-1559
• 13 Sommerville M, Grimes DA, Koonings PP. et al . Ovarian neoplasms and the risk of adnexal torsion.  Am J Obstet Gynecol. 1991;  164 577-578
• 14 Mordehai J, Mares AJ, Barki Y. et al . Torsion of uterine adnexa in neonates and children: a report of 20 cases.  J Pediatr Surg. 1991;  26 1195-1199
• 15 Rody A, Jackisch C, Klockenbush W. et al . The conservative management of adnexal torsion the paraductal lipomas were resected: a case report and review of the literature.  Eur J Obstet Gynecol. 2002;  101 83-86
• 16 Celik A, Ergün O, Aldemir H. et al . Long-term results of conservative management of adnexal torsion in children.  J Pediatr Surg. 2005;  40 704-708
• 17 Oelsner G, Cohen SB, Soriano D. et al . Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function.  Hum Reprod. 2003;  18 2599-2602
• 18 Breech LL, Hillard PJA. Adnexal torsion in pediatric and adolescent girls.  Curr Opin Obstet Gynecol. 2005;  17 483-489
• 19 Kazez A, Ozel SK, Akpolat N. et al . The efficacy of conservative treatment for late term ovarian torsion.  Eur J Pediatr Surg. 2007;  17 110-114

Correspondence