To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.
Multicenter retrospective cohort study.
Italian Units of Pediatric Surgery.
Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014.
Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively.
Main Outcome Measures
A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries.
Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00).
Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric and Adolescent Gynecology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Surgical lesions of the ovary in infancy and childhood.Surg Gynecol Obstet. 1975; 141: 219
- Ovarian torsion.Semin Pediatr Surg. 2005; 14: 86
- Asynchronous bilateral ovarian torsion.J Pediatr Surg. 2004; 39: 746
- Acute ovarian torsion in children.Am J Surg. 2000; 180: 462
- Adnexal torsion in very young girls: diagnostic pitfalls.Eur J Obstet Gynecol Reprod Biol. 2004; 116: 207
- Adnexal torsion in children.J Pediatr Surg. 1989; 24: 974
- Torsion of uterine adnexa in neonates and children: a report of 20 cases.J Pediatr Surg. 1991; 26: 1195
- Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period.J Pediatr Surg. 2001; 36: 693
- Ovarian torsion in children: is oophorectomy necessary?.J Pediatr Surg. 2004; 39: 750
- Urgency of evaluation and outcome of acute ovarian torsion pediatric patients.Arch Pediatr Adolesc Med. 2005; 159: 532
- Conservative management of adnexal torsion. A case-report and review of the literature.Eur J Obstet Gynecol Reprod Biol. 2002; 101: 83
- Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion.J Pediatr Surg. 2002; 37: 1617
- Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center.J Minim Invasive Gynecol. 2012; 19: 29
- Adnexal torsion in pediatric and adolescent girls.Curr Opin Obstet Gynecol. 2005; 17: 483
- The diagnosis and management of ovarian cysts in children.J Pediatr Adolesc Gynecol. 2013; (http://dx.doi.org/10.1016/j.jpag.2013.01.061, in press)
- Ovarian torsion: to pex or not to pex? Case report and review of the literature.J Pediatr Adolesc Gynecol. 2003; 16: 381
- Oophoropexy, hyperbaric oxygen therapy, and contrast-enhanced ultrasound after asynchronous bilateral ovarian torsion.J Pediatr Surg. 2008; 43: 1380
- Uterine adnexal torsion with subsequent contralateral recurrence.J Reprod Med. 1980; 25: 123
- Neonatal ovarian torsion.Am J Dis Child. 1982; 136: 945
- Ovarian suspension in massive ovarian edema.Obstet Gynecol. 1990; 76: 912
- Recurrent ovarian torsion in a premenarchal adolescent girl: contemporary surgical management.Obstet Gynecol. 2009; 114: 422
- Preoperative sonographic and clinical characteristics as predictors of ovarian torsion.J Ultrasound Med. 2008; 27: 7
- Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases.J Pediatr Adolesc Gynecol. 2008; 21: 201
- Sonographic findings of ovarian torsion in children.Pediatr Radiol. 2007; 37: 446
- Bilateral torsion of the adnexa: a case report and a review of the world literature.Obstet Gynecol. 1984; 64: 55S
- The torsion of tubal enlargements with special reference to pyosalpinx.Am J Obstet Gynecol. 1912; 66: 553
- Torsion of normal uterine adnexa in children. Report of three cases.Obstet Gynecol. 1970; 35: 226
- Torsion of the normal uterine adnexa in premenarchal girls.J Pediatr Surg. 1978; 13: 195
- Ovarian torsion. Management and ovarian prognosis: a report of 45 cases.J Pediatr Surg. 2009; 44: 1759
- Ovarian torsion in children: management and outcomes.J Pediatr Surg. 2013; 48: 1946
- Recurrent ipsilateral ovarian torsion: case report and literature review.J Pediatr Adolesc Gynecol. 2015; 28: e197
- High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa.Fertil Steril. 2016; 105: 1561
- Long-term results of conservative management of adnexal torsion in children.J Pediatr Surg. 2005; 40: 704
- OPY in children with ovarian torsion.Eur J Pediatr Surg. 2004; 14: 168
- Management of intermittent ovarian torsion by laparoscopic oophoropexy.Obstet Gynecol. 1996; 88: 715
- “Habitual adnexal torsions”–recurrence after two oophoropexies in a prepubertal girl: a case report and review of the literature.J Pediatr Adolesc Gynecol. 2013; 26: e81
- Torsion of normal adnexa in postmenarchal women and risk of recurrence.Obstet Gynecol. 2007; 109: 355
- Oophoropexy to prevent adnexal torsion: how, when, and for whom?.J Minim Invasive Gynecol. 2010; 17: 205
- Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence.Eur J Obstet Gynecol Reprod Biol. 2012; 162: 203
- Repeated ovariopexy failure in recurrent adnexal torsion: combined approach and review of the literature.Eur J Obstet Gynecol Reprod Biol. 2013; 170: 305
Published online: November 25, 2016
The authors indicate no conflicts of interest.
© 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.