Aim: The purpose of the study is to discuss about the presentation and management of adolescent adnexal torsion at ESIC Medical College and PGIMSR.
Materials and methods: This is a case series study of adolescents with adnexal torsion, from December 2019 to March 2022 at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India. Detailed history and clinical examination followed by ultrasonography with Doppler pelvis were done. The type of surgery and the histopathological findings were studied. Written informed consent was taken from all the subjects for publishing the data and images.
Results: All patients presented with acute onset of abdominal pain. Eight patients had vomiting. Six patients had right-sided torsion and four patients had left-sided torsion. Laparotomy was done for nine cases. A laparoscopy was done for one case. Only two patients underwent salpingo–oophorectomy due to necrotic changes. The ovary was preserved in eight patients. Two patients had oophoropexy done. One was for recurrent torsion and the other case had undue long ovarian ligament and fallopian tube.
Conclusion: Adnexal torsion is a gynecological emergency and requires early surgical intervention. Adnexal torsion in adolescents is usually due to benign functional ovarian cysts and benign teratoma. Malignant ovarian tumors are rare in the adolescent age-group. The goals of surgery are detorsion and preservation of the ovary regardless of its appearance at the time of surgery. Oophorectomy is required only when the ovary is severely necrotic and falls apart. Clinical Significance: Minimally invasive surgical approach with detorsion of adnexa and avoiding oophorectomy will lead to preservation of adnexal structures and their function.
American College of Obstetricians and Gynecologists. Adnexal torsion in adolescents. ACOG Committee Opinion No. 783. Obst Gynecol 2019;134:e56–e63. DOI: 10.1097/AOG.0000000000003373.
Ashwal E, Hiersch L, Krissi H, et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol 2015;126(3):514–520. DOI: 10.1097/AOG.0000000000000995.
Ngo AV, Otjen JP, Parisi MT, et al. Pediatric ovarian torsion: A pictorial review. Pediatric Radiol 2015;45:1845–1855. DOI: 10.1007/s00247-015-3385-x.
Aljohani M, Aljahany M, Elbasheer SY, et al. Premenarchal adolescent female ovarian torsion: A case of delayed diagnosis. Am J Case Rep 2021;22:e9322451–e9322455. DOI: 10.12659/AJCR.932245.
Melcer Y, Maymon R, Pekar–Zlotin M, et al. Clinical and sonographic predictors of adnexal torsion in pediatric and adolescent patients. J Pediatr Surg 2018;53(7):1396–1398. DOI: 10.1016/j.jpedsurg. 2017.07.011.
Julania S, Chown I, Gera S, et al. Management of adnexal torsion in the pediatric and adolescent population at western Australia's single tertiary children's hospital over the last 10 years: Retrospective study. J Minim Invasive Gynecol 2021;28(6):1183–1189. DOI: 10.1016/j.jmig.2020.09.004.
Durga K, Yasodha A, Yuvarajan S. Giant hemorrhagic ovarian cyst with torsion: Rare case report. Obstet Gynecol Cases Rev 2020;7:169. DOI: 10.23937/2377-9004/1410169.
Breech LL, Hillard PJA. Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet and Gynecol 2005;17(5):483–489. DOI: 10.1097/ 01.gco.0000179666.39548.78.
Huchon C, Staraci S, Fauconnier A. Adnexal torsion: A predictive score for pre-operative diagnosis. Hum Reprod 2010;25(9):2276–2280. DOI: 10.1093/humrep/deq173.
Shah AA, Likes CE, Price TM. Early polycystic ovary syndrome as a possible etiology of unexplained premenarcheal ovarian torsion. J Pediatr Adolesc Gynecol 2009;22(4):265–269. DOI: 10.1016/j.jpag.2008.11.005.
Mellor A, Grover S. Auto-amputation of the ovary and fallopian tube in a child. Aust N Z J Obstet and Gynaecol 2014;54(2):189–190. DOI: 10.1111/ajo.12172.
Abraham M, Keyser EA. Adnexal torsion in adolescents. Obstetr Gynecol 2019;134(2):E56–E63. DOI: 10.46405/ejms.v2i2.216.
Kurtoglu E, Kokcu A, Danaci M. Asynchronous bilateral ovarian torsion: A case report and mini review. J Pediatr Adolesc Gynecol 2014;27(3):122–124. DOI: 10.1016/j.jpag.2013.06.016.
Sasaki KJ, Miller CE. Adnexal torsion: Review of the literature. J Minim Invasive Gynecol 2014;21(2):196–202. DOI: 10.1016/j.jmig.2013.09.010.
Gerscovich EO, Corwin MT, Sekhon S, et al. Sonographic appearance of adnexal torsion, correlation with other imaging modalities, and clinical history. Ultrasound Q 2014;30(1):49–55. DOI: 10.1097/RUQ.0000000000000049.
Geimanaite L, Trainavicius K. Ovarian torsion in children: Management and outcomes. J Pediatr Surg 2013;48(9):1946–1953. DOI: 10.1016/j.jpedsurg.2013.04.026.
Idris S, Daud S, Sani NA, et al. A case of twisted ovarian cyst in a Young patient and review of the literature. Am J Case Rep 2021;22:e933438. DOI: 10.12659/AJCR.933438.
Lourenco AP, Swenson D, Tubbs RJ, et al. Ovarian and tubal torsion: Imaging findings on US, CT, and MRI. Emerg Radiol 2014;21:(2)179–187. DOI: 10.1007/s10140-013-1163-3.
Appelbaum H, Abraham C, Choi–Rosen J, et al. Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol 2013;26(3):167–170. DOI: 10.1016/j.jpag.2012.12.005.
Bardin R, Perl N, Mashiach R, et al. Prediction of adnexal torsion by ultrasound in women with acute abdominal pain. Ultraschall Med 2020;41(6):688–694. DOI: 10.1055/a-1014-2593.
Iraha Y, Okada M, Iraha R, et al. CT and MR imaging of gynecologic emergencies. Radiographics 2017;37(5):1569–1586. DOI: 10.1148/rg.2017160170.
Al Jama FE, Al Ghamdi AA, Gasim T, et al. Ovarian tumors in children and adolescents: A clinical study of 52 patients in a university hospital. J Pediatr Adolesc Gynecol 2011;24(1)25–28. DOI: 10.1055/a-1014-2593.
Mashiach R, Melamed N, Gilad N, et al. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med 2011;30(9):1205–1210. DOI: 10.7863/jum.2011.30.9.1205.
Yilmaz M, Cimilli G, Saritemur M, et al. Diagnostic accuracy of neutrophil/lymphocyte ratio, red cell distribution width and platelet distribution width in ovarian torsion. J Obstet Gynaecol 2016;36(2):218–222. DOI: 10.3109/01443615.2015.1049989.
Ercan Ö, Köstü B, Bakacak M, et al. Neutrophil to lymphocyte ratio in the diagnosis of adnexal torsion. Int J Clin Exp Med 2015;8(9):16095–16100. PMID: 26629118.
Kives S, Gascon S, Dubuc E, et al. Diagnosis and management of adnexal torsion in children, adolescents, and adults. J Obstet Gynaecol Can 2017;39(2):82–90. DOI: 10.1016/j.jogc.2016.10.001.
Fuchs N, Smorgick N, Tovbin Y, et al. Oophoropexy to prevent adnexal torsion: How, when, and for whom? J Minim Invasive Gynecol 2010;17(2):205–208. DOI: 10.1016/j.jmig.2009.12.011.
Bertozzi M, Magrini E, Bellucci C, et al. Recurrent ipsilateral ovarian torsion: Case report and literature review. J Pediatr Adolesc Gynecol 2015;28(6):e197–e201. DOI: 10.1016/j.jpag.2015.06.007.