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Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population

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Abstract

Ovarian torsion is rare in the pediatric population. Delayed diagnosis can significantly impact fertility. The aim of this review is to highlight current knowledge regarding clinical presentation, diagnosis, surgical management, and follow-up in the pediatric population. Whilst the presentation is often very unspecific, most children will present with sudden severe unilateral pelvic pain associated with vomiting. A key diagnostic test is pelvic ultrasonography, which may help demonstrate an asymmetric enlarged ovary with peripherally displaced follicles. In the pediatric population, ovarian torsion may occur in a normal ovary. However, underlying lesions can be found in half of cases. Benign neoplasms (teratomas or cystic lesions) represent the commonest etiology, with the risk of malignancy being less than 2%. Surgical management should be focused on fertility preservation. This is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence. Follow-up studies demonstrate excellent recovery rates of detorsed ovaries including those with ischemic appearances.

What is Known:

• Ovarian torsion is a rare diagnosis in the pediatric population.

• Aspecific symptoms and differential diagnoses lead to missed or delayed diagnosis increasing the risk of oophoprectomy and further infertility.

What is New:

• Reviewing the latest knowledge about clinical presentation, diagnostic, surgical management, and follow-up of ovarian torsion in the pediatric population.

• Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.

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Abbreviations

PED:

Pediatric emergency department

US:

Ultrasonography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

AMH:

Anti-Mullerian hormone

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Authors and Affiliations

  1. Department of Pediatric Emergency Care, APHP - Hôpital Robert Debré, 48 Boulevard Serurier, 75019, Paris, France

    Alexandra Tielli, Luigi Titomanlio & Léa Lenglart

  2. Department of Abdominal Surgery, NHS, Guildford, UK

    Andrea Scala & Nicholas Farkas

  3. Department of Pediatric Radiology, APHP - Hôpital Robert Debré, Paris, France

    Marianne Alison & Van Dai Vo Chieu

  4. NeuroDiderot, Inserm U1141, Equipe 5 inDev - Imaging Neurodevelopmental Phenotypes, HU I2D2, 75019, Paris, France

    Marianne Alison

  5. Paris University, INSERM U1141, DHU Protect, Paris, France

    Luigi Titomanlio

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  1. Alexandra Tielli
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  2. Andrea Scala
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Contributions

Alexandra Tielli conceptualized the review, wrote the original draft and edited the manuscript. Andrea Scala, Nicholas Farkas, and Marianne Alison investigated the literature and reviewed the manuscript. Van Dai Vo Chieu investigated the literature, wrote the original draft, and reviewed the manuscript. Luigi Titomanlio conceptualized the methodology of the review and reviewed and edited the manuscript. Léa Lenglart conceptualized the review, investigated the literature, and wrote the original draft of the manuscript. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Léa Lenglart.

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Tielli, A., Scala, A., Alison, M. et al. Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population. Eur J Pediatr 181, 1405–1411 (2022). https://doi.org/10.1007/s00431-021-04352-0

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