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Clinical characteristics of adnexal torsion in premenarchal patients

  • General Gynecology
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Abstract

Purpose

To compare clinical characteristics of adnexal torsion in premenarchal patients as compared to postmenarchal ones.

Methods

A retrospective 22-year cohort of all cases of surgically verified adnexal torsion in premenarchal and postmenarchal patients (excluding postmenopausal and pregnant patients). Data collected included symptoms, signs and imaging at presentation, surgical mode, and procedure and histology.

Results

16 cases of adnexal torsion among premenarchal patients were compared to 302 cases among postmenarchal ones. Clinical presentation was similar, notable only for more nausea and vomiting among the premenarchal group. Ovarian cysts were more commonly demonstrated among postmenarchal patients (82.4 and 30.8 %, p < 0.001), as opposed to a normal adnexal appearance on ultrasound, which was more common in premenarchal patients (69.3 vs. 17.2 %, p < 0.001). Absent Doppler flow, when preformed, did not differ statistically between the groups. Laparoscopic detorsion only was more commonly performed in premenarchal patients (56.2 vs. 19.8 %, p = 0.001), with a trend for detorsion and cystectomy/fenestration, which were more common in postmenarchal surgeries (25 vs. 50.6 %, p = 0.06). Histology was similar among both groups, with no cases of malignancy in premenarchal patients.

Conclusion

Adnexal torsion in premenarchal patients is rare, presents similarly to older patients, but involves a normal adnexa in 69 % of cases, therefore requiring a high index of suspicion in any premenarchal patient with acute onset abdominal pain.

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References

  1. Schrager J, Robles G, Platz T (2012) Isolated fallopian tube torsion: a rare entity in a premenarcheal female. Am Surg 78(2):118–119

  2. Said MR, Bamigboye V (2008) Twisted paraovarian cyst in a young girl. J Obstet Gynaecol 28(5):549–550

    Article  CAS  PubMed  Google Scholar 

  3. Kiseli M, Caglar GS, Cengiz SD, Karadag D, Yilmaz MB (2012) Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations. Arch Gynecol Obstet 285(6):1563–1569

    Article  PubMed  Google Scholar 

  4. Hibbard LT (1985) Adnexal torsion. Am J Obstet Gynecol 152(4):456

    Article  CAS  PubMed  Google Scholar 

  5. Anteby SO, Schenker JG, Polishuk WZ (1975) The value of laparoscopy in acute pelvic pain. Ann Surg 181:484–486

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Guthrie BD, Alder MD (2010) Powell Ec. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000–2006. Pediatrics 125:532–538

    Article  PubMed  Google Scholar 

  7. McWilliams GD, Hill MJ, Dietrich CS 3rd (2008) Gynecologic emergencies. Surg Clin North Am 88(2):265–283

    Article  PubMed  Google Scholar 

  8. Chang YJ, Yan DC, Kong MS et al (2008) Adnexal torsion in children. Pediatr Emerg Care 24:534–537

    Article  PubMed  Google Scholar 

  9. Chapron C, Capella-Allouc S, Dubuisson JB (1996) Treatment of adnexal torsion using operative laparoscopy. Hum Reprod 11(5):998

    Article  CAS  PubMed  Google Scholar 

  10. Bouguizane S, Bibi H, Farhat Y et al (2003) Adnexal torsion: a report of 135 cases. J Gynecol Obstet Biol Reprod (Paris) 32:535–540

    CAS  Google Scholar 

  11. Sasaki KJ, Miller CE (2014) Adnexal torsion: review of the literature. J Minim Invasive Gynecol 21(2):196–202

    Article  PubMed  Google Scholar 

  12. Pansky M, Smorgick N, Herman A, Schneider, Halperin R (2007) Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol 109:355–359

  13. Kokoska ER, Keller MS, Weber TR (2001) Acute ovarian torsion in children. Am J Surg 180:462–465

    Article  Google Scholar 

  14. Celik A, Ergün O, Aldemir H, Ozcan C, Ozok G, Erdener A, Balýk E (2005) Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg 40(4):704

    Article  PubMed  Google Scholar 

  15. Germain M, Rarick T, Robins E (1996) Management of intermittent ovarian torsion by laparoscopic oophoropexy. Obstet Gynecol 88(4 Pt 2):715

    Article  CAS  PubMed  Google Scholar 

  16. Darrell L (2005) Ovarian torsion. Semin Pediatr Surg 14:86–92

    Article  Google Scholar 

  17. Huchon C, Fauconnier A (2010) Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 150(1):8–12 (Epub 2010 Feb 26)

    Article  PubMed  Google Scholar 

  18. Bharathan R, Ramsawak L, Kelly A (2012) Ovarian torsion: opportunities to improve clinical management. J Obstet Gynaecol 32(7):683–686

    Article  CAS  PubMed  Google Scholar 

  19. Rosseau V, Massicot R, Dwarish AA et al (2008) Emergency management and conservative surgery of ovarian torsion in children; a report of 40 cases. J Pediatr Adolesc Gynecol 21:201–206

    Article  Google Scholar 

  20. Shadinger L, Andreotti R, Kurian R (2008) Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 27:7–13

    PubMed  Google Scholar 

  21. Chang H, Bhatt S (2008) Radiographics. Pearls and pitfalls in diagnosis of ovarian torsion. 28:1355–1368

    Google Scholar 

  22. Bertolotto M, Serafini G, Toma P, Zappetti R, Migaleddu V (2008) Adnexal torsion. Ultrasound Clin 3:109–119

    Article  Google Scholar 

  23. Pena JE, Ufberg D, Cooney N, Denis AL (2000) Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 73:1047–1050

    Article  CAS  PubMed  Google Scholar 

  24. Ben-Ami M, Perlitz Y, Haddad S (2002) The effectiveness of spectral and color Doppler in predicting ovarian torsion. Eur J Obstet Gynecol Reprod Biol 104:64–66

    Article  PubMed  Google Scholar 

  25. Cohen SB, Weisz B, Seidman DS, Mashiach S, Lidor AL, Goldenberg M (2001) Accuracy of preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women. J Am Assoc Gynecol Laparosc 8:92–94

    Article  CAS  PubMed  Google Scholar 

  26. Bar-On S, Mashiach R, Stockheim D et al (2010) Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 93:2012–2015

    Article  PubMed  Google Scholar 

  27. Pansky M, Abargil A, Dreazaen E, Golan A, Bukovsky I, Herman A (2000) Conservative management of adnexal torsion in premenarchal girls. J Am Assoc Gynecol Lapar 7:121–124

    Article  CAS  Google Scholar 

  28. Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H (2003) Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 18(12):2599–2602

    Article  PubMed  Google Scholar 

  29. Cohen SB, Wattiez A, Seidman DS et al (2003) Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa. JSLS 7:295–299

    PubMed Central  PubMed  Google Scholar 

  30. Weitzman VN, DiLuigi AJ, Maier DB, Nulsen JC (2008) Prevention of recurrent adnexal torsion. Fertil Steril 90:2018.el–2018.e3

  31. Daemwood MD, Hesla HS, Lowen M, Schultz MJ (1990) Induction of ovulation and pregnancy following lateral oophoropexy for Hodgkin’s disease. Int J Gynecol Obstet 33:369–371

    Article  Google Scholar 

  32. Abes M, Sarihan H (2004) Oophoropexy in children with ovarian torsion. Eur J Pediatr Surg 14:168–171

    Article  CAS  PubMed  Google Scholar 

  33. Wang JH, Wu DH, Jin H, Wu YZ (2010) Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premanarchal girls. Eur J Pediatr Surg 20(5):298–301

    Article  PubMed  Google Scholar 

  34. Tsafrir Z, Azem F, Hasson J, Solomon E, Almog B, Nagar H, Lessing JB, Levin I (2012) Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center. J Minim Invasive Gynecol 19(1):29–33

    Article  PubMed  Google Scholar 

  35. Fuchs N, Smorgick N, Tovbin Y, Ben Ami I, Maymon R, Halperin R, Pansky M (2010) Oophoropexy to prevent adnexal torsion: how, when, and for whom? J Minim Invasive Gynecol 17(2):205–208

  36. Poonai N, Poonai C, Lim R, Lynch T (2013) Pediatric ovarian torsion: case series and review of the literature. Can J Surg 56(2):103–108

    Article  PubMed Central  PubMed  Google Scholar 

  37. Incebiyik A, Seker A, Camuzcuoglu H, Kocaslan S, Camuzcuoglu A, Hilali NG, Vural M, Taskin A, Aksoy N (2015) Does sildenafil have protective effects against ovarian ischemia-reperfusion injury in rats? Arch Gynecol Obstet 291(6):1283–1288

    Article  PubMed  Google Scholar 

  38. Cakir Gungor AN, Gencer M, Karaca T, Hacivelioglu S, Uysal A, Korkmaz F, Demirtas S, Cosar E (2014 ) The effect of hesperetin on ischemia-reperfusion injury in rat ovary. Arch Gynecol Obstet 290(4):763–769

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Halohamim 2, Holon, Israel

    Hadas Ganer Herman, Amir Shalev, Shimon Ginat, Ram Kerner, Ran Keidar, Jacob Bar & Ron Sagiv

  2. Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Tel Aviv, Israel

    Jacob Bar & Ron Sagiv

  3. 16, Lipski st., 6219520, Tel Aviv, Israel

    Hadas Ganer Herman

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  1. Hadas Ganer Herman
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  2. Amir Shalev
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  6. Jacob Bar
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Correspondence to Hadas Ganer Herman.

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Ganer Herman, H., Shalev, A., Ginat, S. et al. Clinical characteristics of adnexal torsion in premenarchal patients. Arch Gynecol Obstet 293, 603–608 (2016). https://doi.org/10.1007/s00404-015-3840-9

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  • DOI: https://doi.org/10.1007/s00404-015-3840-9

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