Pediatric Ovarian Torsion in an 8-year Old Girl; A Case Report Study
Pediatric OT; Symptoms and Operative Managements
DOI:
https://doi.org/10.31661/gmj.v13i.3060Keywords:
Pediatrics; Ovarian Torsion; Laparotomy; Conservative SurgeryAbstract
Background: Ovarian torsion in children causes abdominal pain. The clinical symptoms resemble other abdominal diseases, such as appendicitis. It happens when the ovary twists on its ligamentous attachment, which stops blood from getting to the ovary. A fast diagnosis accompanied by a high level of clinical suspicion and immediate surgical intervention is obligatory to save the ovaries and avoid complications. Case Presentation: In this case study, we describe a case of ovarian torsion in an 8-year-old Iranian girl who came with persistent (non-colicky) right-side abdominal pain. After ultrasonographic examinations, she was identified with an enlarged heterogeneous right ovary indicative of ovarian torsion and underwent emergency laparotomy without oophorectomy. Conclusion: It may be challenging to determine the source of abdominal pain in pediatric patients, due to factors such as insufficiently comprehensive medical histories and examinations, limitations in con-ducting radiological procedures, as well as the comparatively diminished specificity of results in contrast to adult populations. If torsion is confirmed by ultrasonography, detorsion with\ without oophorectomy is advised for conservative treatment. This article presents a case study and a brief examination of the issues and complications associated with the identification and management of pediatric ovarian torsion.
References
Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics. 2010;125(3):532-8.
https://doi.org/10.1542/peds.2009-1360
PMid:20123766
Poonai N, Poonai C, Lim R, Lynch T. Pediatric ovarian torsion: case series and review of the literature. Can J Surg. 2013;56(2):103-8.
https://doi.org/10.1503/cjs.013311
PMid:23351494 PMCid:PMC3617114
Ochsner TJ, Roos JA, Johnson AS, Henderson JL. Ovarian torsion in a three-year-old girl. J Emerg Med. 2010;38(4):e27-30.
https://doi.org/10.1016/j.jemermed.2008.05.018
PMid:19038519
Rody A, Jackisch C, Klockenbusch W, Heinig J, Coenen-Worch V, Schneider HPG. The conservative management of adnexal torsion--a case-report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):83-6.
https://doi.org/10.1016/S0301-2115(01)00518-8
PMid:11803106
Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007;37(5):446-51.
https://doi.org/10.1007/s00247-007-0429-x
PMid:17357806
Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion--a 15-year review. J Pediatr Surg. 2009;44(6):1212-6.
https://doi.org/10.1016/j.jpedsurg.2009.02.028
PMid:19524743
Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152(4):456-61.
https://doi.org/10.1016/S0002-9378(85)80157-5
PMid:4014339
Dunnihoo DR, Wolff J. Bilateral torsion of the adnexa: a case report and a review of the world literature. Obstet Gynecol. 1984;64(3 Suppl):55S-59S.
https://doi.org/10.1097/00006250-198409001-00015
PMid:6236387
Rajwani KM, Mahomed A. Pediatric ovarian torsion: an uncommon clinical entity. Clin case reports. 2015;3(3):193-4.
https://doi.org/10.1002/ccr3.174
PMid:25838911 PMCid:PMC4377253
Ryan MF, Desai BK. Ovarian torsion in a 5-year old: a case report and review. Case Rep Emerg Med. 2012;2012:679121.
https://doi.org/10.1155/2012/679121
PMid:23326720 PMCid:PMC3542900
Corre A, Dandekar S, Lau C, Ranasinghe L. A Case Report of Pediatric Ovarian Torsion: The Importance of Diagnostic Laparoscopy. Clin Pract cases Emerg Med. 2021;5(1):109-12.
https://doi.org/10.5811/cpcem.2020.12.50319
PMid:33560966 PMCid:PMC7872599
Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2000;180(6):462-5.
https://doi.org/10.1016/S0002-9610(00)00503-1
PMid:11182398
Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004;39(5):750-3.
https://doi.org/10.1016/j.jpedsurg.2004.01.034
PMid:15137012
Beaunoyer M, Chapdelaine J, Bouchard S, Ouimet A. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004;39(5):746-9.
https://doi.org/10.1016/j.jpedsurg.2004.01.037
PMid:15137011
Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, et al. Ovarian torsion Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg. 2009;44(9):1759-65.
https://doi.org/10.1016/j.jpedsurg.2008.11.058
PMid:19735822
Rousseau V, Massicot R, Darwish AA, Sauvat F, Emond S, Thibaud E, et al. Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases. J Pediatr Adolesc Gynecol. 2008;21(4):201-6.
https://doi.org/10.1016/j.jpag.2007.11.003
PMid:18656074
Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med. 2005;159(6):532-5.
https://doi.org/10.1001/archpedi.159.6.532
PMid:15939851
Ozcan C, Celik A, Ozok G, Erdener A, Balik E. Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion. J Pediatr Surg. 2002;37(11):1617-20.
https://doi.org/10.1053/jpsu.2002.36195
PMid:12407550
Breech LL, Hillard PJA. Adnexal torsion in pediatric and adolescent girls. Curr Opin Obstet Gynecol. 2005;17(5):483-9.
https://doi.org/10.1097/01.gco.0000179666.39548.78
PMid:16141762
Pansky M, Smorgick N, Herman A, Schneider D, Halperin R. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol. 2007;109(2 Pt 1):355-9.
https://doi.org/10.1097/01.AOG.0000250969.15438.17
PMid:17267836
Pomeranz AJ, Sabnis S. Misdiagnoses of ovarian masses in children and adolescents. Pediatr Emerg Care. 2004;20(3):172-4.
https://doi.org/10.1097/01.pec.0000117925.65522.e8
PMid:15094575
Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018;25(1):51-9.
https://doi.org/10.1007/s10140-017-1549-8
PMid:28884300
Bronstein ME, Pandya S, Snyder CW, Shi Q, Muensterer OJ. A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 2015;25(1):82-6.
https://doi.org/10.1055/s-0034-1387946
PMid:25172980
McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999;54(9):601-8.
https://doi.org/10.1097/00006254-199909000-00025
PMid:10481857
Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol. 2014;21(2):179-87.
https://doi.org/10.1007/s10140-013-1163-3
PMid:24078282
Kives S, Gascon S, Dubuc É, Van Eyk N. No 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults. J Obstet Gynaecol Can. 2017;39(2):82-90.
https://doi.org/10.1016/j.jogc.2016.10.001
PMid:28241927
Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 2004;23(12):1643-9-1.
https://doi.org/10.7863/jum.2004.23.12.1643
PMid:15557307
Naiditch JA, Barsness KA. The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. J Pediatr Surg. 2013;48(6):1283-7.
https://doi.org/10.1016/j.jpedsurg.2013.03.024
PMid:23845619
Childress KJ, Dietrich JE. Pediatric Ovarian Torsion. Surg Clin North Am. 2017;97(1):209-21.
https://doi.org/10.1016/j.suc.2016.08.008
PMid:27894428
De Silva MHAD, Kolombage P, Kasthuri S. An ovarian torsion in a 2-year-old girl: a case report. J Med Case Rep. 2020;14(1):194.
https://doi.org/10.1186/s13256-020-02518-2
PMid:33069250 PMCid:PMC7568833
Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. J Pediatr Surg. 2018;53(7):1387-91.
https://doi.org/10.1016/j.jpedsurg.2017.10.053
PMid:29153467
Adeyemi-Fowode O, Lin EG, Syed F, Sangi-Haghpeykar H, Zhu H, Dietrich JE. Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution. J Pediatr Adolesc Gynecol. 2019;32(1):64-9.
https://doi.org/10.1016/j.jpag.2018.07.003
PMid:30012428
Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach S. Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril. 1993;60(6):976-9.
https://doi.org/10.1016/S0015-0282(16)56395-X
PMid:8243702
Pansky M, Abargil A, Dreazen E, Golan A, Bukovsky I, Herman A. Conservative management of adnexal torsion in premenarchal girls. J Am Assoc Gynecol Laparosc. 2000;7(1):121-4.
https://doi.org/10.1016/S1074-3804(00)80021-3
PMid:10648751
Chen M, Chen CD, Yang YS. Torsion of the previously normal uterine adnexa Evaluation of the correlation between the pathological changes and the clinical characteristics. Acta Obstet Gynecol Scand. 2001;80(1):58-61.
https://doi.org/10.1034/j.1600-0412.2001.800111.x
PMid:11167190
Bertozzi M, Esposito C, Vella C, Briganti V, Zampieri N, Codrich D, et al. Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study. J Pediatr Adolesc Gynecol. 2017;30(3):413-7.
https://doi.org/10.1016/j.jpag.2016.11.008
PMid:27894860
Celik A, Ergün O, Aldemir H, Ozcan C, Ozok G, Erdener A, et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg. 2005;40(4):704-8.
https://doi.org/10.1016/j.jpedsurg.2005.01.008
PMid:15852284
Dumont T, Caccia N, Allen L. Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature. J Pediatr Surg. 2011;46(12):e19-23.
https://doi.org/10.1016/j.jpedsurg.2011.08.024
PMid:22152901
Rossi B V, Ference EH, Zurakowski D, Scholz S, Feins NR, Chow JS, et al. The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population. J Pediatr Adolesc Gynecol. 2012;25(2):109-13.
https://doi.org/10.1016/j.jpag.2011.10.006
PMid:22206683
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