Original StudyPediatric Ovarian Torsion and its Recurrence: A Multicenter Study
Introduction
Ovarian torsion (OT) is a rare condition in pediatric patients. Overall, approximately 15% of cases occur during infancy and childhood1 and this percentage is greater if adolescent and teenage patients are included.2
Large series from pediatric centers report an incidence between 0.3 and 3.5 cases per year.1, 3, 4, 5, 6, 7, 8, 9
In pediatric patients the torsion of normal ovaries ranges from 16% to 49% and the remaining percentage is associated with the presence of masses.3, 10, 11, 12
The etiology of OT in the absence of cysts or masses is more obscure. Contributing factors could be the hypermobility caused by an elongated ovarian ligament or a hyperlax mesosalpinx or meso-ovarium.13
In the case of OT, adnexectomy appears largely abandoned for a conservative management also in the case of a necrotic-appearing ovary.14, 15
Indeed, recent literature suggests that standard care for OT is detorsion without removal of the fallopian tube/ovary and excision or aspiration of the cause of the torsion.2
OT recurrence is rarely reported and different surgical techniques to limit ovarian mobility,16, 17, 18, 19, 20 also called oophoropexy (OPY), have been described.
There are concerns that OPY might damage the ovary or distort the relationship between ovary follicles and the fallopian tubes.2
Indeed, alteration of pelvic anatomy during OPY might lead to tubal occlusion and impaired tube-ovary interaction.21 Nevertheless, there is no evidence in the literature that OPY decreases fertility.2
Here we report results of a multicenter Italian survey of a 10-year retrospective study concerning the treatment of OT and its recurrence in children. This report describes the management of 10 different centers in the case of OT and OT recurrence as well as results at 1 year follow-up of the preserved ovaries, to describe the current management of OT.
Section snippets
Materials and Methods
Data collection ranged from January 2004 to January 2014 and was carried out by a questionnaire sent to 10 Italian centers of pediatric surgery. A total of 124 questionnaires were returned and analyzed. The information obtained was: (1) patient age; (2) presence of menarche; (3) site of torsion; (4) presence of mass in the torsed ovary; (5) type of mass; (6) type of procedure performed; (7) associated procedures; (8) if an OPY was performed after the first episode of torsion, the site and the
Results
The mean age at the time of surgery was 9.79 ± 3.54 (range, 2-14) years. Eighty-four of 124 patients were premenarchal (67.7%) and 40 of 124 were postmenarche (32.3%). Torsion involved the right ovary in 82 of 125 cases (66.1%) and left OT was reported in 41 of 125 cases (33%). In 1 of 125 patients the OT was bilateral and synchronous (0.9%).
In 59 of 125 cases (47.2%; 39 right, 20 left) the OT was caused by the presence of a mass; the other 66 of 125 torsed ovaries (52.8%; 44 right, 22 left)
Discussion
OT is an uncommon event in the pediatric age group.22 Approximately half of these cases involves an ovarian mass.3, 10, 11, 12, 23, 24 However, several case series with torsion of normal premenarchal ovaries have been reported in the literature.7, 10, 23
In our multicenter study results confirmed data reported in the literature because in 47.2% of the cases the OT was caused by the presence of a mass and in 52.8% there was a normal ovary.
Eighty-four of 124 patients were in the premenarchal
References (40)
Ovarian torsion
Semin Pediatr Surg
(2005)- et al.
Asynchronous bilateral ovarian torsion
J Pediatr Surg
(2004) - et al.
Acute ovarian torsion in children
Am J Surg
(2000) - et al.
Adnexal torsion in very young girls: diagnostic pitfalls
Eur J Obstet Gynecol Reprod Biol
(2004) - et al.
Adnexal torsion in children
J Pediatr Surg
(1989) - et al.
Torsion of uterine adnexa in neonates and children: a report of 20 cases
J Pediatr Surg
(1991) - et al.
Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period
J Pediatr Surg
(2001) - et al.
Ovarian torsion in children: is oophorectomy necessary?
J Pediatr Surg
(2004) - et al.
Conservative management of adnexal torsion. A case-report and review of the literature
Eur J Obstet Gynecol Reprod Biol
(2002) - et al.
Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion
J Pediatr Surg
(2002)
Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center
J Minim Invasive Gynecol
Ovarian torsion: to pex or not to pex? Case report and review of the literature
J Pediatr Adolesc Gynecol
Oophoropexy, hyperbaric oxygen therapy, and contrast-enhanced ultrasound after asynchronous bilateral ovarian torsion
J Pediatr Surg
Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases
J Pediatr Adolesc Gynecol
Torsion of the normal uterine adnexa in premenarchal girls
J Pediatr Surg
Ovarian torsion. Management and ovarian prognosis: a report of 45 cases
J Pediatr Surg
Ovarian torsion in children: management and outcomes
J Pediatr Surg
Recurrent ipsilateral ovarian torsion: case report and literature review
J Pediatr Adolesc Gynecol
High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa
Fertil Steril
Long-term results of conservative management of adnexal torsion in children
J Pediatr Surg
Cited by (27)
Underutilization of laparoscopy for ovarian surgeries in the pediatric population: A nationwide analysis
2023, Journal of Pediatric SurgeryRecurrent Ovarian Torsion: Risk Factors and Predictors for Outcome of Oophoropexy
2022, Journal of Minimally Invasive GynecologyOvarian Preservation and Recurrent Torsion in Children: Both Less Common Than We Thought
2022, Journal of Surgical ResearchIsolated fallopian tube torsion in pediatric age: An Italian multicenter retrospective study
2020, Journal of Pediatric SurgeryCitation Excerpt :Salpingectomy is in conflict with the current recommendation for ovarian torsion. Recent trends in conservative management of adnexal torsion by detorsion even in those cases of black and necrotic appearing ovaries [18] do not correlate with an increased patient morbidity [21]. In the case of IFTT, the dilemma to perform salpingectomy or conservative management may not be resolved without a prospective long-term study where long term function of the de-torsed fallopian tube can be examined.
Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution
2019, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :The benefits to oophoropexy are controversial. Some have cited fears that ovarian fixation could impair the ovary and compromise the anatomic relationship between the ovarian follicles and oviduct.19,40–42 Although this is a theoretical concern, there are no prospective studies available to assist with decision-making in this situation.
Adnexal Torsion
2018, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Pediatric ovarian torsion accounts for approximately 15% of all cases of ovarian torsion.7–10 Although the actual incidence of AT is unknown, studies have reported between 0.3 and 3.5 cases per year.3,5,11–13 The largest analysis of pediatric ovarian torsion-related hospitalizations in the United States (Kids Inpatient Database) provides an estimated incidence of ovarian torsion of 4.9 per 100,000 female patients aged 1-20 years.14
The authors indicate no conflicts of interest.