Abstract
Ovarian torsion is the twisting of the ovary on its vascular pedicle that can lead to vascular compromise and necrosis. Ovarian torsion can occur prenatally and at any postnatal age but is more common in adolescents. A high index of suspicion is required to make the diagnosis because of the typical nonspecific clinical presentation of lower abdominal pain and lack of physical findings. Imaging may suggest the diagnosis of ovarian torsion by demonstrating an enlarged ovary but has limited sensitivity. If the diagnosis of ovarian torsion is suspected then laparoscopic exploration is indicated and if torsion is discovered the recommended procedure in the absence of frank necrosis is ovarian detorsion rather than resection since visual inspection is a poor predictor of eventual viability of the ovary.
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Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2000;180:462–5.
Oltmann SC, Fischer AC, Barber R, et al. Cannot exclude torsion—a fifteen year review. J Pediatric Surg. 2009;44:1212–7.
Chan Y, Yan D, Kong M, et al. Adnexal torsion in children. Pediatr Emerg Care. 2008;24(8):534–7.
Beaunoyer M, Chapdelaine J, Bouchard S, et al. Asynchronous bilateral ovarian torsion. Am J Surg. 2000;180:462–5.
Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med. 2005;159:532–5.
Gutherie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000–2006. Pediatrics. 2010;125:532–8.
Celik A, Ergun O, Aldemir H, et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg. 2005;40(4):704–8.
Aziz D, Davis V, Allen L, Langer J. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004;39(5):750–3.
Rousseau V, Massicot R, Ahmed A, 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.
Oelsner G, Bider G, Goldenberg M, et al. Long term follow-up of the twisted of ischemic adnexa managed by detorsion. Fertil Steril. 1993;60:976–9.
Roday A, Jackish C, Klockenbusch W, et al. The conservative management of adnexal torsion—a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2002;101:83–6.
Oltmann SC, Fischer AC, Barber R, et al. Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance. J Pediatr Surg. 2010;45:135–9.
Dumont T, Caccia N, Allen L. Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature. J Pediatr Surg. 2011;46:e19–23.
Evans JP. Torsion of the normal uterine adnexa in premenarchal girls. J Pediatr Surg. 1978;13:195–6.
Wang J-H, Wu D-H, Jin H, Wu Y-Z. Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls. Eur J Pediatr Surg. 2010;20:298–301.
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. 2000;37:1617–29.
Dunnihoo DR, Wolff J. Bilateral torsion of the adnexa: a case report and a review of the world literature. Obstet Gynecol. 1984;64:55S–9S.
Kurzbart E, Mares AJ, Cohen Z, et al. Isolated torsion of the fallopian tube in premenarcheal girls. J Pediatr Surg. 1994;29:1384–5.
Sozen I, Nobel P, Nobel J. Partial tubal salvage through neosalpingostomy in a 12-year-old girl with combined ovarian and fallopian tube torsion. J Pediatr Surg. 2006;41:E17–9.
Crough S, Gyampoh B, Cutner AS, et al. Ovarian torsion: to pex or not to pex? Case report and revue of the literature. J Pediatr Adolesc Gynecol. 2003;16:381.
McCrea RS. Uterine adnexal torsion with subsequent contralateral recurrence. J Reprod Med. 1980;24:123–4.
Moredehai J, Mares AJ, Barki Y, et al. Torsion of uterine adnexa in neonates and children: a report of 20 cases. J Pediatr Surg. 1991;26:1195–9.
Descargues G, Tinlot-Mauger F, Gravier A, et al. Adnexal torsion: a report on forty-five cases. Euro J Obstet Gynecol Reprod Biol. 2001;98:91–6.
Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005;14:86–92.
Bagolan P, Rivosecchi M, Giorlandino C, et al. Prenatal diagnosis and clinical outcome of ovarian cysts. J Pediatr Surg. 1992;27:879–81.
Helmrath MA, Shin CE, Warner BW. Ovarian cysts in the pediatric population. Semin Pediatr Surg. 1998;7:19–28.
Legro RS, Lin HM, Demers LM, et al. Rapid maturation of the reproductive axis during perimenarche independent of body composition. J Clin Endocrinol Metab. 2000;85:1021–5.
Chumlea WC, Schubert CM, Roche AF, et al. Age at menarche and racial comparisons in US girls. Pediatrics. 2003;111:110–3.
Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. 2001;38:156–9.
Cass D, Hawkings E, Brandt ML, et al. Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001;36:693–9.
Sommerville M, Grimes DA, Koonings PP, et al. Ovarian neoplasms and the risk of adnexal torsion. Am J Obstet Gynecol. 1991;164:577–8.
Meyer JS, Harmon CM, Harty MP, et al. Ovarian torsion: clinical and imaging presentation in children. J Pediatr Surg. 1995;30:1433–6.
Emonts M, Doornewaard H, Admiral JC. Adnexal torsion in very young girls: diagnostic pitfalls. Eur J Obstet Gynecol Reprod Biol. 2004;1126:207–10.
Styaert H, Meynol F, Valla JS. Torsion of the adnexa in children: the value of laparoscopy. Pediatr Surg Int. 1998;13:384–7.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64.
Merriman TE, Auldist AW. Ovarian torsion in inguinal hernias. Pediatr Surg Int. 2000;16:383–5.
Boley SJ, Cahn D, Lauer T, et al. The irreducible ovary: a true emergency. J Pediatr Surg. 1991;26:1035–8.
Pena JE, Ufberg D, Cooney N, et al. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril. 2000;73:1047–50.
Schultz KA, Ness KK, Nagarajan R, et al. Adnexal masses in infancy and childhood. Clin Obstet Gynecol. 2006;49:464–79.
Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. Am J Roentgenol. 1988;150:647–9.
Herter LD, Golendziner E, Monteiro Flores JA, et al. Ovarian and uterine sonography in healthy girls between 1 and 13 years old: correlation of findings with age and pubertal status. Am J Roentgenol. 2002;178:1531.
Vijayaraghavan SB. Sonographic whirlpool signs in ovarian torsion. J Ultrasound Med. 2004;23:1643–9.
Stark JE, Siegel MJ. Ovarian torsion in prepubertal and pubertal girls: sonographic findings. Am J Roentgenol. 1994;163:1479–82.
Servaes S, Zurakowski D, Laufer M, et al. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007;37:446–51.
Hurh PJ, Meyer JS, Shaaban A. Ultrasound of a torsed ovary: characteristic gray-scale appearance despite normal arterial and venous flow on Doppler. Pediatr Radiol. 2002;32:586–8.
Nizar K, Deutsch M, Filmer S, et al. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. J Clin Ultrasound. 2009;37:436–9.
Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correction. J Ultrasound Med. 2001;20:1083–9.
McGovern P, Noah R, Koenigsberg R, Little A. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999;54(9):601–8.
Karpelowsky J, Hei E, Matthews K. Laparoscopic resection of benign ovarian tumors in children with gonadal preservation. Pediatr Surg Int. 2009;25:251–4.
Dolgin S, Lublin M, Shlasko E. Maximizing ovarian salvage when treating idiopathic adnexal torsion. J Pediatr Surg. 2000;35(4):624–6.
Galinier P, Carfagna L, Delsol M, et al. Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Ped Surg. 2009;44:1759–65.
Fuchs N, Smogick N, Tovbin Y, et al. Oophoropexy to prevent torsion: How, When and for Whom? J Minim Invas Gynecol. 2010;17:205–8.
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Fischer, A.C. (2018). Ovarian Torsion. In: Ledbetter, D., Johnson, P. (eds) Endocrine Surgery in Children. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54256-9_25
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DOI: https://doi.org/10.1007/978-3-662-54256-9_25
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