Scientific paper
Acute ovarian torsion in children

Presented at the 52nd Annual Meeting of the Southwestern Surgical Congress, Colorado Springs, Colorado, April 9–12, 2000.
https://doi.org/10.1016/S0002-9610(00)00503-1Get rights and content

Abstract

Background: Acute ovarian torsion (OT) is an uncommon cause of abdominal pain in children and is frequently confused with other conditions.

Methods: We reviewed the records (1983 to 1999) of all children treated for acute OT at our children’s hospital.

Results: Mean child age (n = 51) was 12.5 ± 0.3 years. Children presented with either right-sided (n = 29) or left-sided (n = 22) pain. Diagnosis of OT was confirmed preoperatively by ultrasound (73%) or computed tomography (CT) scan (10%) while nine children (17%) with right-sided pain underwent surgery for presumed appendicitis. Despite a relatively short time from diagnosis to surgery, all 51 children required salpingooophorectomy. Contralateral biopsy was performed in 29% and 57% had an appendectomy. Younger children more commonly had either a mature cystic teratoma or torsion with no underlying abnormality as an etiology compared with OT in older children that was more likely to result from either a follicular or corpus luteal cyst. Pathologic examination of the contralateral ovary and appendix was normal in all children who underwent biopsy and appendectomy.

Conclusions: Ultrasonography with color doppler is helpful for differentiating acute OT from appendicitis. Although the twisted ovary can rarely be salvaged, the etiology is usually benign. Preoperative serum markers and contralateral ovary biopsy may be unnecessary.

Section snippets

Methods

We reviewed the records of all children (aged ≤16 years) who underwent operative treatment for acute ovarian torsion at Cardinal Glennon Children’s Hospital, Saint Louis University Health Sciences Center between January 1983 and January 1999. Neonates with ovarian masses and torsion were excluded. Hospital charts (including operative and pathology reports) and follow-up records were reviewed. A fever was defined as a temperature greater than 38.5°C. Patients were generally considered for

Results

Mean child age (n = 51) was 12.5 ± 0.3 (8 to 16) years (Figure 1). Children presented with an abrupt onset of either right-sided (n = 29; 57%) or left-sided (n = 22; 43%) pain. Other common signs and symptoms were vomiting (n = 37; 73%), fever (n = 11; 22%), a palpable abdominal mass (n = 10; 20%), and dysuria (n = 7; 14%). The neutrophil (white blood cell) count was elevated 82% of the time. The mean WBC count was 13,000 ± 500 cells/mm3 with a mean of 76% segmented and 7% banded neutrophils.

Comments

Acute ovarian torsion in children is uncommon and difficult to diagnose in a timely fashion. Several studies support our observation that the only constant symptom is pain, which results from occlusion of the vascular supply to the twisted ovary.1, 2 Other reported symptoms may include nausea and vomiting, fever, and urinary symptoms.1 Torsion of the right ovary is more common than the left with a ratio that approximates 3:2. A right-sided dominance has been explained by the sigmoid colon

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