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Acute ovarian torsion in children
E R Kokoska1, M S Keller, T R Weber
1Department of Surgery, Division of Pediatric Surgery, Saint Louis University Health Sciences Center and Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA.
Insights
Acute ovarian torsion (OT) in children is often misdiagnosed. This study found that while salpingooophorectomy was necessary for all patients, ultrasonography aids in differentiating OT from appendicitis, suggesting some tests may be unnecessary.
Area of Science:
- Pediatric Surgery
- Gynecologic Oncology
- Emergency Medicine
Background:
- Acute ovarian torsion (OT) is a rare cause of abdominal pain in children.
- OT is frequently misdiagnosed, often confused with other conditions.
Purpose of the Study:
- To analyze the clinical presentation, diagnosis, and management of acute ovarian torsion in pediatric patients.
- To evaluate the effectiveness of diagnostic tools and identify common etiologies.
Main Methods:
- Retrospective review of pediatric patients treated for acute ovarian torsion between 1983 and 1999.
- Analysis of diagnostic methods (ultrasound, CT scan), surgical interventions, and pathological findings.
Main Results:
- Fifty-one children were included, with a mean age of 12.5 years. Ultrasound confirmed OT in 73% of cases.
- All patients required salpingooophorectomy; appendicitis was presumed in 17% of cases presenting with right-sided pain.
- Etiologies varied by age, with younger children more commonly presenting with mature cystic teratomas or torsion without abnormality, while older children had follicular or corpus luteal cysts.
Conclusions:
- Ultrasonography with color Doppler is valuable for distinguishing OT from appendicitis.
- While ovarian salvage is rare, the underlying causes of OT in children are typically benign.
- Preoperative serum markers and contralateral ovary biopsy may not be necessary for diagnosis or management.
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.
Conclusion:
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.
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