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Adnexal torsion in children
Yi-Jung Chang1, Dah-Chin Yan, Man-Shan Kong
1Division of Pediatric Critical Care, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Pediatric Emergency Care
|July 23, 2008
Summary
Adnexal torsion in children is often misdiagnosed. Ultrasound is key for diagnosis, but not always definitive. Consider adnexal torsion in girls with abdominal pain or masses.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Gynecologic Emergencies
Background:
- Adnexal torsion is a surgical emergency in children, frequently misdiagnosed.
- Early diagnosis is crucial to preserve ovarian function.
Purpose of the Study:
- To evaluate the diagnostic accuracy and characteristics of adnexal torsion in pediatric patients.
- To identify factors influencing diagnosis and outcomes.
Main Methods:
- Retrospective review of 49 surgically confirmed pediatric adnexal torsion cases (1992-2005).
- Exclusion of neonatal cases.
- Analysis of clinical presentation, imaging findings (ultrasound, CT), and diagnostic timelines.
Main Results:
- Mean age was 12.5 years; 32.6% were premenarchal girls, often missed at initial diagnosis.
- Common symptoms included severe or recurrent abdominal pain.
- Ultrasound suggested ovarian pathology in most cases but definitively diagnosed only 3 torsions.
- Combined ultrasound and CT offered no diagnostic advantage over ultrasound alone; multiple imaging studies delayed surgery.
Conclusions:
- Ultrasound plays a vital, though not definitive, role in diagnosing pediatric adnexal torsion.
- Combined advanced imaging does not improve diagnostic yield over ultrasound alone.
- Adnexal torsion should be considered in all children presenting with abdominal pain or masses, especially in postmenarchal girls, but also in premenarchal girls.
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