Abstract

OBJECTIVES: To establish the frequency of torsion with multiple twists of the adnexa in girls 19years old and younger surgically diagnosed with torsion.STUDY DESIGN: A retrospective chart review using an institutional tool to review charts of female patients 19years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion.RESULTS: Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain>24h up to 4weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36=39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p=0.098).CONCLUSIONS: Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.

View details for DOI 10.1016/j.ejogrb.2021.11.435

View details for PubMedID 34883338