Torsion of the normal uterine adnexa in premenarchal girls

doi:10.1016/S0022-3468(78)80022-0

Journal of Pediatric Surgery

Volume 13, Issue 2, April 1978, Pages 195-196

https://doi.org/10.1016/S0022-3468(78)80022-0 Get rights and content

Two cases are reported of torsion of the normal uterine adnexa in premenarchal girls. In one patient, aged 3 yr, both the ovary and fallopian tube had undergone tosion. The second patient, aged 11 yr, had sustained torsion of the fallopian tube alone. This is the first reported case of torsion of the fallopian tube occurring without torsion of the ovary in a patient in this age group. The mechanisms of torsion of normal uterine adnexa are described and the operative management is discussed.

References (7)

DownerIG et al.
Torsion of the undiseased uterine adnexa
Am J Obstet Gynecol
(1931)
JamesDF et al.
Torsion and infarction of the normal ovary
Am J Dis Child
(1956)
SuttonJB
Salpingitis and some of its effects
Lancet
(1890)

There are more references available in the full text version of this article.

Cited by (48)

Unilateral Ovarian Hypoplasia with Ipsilateral Fallopian Tube Hypoplasia
2023, Journal of Minimally Invasive Gynecology
Ovarian torsion in pediatric and adolescent patients: A systematic review
2018, Journal of Pediatric Surgery
Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion.
Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence.
Ninety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3 months postprocedure but sooner if there is a concern for malignancy.
There appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion.
Systematic review of level 3–4 studies.
3–4
Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study
2017, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
OT is more common on the right side than on the left side.26,27 This incidence might be explained presumably because the presence of the sigmoid colon is responsible for reduced mobility of the left adnexa.28 In our experience torsion involved the right ovary in 66.1% of cases (82 of 125) and involvement of the left ovary was reported in 33% cases (41 of 125).
To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.
Multicenter retrospective cohort study.
Italian Units of Pediatric Surgery.
Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014.
Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively.
A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries.
Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00).
Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
Rates and Technique for Oophoropexy in Pediatric Ovarian Torsion: A Single-Institution Case Series
2017, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
The recurrence rate after pediatric and adolescent OT in our institution was 6.2% overall, 2.9% of patients with OT associated with a discrete ovarian or adnexal mass, and 14.8% of patients with idiopathic OT, similar to the reported rates of Beaunoyer et al. A number of theories have been proposed to explain the torsion events in normal adnexa, these include abnormally long tubes, mesovarium or mesosalpinx leading to increase ovary mobility21; long utero-ovarian ligaments18; as well as impeded venous return with stasis and congestion resulting in a heavier ovary.22 Because of the theories of long ligaments and ovarian or adnexal mobility, OP has been proposed and used as a potential solution to prevent the occurrence or recurrence of OT.
Ovarian torsion (OT) is uncommon, but can result in loss of reproductive function. Traditionally managed using adnexectomy, torsed adnexae are now being conserved, increasing the potential for recurrent OT. As a result, some experts suggest oophoropexy (OP) to prevent recurrence. We report on a series of 11 patients who underwent OP.
A retrospective case series was conducted from 2004 to 2013 to identify patients younger than the age of 18 years with OT. From this, data for patients with OP were extracted for detailed review.
We identified 97 patients with OT; 6 of 97 (6.2%) had recurrent OT. The rate of recurrence was higher (14.8%, 4/27) in the group with torsion without an adnexal mass. Eleven of 97 patients (11.3%) underwent OP. The mean age of patients with OP was 8.8 years. Nine patients had normal adnexae at initial torsion. Five of 11 had OP during their initial procedure. OP was most commonly performed for long utero-ovarian ligaments (n = 6), recurrence (n = 4), or bilateral OT (n = 2). Eight of 8 patients with follow-up ultrasound imaging after torsion showed at least 1 marker of normal ovarian function. One of 11 patients (9%) had a recurrence of OT of an oophoropexied ovary. There were no complications due to the OP portion of the procedure.
In our series of OT, a small percentage of patients underwent prophylactic OP. Recurrence might still occur after OP. It seems reasonable to offer OP to patients at higher risk of recurrent OT although level 1 evidence is lacking. Future research should focus on techniques and long-term outcomes of OP.
Recurrent Ipsilateral Ovarian Torsion: Case Report and Literature Review
2015, Journal of Pediatric and Adolescent Gynecology
Recurrent ipsilateral ovarian torsion at pediatric age is a rare event. Different surgical techniques for its prevention are available. We present a case of recurrent ipsilateral ovarian torsion in a prepubertal girl and we reviewed the literature about the management of this condition.
A 6-year-old girl presented with right ovarian torsion and underwent a laparoscopic untwisting. Nine months later an ipsilateral recurrence occurred. Laparoscopic untwisting and right-sided oophoropexy with plication to the round ligament was performed.
In addition to our presented case, four cases of recurrent ipsilateral ovarian torsion in pediatric patients were identified in the literature. The few available reports in the pediatric literature show different management techniques. A long-term study is necessary to define the most effective treatment.
Fallopian tubes and broad ligament
2009, Modern Surgical Pathology

View all citing articles on Scopus

¹: From the Alder Hey Children's Hospital, Liverpool, U.K.

View full text

Torsion of the normal uterine adnexa in premenarchal girls

Am J Obstet Gynecol

Torsion and infarction of the normal ovary

Am J Dis Child

Salpingitis and some of its effects

Lancet