Cannot exclude torsion-a 15-year review

Sarah C. Oltmann, Anne Fischer, Robert Barber, Rong Huang, Barry Hicks, Nilda Garcia

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102 Scopus citations

Abstract

Background: Ovarian torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Methods: Charts of patients with ovarian operative cases were retrospectively reviewed at a free-standing children's hospital over 15 years. Torsion was based on intraoperative findings. Results: Of 328 operative ovarian cases, 97 (29.6%) demonstrated torsion. Mean patient age was 9.2 years (2 days to 17 years, ±0.54 SEM), with 52% occurring between 9 and 14 years. Of the patients, 97% presented in pain. Presence of a pelvic mass 5 cm or larger on imaging had 83% sensitivity for torsion: an ultrasound reading was only 51% sensitive. Elevated white blood cell count was the only preoperative characteristic associated with prompt operative intervention. Utilization of laparoscopy increased during the latter half of the study (18%-42%, P < .0434). There was a positive trend, although insignificant, in the use of laparoscopy and ovarian salvage. Pathology was overwhelmingly benign (infarction [46%], cysts [33%], and benign neoplasms [19%]). Conclusion: Torsion was responsible for one third of all operative ovarian cases. Sonography is not reliable in diagnosis or exclusion of ovarian torsion. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL), particularly with a pelvic mass of approximately 5 cm, may improve ovarian salvage. Because pathology is predominantly benign, the edematous detorsed ovary is safe to salvage.

Original languageEnglish (US)
Pages (from-to)1212-1217
Number of pages6
JournalJournal of Pediatric Surgery
Volume44
Issue number6
DOIs
Publication statusPublished - Jun 2009

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Keywords

  • Ovarian mass
  • Ovarian salvage
  • Ovarian torsion
  • Ovarian tumor
  • Pediatric surgery
  • Ultrasound

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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