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Email this article OUR EXPERIENCE IN DIAGNOSIS AND TREARMENT OF CHILDREN WITH ADNEXAL TORSION
Abstract
Background. The diagnosis of adnexal torsion is challenging due to the absence of specific symptoms that can determine the postponing of surgery, and as the consequence, the development of necrotic changes of adnexa. Nowadays, the surgical treatment of patients with this pathology shifting to the ovary-sparing surgery (detorsion) despite to the presence of necrotic changes during surgery. By that, the question of the choice of the method of treatment in case of adnexal torsion still under debate between pediatric surgeons and gynecologists.
Aim of the study was to summarize the own experience in treatment of patients with adnexal torsion
Material and methods. This study based on the results of the treatment of 73 patients with adnexal torsion, which were operated during 2010-2022 years.
Diagnosis was established on results of clinical investigation and ultrasonography (US)
It was performed 74 surgical procedures (one patient was operated twice), among them 57 (77%) by laparoscopic and 17 (23%) by open approach (laparotomy). It was 49 (66,2%) ovary-sparing surgeries (detorsion with or without cystectomy) and 25 (33,8%) – adnexectomy.
Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8).
Results. The average age of patients was 11,5±0,5 years. Abdominal pain (in 100%) and vomiting (in 49,3%) were the main clinical appearances.
Unilateral ovarian enlargement and peripherally displaced follicles were the most frequent US findings. The absence of the blood supply was revealed in 39,5% and the whirlpool sign in 11,6% of patients.
Among all patients, simple torsion confirmed in 24,3%, while the torsion caused by cyst or dermoid tumor, revealed in 75,7% of patients. Detorsion was performed only in 24,3% of patients and in 42,5% of patients it was supplemented by cystectomy. Adnexectomy was performed in 32,2% of patients.
Conclusions. The diagnosis of adnexal torsion should be considered in all females with acute abdominal pain syndrome. Ultrasonography with or without Doppler is the first-line imaging modality. Laparoscopic detorsion, simple or with cystectomy, is the method of choice for treatment of patients with adnexal torsion.
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