Pediatr Emerg Med J.  2023 Apr;10(2):49-53. 10.22470/pemj.2022.00633.

Premenarchal ovarian torsion

• Eilbert W
• Nguyen H

• KMID: 2540908
• DOI: http://doi.org/10.22470/pemj.2022.00633

Abstract

Ovarian torsion is a common gynecologic emergency seen in women of all ages, mostly in reproductive women, resulting in ischemia and necrosis of the adnexal tissue. However, it is rare in premenarchal girls. This article reviews the limited published literature, and discusses special considerations about premenarchal ovarian torsion.

Keyword

Laparoscopy; Menarche; Ovarian Torsion; Pediatrics; Ultrasonography, Doppler, Color

Reference

References

1. Bland Sutton J. Salpingitis and some of its effects. Lancet. 1890; 136:1206–9.

2. Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985; 152:456–61.

3. Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: ovarian torsion. Am J Emerg Med. 2022; 56:145–50.

4. Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000-2006. Pediatrics. 2010; 125:532–8.

5. Pansky M, Abargil A, Dreazen E, Golan A, Bukovsky I, Herman A. Conservative management of adnexal torsion in premenarchal girls. J Am Assoc Gynecol Laparosc. 2000; 7:121–4.

6. Wang JH, Wu DH, Jin H, Wu YZ. Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls. Eur J Pediatr Surg. 2010; 20:298–301.

7. Ashwal E, Hiersch L, Krissi H, Eitan R, Less S, Wiznitzer A, et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol. 2015; 126:514–20.

8. Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Presentation, diagnosis, and treatment of ovarian torsion in premenarchal girls. J Pediatr Adolesc Gynecol. 2015; 28:526–9.

9. Ganer Herman H, Shalev A, Ginat S, Kerner R, Keidar R, Bar J, et al. Clinical characteristics of adnexal torsion in premenarchal patients. Arch Gynecol Obstet. 2016; 293:603–8.

10. Schuh AM, Klein EJ, Allred RJ, Christensen A, Brown JC. Pediatric adnexal torsion: not just a postmenarchal problem. J Emerg Med. 2017; 52:169–75.

11. Tasset J, Rosen MW, Bell S, Smith YR, Quint EH. Ovarian torsion in premenarchal girls. J Pediatr Adolesc Gynecol. 2019; 32:254–8.

12. Prieto JM, Kling KM, Ignacio RC, Bickler SW, Fairbanks TJ, Saenz NC, et al. Premenarchal patients present differently: a twist on the typical patient presenting with ovarian torsion. J Pediatr Surg. 2019; 54:2614–6.

13. Sosnowska-Sienkiewicz P, Mankowski P. Profile of girls with adnexal torsion: single center experience. Indian Pediatr. 2022; 59:293–5.

14. Tseng YC, Lee MS, Chang YJ, Wu HP. Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol. 2008; 49:126–34.

15. Rey-Bellet Gasser C, Gehri M, Joseph JM, Pauchard JY. Is it ovarian torsion? A systematic literature review and evaluation of prediction signs. Pediatr Emerg Care. 2016; 32:256–61.

16. Kokoska ER, Keller MS, Weber TR. Acute ovarian torsion in children. Am J Surg. 2000; 180:462–5.

17. Lucchetti MC, Orazi C, Lais A, Capitanucci ML, Caione P, Bakhsh H. Asynchronous bilateral ovarian torsion: three cases, three lessons. Case Rep Pediatr. 2017; 2017:6145467.

18. Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005; 14:86–92.

19. Beaunoyer M, Chapdelaine J, Bouchard S, Ouimet A. Asynchronous bilateral ovarian torsion. J Pediatr Surg. 2004; 39:746–9.

20. Shust NM, Hendricksen DK. Ovarian torsion: an unusual cause of abdominal pain in a young girl. Am J Emerg Med. 1995; 13:307–9.

21. Tsafrir Z, Azem F, Hasson J, Solomon E, Almog B, Nagar H, et al. Risk factors, symptoms, and treatment of ovarian torsion in children: the twelve-year experience of one center. J Minim Invasive Gynecol. 2012; 19:29–33.

22. Hoey BA, Stawicki SP, Hoff WS, Veeramasuneni RK, Kovich H, Grossman MD. Ovarian torsion associated with appendicitis in a 5-year-old girl: a case report and review of the literature. J Pediatr Surg. 2005; 40:e17–20.

23. Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion--a 15-year review. J Pediatr Surg. 2009; 44:1212–7.

24. Rossi BV, Ference EH, Zurakowski D, Scholz S, Feins NR, Chow JS, et al. The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population. J Pediatr Adolesc Gynecol. 2012; 25:109–13.

25. Poonai N, Poonai C, Lim R, Lynch T. Pediatric ovarian torsion: case series and review of the literature. Can J Surg. 2013; 56:103–8.

26. Schultz LR, Newton WA Jr, Clatworthy HW Jr. Torsion of previously normal tube and ovary in children. N Engl J Med. 1963; 268:343–6.

27. Emonts M, Doornewaard H, Admiraal JC. Adnexal torsion in very young girls: diagnostic pitfalls. Eur J Obstet Gynecol Reprod Biol. 2004; 1116:207–10.

28. Mordehai J, Mares AJ, Barki Y, Finaly R, Meizner I. Torsion of uterine adnexa in neonates and children: a report of 20 cases. J Pediatr Surg. 1991; 26:1195–9.

29. Smith CJ, Bey T, Emil S, Wichelhaus C, Lotfipour S. Ovarian teratoma with torsion masquerading as intussusception in 4-year-old child. West J Emerg Med. 2008; 9:228–31.

30. Chang YJ, Yan DC, Kong MS, Wu CT, Chao HC, Luo CC, et al. Adnexal torsion in children. Pediatr Emerg Care. 2008; 24:534–7.

31. Schmitt ER, Ngai SS, Gausche-Hill M, Renslo R. Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 2013; 29:518–23.

32. Bolli P, Schädelin S, Holland-Cunz S, Zimmermann P. Ovarian torsion in children: development of a predictive score. Medicine (Baltimore). 2017; 96:e8299.

33. Piper HG, Oltmann SC, Xu L, Adusumilli S, Fischer AC. Ovarian torsion: diagnosis of inclusion mandates earlier intervention. J Pediatr Surg. 2012; 47:2071–6.

34. Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Eur J Radiol. 2014; 83:733–8.

35. Naiditch JA, Barsness KA. The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. J Pediatr Surg. 2013; 48:1283–7.

36. Bronstein ME, Pandya S, Snyder CW, Shi Q, Muensterer OJ. A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. Eur J Pediatr Surg. 2015; 25:82–6.

37. Ssi-yan-kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, et al. What every radiologist should know about adnexal torsion. Emerg Radiol. 2018; 25:51–9.

38. Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG. 2021; 128:37–44.

39. Scheier E, Balla U. Pediatric ovarian torsion on point-of-care ultrasound: a case series. Pediatr Emerg Care. 2022; 38:e1159–63.

40. Tielli A, Scala A, Alison M, Vo Chieu VD, Farkas N, Titomanlio L, et al. Ovarian torsion: diagnosis, surgery, and fertility preservation in the pediatric population. Eur J Pediatr. 2022; 181:1405–11.

41. Melcer Y, Maymon R, Pekar-Zlotin M, Pansky M, Smorgick N. Clinical and sonographic predictors of adnexal torsion in pediatric and adolescent patients. J Pediatr Surg. 2018; 53:1396–8.

42. Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Sonographic findings of ovarian torsion in children. Pediatr Radiol. 2007; 37:446–51.

43. Spinelli C, Buti I, Pucci V, Liserre J, Alberti E, Nencini L, et al. Adnexal torsion in children and adolescents: new trends to conservative surgical approach -- our experience and review of literature. Gynecol Endocrinol. 2013; 29:54–8.

44. Grunau GL, Harris A, Buckley J, Todd NJ. Diagnosis of ovarian torsion: is it time to forget about Doppler? J Obstet Gynaecol Can. 2018; 40:871–5.

45. Childress KJ, Dietrich JE. Pediatric ovarian torsion. Surg Clin North Am. 2017; 97:209–21.

46. Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: is oophorectomy necessary? J Pediatr Surg. 2004; 39:750–3.

47. Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA, et al. Ovarian torsion in pediatric and adolescent patients: a systematic review. J Pediatr Surg. 2018; 53:1387–91.

48. Appelbaum H, Abraham C, Choi-Rosen J, Ackerman M. Key clinical predictors in the early diagnosis of adnexal torsion in children. J Pediatr Adolesc Gynecol. 2013; 26:167–70.

49. Yildiz A, Erginel B, Akin M, Karadag CA, Sever N, Tanik C, et al. A retrospective review of the adnexal outcome after detorsion in premenarchal girls. Afr J Paediatr Surg. 2014; 11:304–7.