Surgical Approach to Ovarian Torsion in Children

Abstract

Study Objective: Ovarian torsion in children is a relatively rare cause of acute abdominal pain. This study evaluates the diagnosis and treatment of ovarian torsion with an emphasis on conservative treatment approaches including the long-term follow-up results. Design and Participants: Patients with surgically treated ovarian torsions between December 2006 and February 2014 were included in this retrospective study. The patient population consisted of 41 patients with 42 ovaries involved. The mean age was 11 3.9 (range, 1-17) years. The most common presenting symptom was abdominal pain. Intervention: All patients underwent preoperative pelvic color Doppler ultrasonography that identified torsion in 34 (81%) ovaries. Results: During surgery, a right-sided torsion was detected in 25 (59.5%), and a left-sided one was detected in 17 (40.5%) ovaries. An excisional surgery was used for 16 (38%) ovaries, and detorsion with conservation of the ovary was used for 26 (62%). A trend toward conservative management was seen over the years. Regular follow-up for those patients who underwent conservative surgery was done in 22 patients for a mean of 25 months (range, 1.5-83 months). Control color Doppler ultrasonographic results were within normal limits in terms of ovarian size and blood supply in 17 (77%) patients. Despite normal parenchymal echogenicity, an involved ovary was smaller in size compared to the other ovary in five patients. Ovarian follicles were present in three of them. Conclusion: The ovary-sparing, conservative surgery is found to be highly successful in the presented series. Although malignancies are rarely encountered in torsed ovaries with associated masses, biopsy samples should be obtained in suspicious cases.