Long-term results of conservative management of adnexal torsion in children

Abstract

Background/purpose: Adnexal torsion is a condition that may result in serious morbidity including adnexal removal. However, conservative management with preserving the torsed adnexa is not justified, and long-term outcomes remain unclear.

Methods: The records of 14 girls with ovarian torsion whose adnexal structures were preserved after detorsion were reviewed to evaluate the long-term results of conservative management. Data including age, previous history, duration of complaints, surgical findings and type of intervention, color Doppler ultrasound findings performed in the early and late postoperative periods, and final outcomes were collected.

Results: Mean age of patients was 11.5 +/- 2.8 (range 6 to 15) years. Time interval between the onset of pain to surgery was 46.78 +/- 35.5 (range 12 to 126) hours. Seven patients had a benign solitary cyst as an underlying cause for adnexal torsion. The intervention performed by open surgery in 9 and by laparoscopy in 5 patients included detorsion, simple cyst aspiration, unroofing and/or cystectomy in 7 patients with ovarian cysts, and oophoropexy in 9 of 14 patients. Follow-up ranged from 3 to 66 (mean 21.9 +/- 20.1) months. Thirteen patients resumed normal size and folliculogenesis, whereas in 1 patient, the involved ovary atrophied. No recurrence or contralateral adnexal torsion was observed on follow-up.

Conclusions: Conservative management with untwisting the ovary and pexing both retained detorsed and contralateral ovaries especially in idiopathic torsions should be considered in cases of ovarian torsion in children.