The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population

Abstract

Study objective: To determine the history, clinical presentation, physical exam, and laboratory findings of ovarian and/or tubal torsion in the pediatric and adolescent population and to examine the surgical management of adnexal torsion.

Design: Descriptive, retrospective chart review.

Setting: Academic children's hospital.

Participants: Children and adolescents, aged 3-21 years, with the surgical diagnosis of ovarian and/or tubal torsion.

Main outcome measures: Pain, physical exam, and laboratory characteristics and surgical outcomes.

Results: Of the 82 cases, there was a higher rate of right-sided adnexal torsion (64%). The most commonly reported duration of pain was 24 hours. Most (91%) stated the pain has sudden onset and 69% qualified the pain as severe. Eighty-three percent complained of nausea and 67% had vomiting. There was a higher rate of tachycardia in younger patients (P = 0.003). On exam, 91% of subjects presented with tenderness, usually in the right lower quadrant (61%). A longer duration of pain was associated with a higher rate of oophorectomy and/or salpingectomy. There was no difference in the rates of the removal of adnexal structures between gynecologists and pediatric surgeons.

Conclusions: Most pediatric or adolescent patients with adnexal torsion present with acute onset of severe, intermittent pain lasting for 24 hours. Nausea and vomiting, as well as abdominal tenderness were common. Our findings will facilitate the accurate diagnosis of adnexal torsion and may contribute to more expedient surgical management.