Clinical presentation,diagnosis and treatment of adnexal torsion in children and adolescents

Abstract

Actuality. One of the most frequent causes of children admission to the surgical department is conditioned by abdominal pain, which can often result from gynecological diseases, particularly adnexal torsion (in 2-3% of cases). Adnexal torsion develops much more commonly in children and adolescents than in adult women, which is due to anatomical features of internal genital organs (small size of the uterus, a relatively high location of the ovaries in the small pelvis), physiological characteristics (overload of the bladder, juvenile constipation, overactive intestinal peristalsis), as well as more mobile lifestyle inherent to this age group. The aim. To study the incidence of adnexal torsion in children and adolescents. Materials and methods. The study involved clinical and statistical analysis of medical records of patients with diagnosed adnexal torsion, who underwent inpatient treatment at gynecologic department of Kharkiv Regional Children's Clinical Hospital from 2010 to 2016. Results. The assessment of the records for the period under investigation showed that adnexal torsion was diagnosed in 30 patients, including 11 girls under 12 years of age and 18 adolescents. Solitary torsion of the ovary was observed in 12 patients, torsion of an ovarian cyst - in 10, torsion of a paratubal cyst - in 5, torsion of the ovary and fallopian tube - in 2, torsion of ovarian teratoma - in 1. The treatment included 28 surgical operations by laparoscopy and 2 operations by laparotomy. Organ-preserving surgical treatment implied determination of the state of adnexal tissues: patients with intact blood flow and without necrotic changes underwent detorsion while adnexa with absent blood flow and presence of necrosis were removed. Conclusion. All cases of suspected adnexal torsion in children and adolescents need to be comprehensively diagnosed. Minimally invasive organ-preserving laparoscopic intervention should be considered the method of choice.