Abstract
Background: Ovarian torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Methods: Charts of patients with ovarian operative cases were retrospectively reviewed at a free-standing children's hospital over 15 years. Torsion was based on intraoperative findings. Results: Of 328 operative ovarian cases, 97 (29.6%) demonstrated torsion. Mean patient age was 9.2 years (2 days to 17 years, ±0.54 SEM), with 52% occurring between 9 and 14 years. Of the patients, 97% presented in pain. Presence of a pelvic mass 5 cm or larger on imaging had 83% sensitivity for torsion: an ultrasound reading was only 51% sensitive. Elevated white blood cell count was the only preoperative characteristic associated with prompt operative intervention. Utilization of laparoscopy increased during the latter half of the study (18%-42%, P < .0434). There was a positive trend, although insignificant, in the use of laparoscopy and ovarian salvage. Pathology was overwhelmingly benign (infarction [46%], cysts [33%], and benign neoplasms [19%]). Conclusion: Torsion was responsible for one third of all operative ovarian cases. Sonography is not reliable in diagnosis or exclusion of ovarian torsion. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL), particularly with a pelvic mass of approximately 5 cm, may improve ovarian salvage. Because pathology is predominantly benign, the edematous detorsed ovary is safe to salvage.
Original language | English (US) |
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Pages (from-to) | 1212-1217 |
Number of pages | 6 |
Journal | Journal of Pediatric Surgery |
Volume | 44 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2009 |
Keywords
- Ovarian mass
- Ovarian salvage
- Ovarian torsion
- Ovarian tumor
- Pediatric surgery
- Ultrasound
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Surgery