title: Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases.
abstract: BACKGROUND
  The authors describe and discuss the clinical and therapeutic features of 40 ovarian torsions (OT) in children with its urgent treatment that has advanced in recent years.
  
  
  METHODS
  A retrospective study of 40 cases of OT in 38 children under 16 years of age, excluding adnexal torsions in neonates.
  
  
  RESULTS
  Abdominal and/or pelvic pain was the presenting symptom ; 8 of these children had pain between 2 to 9 months prior to surgery and 27/40 (67.5%) had associated vomiting. Before the procedure, ultrasound (US) diagnosed 29 ovarian lesions, related to 14 mature teratomas (MTE) and 10 cystadenomas (CA), one association of MTE and CA in the same ovary, 2 functional cysts and 2 malignant neoplasms. 19/40 torsions could benefit from conservative management. Eleven torsions occurred, 10/11 of these ovaries had an increased volume, and 5/11 had US evidence of small subcortical cysts. Three detorsions with incomplete removal of CA were followed by enlargement of the tumor and re-torsion in 2 of them. Five children had bilateral ovarian pathology which led to unilateral ovariectomy, while the other benefited from conservative treatment.
  
  
  CONCLUSIONS
  In any girl presenting with abdominal pain, the diagnosis of an ovarian torsion must be considered. US is performed emergently, but only surgery, most often a laparoscopic procedure, assures diagnosis. The treatment of the torsion is an emergency and must be as conservative as possible in order to preserve the ovarian function. Bilateral torsions are not unusual.
authors.affiliation: Department of Pediatric Surgery, Hopital Necker-Enfants Malades, Paris, France. richardmassicot@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Rousseau
authors.forename: R
authors.initials: R
authors.lastname: Massicot
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Darwish
authors.forename: F
authors.initials: F
authors.lastname: Sauvat
authors.forename: S
authors.initials: S
authors.lastname: Emond
authors.forename: E
authors.initials: E
authors.lastname: Thibaud
authors.forename: C
authors.initials: C
authors.lastname: Nihoul-Fékété
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010049:Ovarian Diseases / Q000150:complications / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000150:complications / Q000601:surgery*; D010052:Ovariectomy; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000601:surgery*