title: Cannot exclude torsion--a 15-year review.
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%]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Anne
authors.initials: A
authors.lastname: Fischer
authors.forename: Robert
authors.initials: R
authors.lastname: Barber
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.forename: Barry
authors.initials: B
authors.lastname: Hicks
authors.forename: Nilda
authors.initials: N
authors.lastname: Garcia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010049:Ovarian Diseases / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000175:diagnosis* / Q000601:surgery