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


METHODS
Descriptive, retrospective chart review.


METHODS
Academic children's hospital.


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


METHODS
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.
Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Brooke V
BV
Rossi
Division of Gynecology, Departments of Medicine and Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Elisabeth H
EH
Ference
Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
David
D
Zurakowski
Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Stefan
S
Scholz
Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Neil R
NR
Feins
Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Jeanne S
JS
Chow
Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Gynecology, Departments of Medicine and Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: Marc.laufer@childrens.harvard.edu.
Marc R
MR
Laufer
D059787:Acute Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005184:Fallopian Tube Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006176:Gynecology; D006801:Humans; D007964:Leukocytosis / Q000209:etiology; D009325:Nausea / Q000209:etiology; D010049:Ovarian Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy; D010370:Pediatric Assistants; D017699:Pelvic Pain / Q000209:etiology*; D010808:Physical Examination; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D058994:Salpingectomy; D013610:Tachycardia / Q000209:etiology; D013997:Time Factors; D014102:Torsion Abnormality / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D014839:Vomiting / Q000209:etiology; D055815:Young Adult