title: Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls.
abstract: OBJECTIVE
  To describe the clinical characteristics and treatment of ovarian torsion in premenarchal girls with surgically verified ovarian torsion.
  
  
  METHODS
  A retrospective cohort study design was used. The medical charts of all premenarchal girls with surgically verified ovarian torsion treated in a university-affiliated tertiary medical center from 1997 to 2012 were reviewed for clinical, treatment, and outcome data.
  
  
  RESULTS
  Thirty-two premenarchal girls were identified. Their median age was 9 years. There were 7 recurrences during the study period (17.9%), for a total of 39 cases. The main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). Physical examination revealed abdominal tenderness in 25 cases (64.1%). Abdominal ultrasound, performed in 31 patients (38 cases), yielded pathologic findings in 28 (73.7%), mainly an enlarged ovary (11 cases, 28.9%). Doppler flow studies were abnormal in 15 cases. In 26 cases (68.4%), the tentative preoperative working diagnosis was ovarian torsion. Laparoscopy was performed in 26 cases, laparotomy in 10, and laparoscopy converted to laparotomy in 3 cases. Conservative management, mainly with additional cyst drainage or cystectomy, was used in 37 cases (95.2%) with oophoropexy in 5 cases. Two patients required oophorectomy because of a suspected neoplasm and severe ovarian necrosis. Pathologic examination demonstrated 5 simple cysts, 1 necrotic ovary, and 1 mature cystic teratoma.
  
  
  CONCLUSIONS
  Ovarian torsion in premenarchal girls is associated with nonspecific signs and symptoms. Abdominal ultrasound and Doppler imaging may assist in the diagnosis. Laparoscopy with conservative management is preferred. Owing to the high recurrence rate, oophoropexy may be considered.
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Krissi
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Saharon
authors.initials: S
authors.lastname: Less
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ram
authors.initials: R
authors.lastname: Eitan
authors.affiliation: Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dr.peled@gmail.com.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Peled
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D003884:Dermoid Cyst / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D009325:Nausea / Q000209:etiology; D010049:Ovarian Diseases / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D010052:Ovariectomy; D010808:Physical Examination; D012008:Recurrence; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D014839:Vomiting / Q000209:etiology
keywords: Adnexal torsion; Conservative surgery; Ovarian torsion; Premenarche; Ultrasound