title: Similar But Different: A Comparison of Adnexal Torsion in Pediatric, Adolescent, and Pregnant and Reproductive-Age Women.
abstract: BACKGROUND
  We sought to investigate and compare the clinical presentation, ultrasound findings, surgical characteristics, and causes of adnexal torsion among three groups: pediatric and adolescent population, reproductive-age women, and pregnant women.
  
  
  METHODS
  Two hundred twenty-seven surgically confirmed episodes of adnexal torsion in 199 patients treated in our department from January 2008 to December 2014 were retrospectively analyzed.
  
  
  RESULTS
  Abdominal pain duration of >24 hours before emergency room presentation was more common in pediatric and adolescent patients compared with reproductive-age and pregnant women (42.3% vs. 28.4% and 15.5%, respectively, p = 0.04). However, there was no difference between the groups in the time interval from their emergency room admission to surgery. Torsion of "normal adnexa" occurred in 11/44 (25.0%) of pediatric and adolescent patients, 30/99 (30.3%) of reproductive-age patients, and 12/56 (21.4%) of pregnant patients, while torsion involving multicystic ovaries occurred in 0%, 4%, and 32.1%, respectively, torsion involving paraovarian cysts occurred in 20.5%, 14.1%, and 1.8%, respectively, and torsion involving benign dermoid cysts occurred in 4.5%, 15.2%, and 5.4%, respectively (p < 0.001). Torsion involving supposedly functional ovarian cysts occurred in 45.5%, 34.3%, and 69.6%, respectively (p < 0.001). The torsion recurrence rates were 18.2% in the pediatric subjects, 19.2% in reproductive-age women, and 10.7% in pregnant women (p = 0.3).
  
  
  CONCLUSIONS
  The presentation of adnexal torsion is similar in pediatric and reproductive-age and pregnant women, although the underlying adnexal pathology may be different. Functional ovarian cysts cause the majority of torsion cases in pregnant women. Recurrence of torsion may occur in any age group.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Melcer
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Tal
authors.initials: T
authors.lastname: Sarig-Meth
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Ron
authors.initials: R
authors.lastname: Maymon
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Moty
authors.initials: M
authors.lastname: Pansky
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vaknin
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Affiliated with the Tel-Aviv University , Sackler School of Medicine, Zerifin, Israel .
authors.forename: Noam
authors.initials: N
authors.lastname: Smorgick
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000290:Adnexa Uteri / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011247:Pregnancy; D037841:Pregnant People; D012189:Retrospective Studies; D012307:Risk Factors; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color