Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls.

BACKGROUND/PURPOSE: Consensus has not been reached regarding the treatment of ovarian torsion in premenarchal girls. If viable adnexa can be salvaged, the future reproductive potential of the girl is maximized. The authors determined the predominant etiology, evaluated the restoration of ovarian function and anatomic structure postoperatively in premenarchal girls with adnexal torsion, and discuss the most appropriate treatment.

METHODS

Sixty-six premenarchal girls with twisted adnexa underwent salpingoophorectomy (27 cases), or detorsion and adnexal conservation surgery (39 cases), according to the extent of adnexal damage found intraoperatively. These patients' data were collected and analyzed. The typical presentation, predominant etiology, surgical outcome, and restoration of ovarian function postoperatively were investigated.

RESULTS

Of all torsive ovaries, histopathology verified that 2 (3.0%) cases were malignant, 8 (12.1%) cases were normal, and 56 (84.9%) cases were benign. After operation and menarche, ultrasound showed that the involved ovaries were of normal size with normal follicular development in 33 of the 35 (94.3%) patients who received detorsion and adnexal conservation surgery. In the remaining two (5.7%) of the 35 detorsion patients, the affected ovaries were atrophied (small sized) and there was no ultrasound evidence of follicular development.

CONCLUSIONS

Premenarchal girls with adnexal torsion more commonly had a benign ovarian tumor or no underlying abnormality as an etiology; ovarian malignancy was rare. In the management of these cases, detorsion and adnexal conservation surgery should be considered in cases with adnexa appearing to be ischemic or hemorrhagic infarction.