Adnexal Torsion in Adolescents: A Case Series

Abstract

Aim:The purpose of the study is to discuss about the presentation and management of adolescent adnexal torsion at ESIC Medical College and PGIMSR. Materials and methods: This is a case series study of adolescents with adnexal torsion, from December 2019 to March 2022 at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India. Detailed history and clinical examination followed by ultrasonography with Doppler pelvis were done. The type of surgery and the histopathological findings were studied. Written informed consent was taken from all the subjects for publishing the data and images. Results: All patients presented with acute onset of abdominal pain. Eight patients had vomiting. Six patients had right-sided torsion and four patients had left-sided torsion. Laparotomy was done for nine cases. A laparoscopy was done for one case. Only two patients underwent salpingo-oophorectomy due to necrotic changes. The ovary was preserved in eight patients. Two patients had oophoropexy done. One was for recurrent torsion and the other case had undue long ovarian ligament and fallopian tube. Conclusion: Adnexal torsion is a gynecological emergency and requires early surgical intervention. Adnexal torsion in adolescents is usually due to benign functional ovarian cysts and benign teratoma. Malignant ovarian tumors are rare in the adolescent age-group. The goals of surgery are detorsion and preservation of the ovary regardless of its appearance at the time of surgery. Oophorectomy is required only when the ovary is severely necrotic and falls apart. Clinical Significance: Minimally invasive surgical approach with detorsion of adnexa and avoiding oophorectomy will lead to preservation of adnexal structures and their function.

The Role of Neutrophil/Lymphocyte Ratio in Ovarian Torsions

“…Another study reported an increase in WBC levels in patients with ovarian torsion (19). In our study, we found that WBC values were significantly higher in the ovarian torsion group than in other groups.…”

“…Mazouni et al found that an increase in white blood cell (WBC) count was observed in 36.50%-64.00% of patients diagnosed with adnexal torsion(18). Another study reported an increase in WBC levels in patients with ovarian torsion(19). In our study, we found that WBC values were significantly higher in the ovarian torsion group than in other groups.…”