Pediatric Ovarian Torsion on Point-of-Care Ultrasound

Scheier, Eric; Balla, Uri

doi:10.1097/pec.0000000000002522

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Scheier and Levy in 2023 described a similar phenomenon where each traction attempt returned transient and pulsatile blood flow to the testicle despite the manual detorsion failing. 10 Our case was consistent with what was described in the first case series reporting use of this technique. 9 The traction technique in our case was employed as an adjunct maneuver, which removed the resistance felt during the initial detorsion attempt using standard methods.…”

Section: Articles In Presssupporting

confidence: 91%

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report

Trang,

Brinkerhoff

2024

Clinical Practice and Cases in Emergency Medicine

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Introduction: Recognizing testicular torsion is extremely important in patients presenting to the emergency department (ED) with acute scrotal pain. Traditional manual detorsion techniques are frequently employed by emergency physicians but are not always successful. Delays in detorsion increase the risk of testicular infarction and infertility, and the need for orchiectomy. Novel techniques such as the testicular traction technique have been described as a potential solution for difﬁcult-to-detorse testicles. Case Report: Our case report describes a 20-year-old male with no signiﬁcant past medical history who presented to a rural ED with acute, atraumatic testicular pain secondary to testicular torsion with an intact cremasteric reﬂex. After conﬁrming the diagnosis using Doppler ultrasound, manual detorsion using the traditional “open book” technique was attempted and unsuccessful. The patient was subsequently successfully detorsed using the novel testicular traction technique. Conclusion: The testicular traction technique is a safe, rapid, and effective primary or adjunctive technique in manual testicular detorsion. Given the time-sensitive nature of testicular torsions, adjunctive techniques play a crucial role in managing challenging detorsions, particularly in resource-limited rural settings with limited access to urologic services. Although it is commonly thought that the cremasteric reﬂex is absent in testicular torsions, it may be present in rare circumstances, and its presence should not be an absolute in ruling out torsion.

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Section: Articles In Presssupporting

confidence: 91%

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report

Trang,

Brinkerhoff

2024

Clinical Practice and Cases in Emergency Medicine

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“…Computed tomography has reported a 90%-100% sensitivity and an 85%-90% specificity, but it has a disadvantage of radiation exposure 34,36) . For this reason, US is considered the imaging modality of choice 15,[36][37][38][39] . Magnetic resonance imaging has an 81% sensitivity and a 91% specificity, and has the advantage of no radiation exposure like US 37) .…”

Section: Discussionmentioning

confidence: 99%

Premenarchal ovarian torsion

Eilbert

Nguyen

2023

Pediatr Emerg Med J

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“…While absence of an enlarged ovary without a full bladder has been suggested to exclude ovarian torsion, 43 bowel gas can obscure the torsed ovary 32 and a rapid intravenous fluid bolus prior to sonography can increase diagnostic accuracy.…”

Section: Point-of-care Ultrasoundmentioning

confidence: 99%

Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights

Scheier¹

2022

OAEM

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Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.

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Pediatric Ovarian Torsion on Point-of-Care Ultrasound

Abstract: Supplemental digital content is available in the text.

Cited by 3 publications

References 24 publications

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report

Premenarchal ovarian torsion

Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights

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