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      Laparoscopic Management of a Rare Case of Spontaneous Adnexal Torsion in an Adolescent

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          Abstract

          The occurrence of spontaneous torsion of normal ovary and fallopian tube in an adolescent is very rare. We report a case of a 14-year-old post-menarche teenager who presented as acute abdomen. Here, we discuss the differential diagnosis of acute pain abdomen, importance of immediate diagnostic laparoscopy and prompt decision for de torsion of the ovarian pedicle and mesoalphinx to salvage the fallopian tube and ovary, which has a bearing on future reproduction. The teenager is on follow-up for 4 years and has regular cycles and no recurrence of the symptoms.

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          Ovarian torsion.

          Darrell L Cass (2005)
          Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Ultrasound scan remains the most useful investigation, but blood flow on Doppler examination does not exclude ovarian torsion. Current recommendations of treatment strongly support ovary conservation, and macroscopic appearance of the ovary is not a reliable indicator of the degree of necrosis and potential for ovary recovery. For children with ovarian torsion, laparoscopic detorsion should be performed with strong consideration of oophoropexy. An underlying ovary lesion such as mature teratoma or functional cyst is found in most cases; however, the risk of cancer in these patients is extremely low. If there is concern of a mass or underlying pathology, then follow-up ultrasound, resolution of edema and interval laparoscopic treatment may be required.
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            Laparoscopic management of adnexal torsion. A review of 35 cases.

            J-L Pouly, M Bruhat, G Mage … (1989)
            Laparoscopic management was used for 35 cases of adnexal torsion. Since early diagnosis and treatment are necessary to preserve the adnexa, laparoscopy is the best procedure for diagnosing this rare condition. In 27 cases (77%) conservative treatment was carried out, with only 1 recurrence. Complete laparoscopic treatment was achieved in 27 cases (77%), including 3 of endoscopic salpingectomy. Laparotomy was indicated in cases of gangrenous adnexa, organic ovarian cyst and unusual ovarian attachment.
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              Transvaginal sonography of adnexal masses.

              Carrie Coleman (1992)
              In conclusion, the clinical utility of TVS has expanded since its inception so that numerous gynecologic applications now exist. TVS has most certainly had a major impact upon the diagnosis of adnexal disease. The addition of duplex and color Doppler capability to vaginal probes has expanded further the scope of TVS. In our laboratory, TVS is used as an adjunctive tool to complement TAS in cases of inadequate bladder distention, incomplete evaluation of the pelvis, and equivocal findings that require improved visualization for diagnosis. TVS is now recognized as the procedure of choice in the evaluation of patients who have a suspected ectopic pregnancy. It also can be used as the initial procedure in the follow-up of a known adnexal process. This article has emphasized how TVS can contribute to the diagnosis of cystic, complex, and solid adnexal masses. With continued technologic advancements, additional applications for TVS are likely to emerge.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Gynecol Endosc Surg
                Journal ID (iso-abbrev): J Gynecol Endosc Surg
                Journal ID (publisher-id): JGES
                Title: Journal of Gynecological Endoscopy and Surgery
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-1216
                ISSN (Electronic): 0974-7818
                Publication date (Print): Jul-Dec 2011
                Volume: 2
                Issue: 2
                Pages: 109-111
                Affiliations
                [1]Department of Obstetrics and Gynaecology, Sevashetra Hospital, Bangalore, India
                [1 ]Department of Pediatric Surgery, Sevashetra Hospital, Bangalore, India
                Author notes
                Address for correspondence: Dr. PN Shakuntala, 119, 28 th Cross, 12 th Main, BSK 2 nd Stage, Bangalore - 560 070, India. E-mail: shakuntala_pn@ 123456yahoo.co.in
                Article
                Publisher ID: JGES-2-109
                DOI: 10.4103/0974-1216.114164
                PMC ID: 4453206
                SO-VID: 11f2c2ea-3547-43d7-9afd-772a27b1ffa8
                Copyright © Copyright: © Journal of Gynecological Endoscopy and Surgery
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: adnexal torsion,adolescent,diagnostic laparoscopy
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: adnexal torsion, adolescent, diagnostic laparoscopy

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