75. Ovarian Function in Paediatric and Adolescent Ovarian Torsion- Effect of immediate cystectomy

2021 ◽  
Vol 34 (2) ◽  
pp. 269
Author(s):  
Niamh Murphy ◽  
Sari Kives ◽  
Lisa Allen
Keyword(s):  
Ovarian Function ◽  
Ovarian Torsion ◽  
Torsion Effect

Ovarian function in pediatric and adolescent ovarian torsion: effect of immediate cystectomy

2021 ◽  
Vol 43 (5) ◽  
pp. 672
Author(s):  
Niamh Murphy ◽  
Anton Svendrovski ◽  
Sari Kives ◽  
Lisa Allen
Keyword(s):  
Ovarian Function ◽  
Ovarian Torsion ◽  
Torsion Effect

scholarly journals Cases of management of paediatric tubo-ovarian torsion

2019 ◽  
Vol 8 (7) ◽  
pp. 2888 ◽  
Author(s):  
Ruchi Bhandari ◽  
Manju Khemani ◽  
Asif Mustafa
Keyword(s):  
Fallopian Tube ◽  
Ovarian Function ◽  
Case Series ◽  
Conservative Surgery ◽  
Paediatric Population ◽  
Ovarian Torsion ◽  
Vascular Compromise ◽  
Laparoscopic Cystectomy ◽  
Paediatric Age ◽  
Loss Of Appetite

Ovarian torsion is the fifth most common cause of gynaecologic surgical emergency. It warrants early diagnosis as timely surgical management will avoid the further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation. This leads to delay in surgical exploration and loss of ovarian function. In these cases, the ovary and often the ipsilateral fallopian tube twist with the vascular pedicle, resulting in vascular compromise. Unrelieved torsion leads to haemorrhagic infarction. We encountered 3 cases of ovarian torsion in paediatric age group during a period of 12 months. All cases presented with acute pain abdomen for 3-7 days period with loss of appetite and unable to pass motion with varied disappearance of pain. On ultrasound all the cases were diagnosed with ovarian cyst with torsion and underwent laparoscopic cystectomy. This case series is written just to show the results of de-torsion and conserving the fallopian tube and ovary after vascular damage. This type of conservative management may give chance to ovary to return to viability. This was seen in all 3 cases dealt by us on repeat scan on follow up. Even on de-torsion if ovary does not regain its colour immediately it should be conserved, and cystectomy should be performed rather than oophorectomy. Conservative surgery, in the form of ovarian de-torsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.

scholarly journals Case series of paediatric adnexal torsion: rare yet urgent entity

2016 ◽  
Vol 6 (1) ◽  
pp. 315 ◽  
Author(s):  
Vineet Mishra ◽  
Shaheen Hokabaj ◽  
Priyankur Roy ◽  
Rohina Aggarwal ◽  
Bhumika Vyas ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Series ◽  
Conservative Surgery ◽  
Paediatric Population ◽  
Ovarian Torsion ◽  
Care Hospital ◽  
Paediatric Age ◽  
High Degree

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.

Usefulness of Grey Scale and Doppler transvaginal sonography in diagnosis of ovarian torsion

2020 ◽  
Vol 14 (2) ◽  
pp. 97-102
Author(s):  
Khalid Rehman `Yousaf ◽  
Shahzad Saeed ◽  
Saman Chaudhry ◽  
Rabia Bashrat ◽  
Abadullah Khalid ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Ovarian Function ◽  
Imaging Modality ◽  
Ovarian Torsion ◽  
Transvaginal Sonography ◽  
Predictive Values ◽  
Grey Scale ◽  
Sensitivity Specificity

Background: Ovarian torsion diagnosis is a great challenge as delay in diagnosis can cause severe morbidity. Early accurate diagnosis is crucial to preserve ovarian function. Ultrasonography being the primary imaging modality plays a vital role in the evaluation of suspected ovarian torsion by helping surgeons reach the correct diagnosis, thus avoiding unnecessary intervention. This study aims to determine the diagnostic accuracy of isolated and combined sonographic features of ovarian torsion on grey scale and Doppler transvaginal ultrasonography. Patients and methods: From radiology database, from January 2016 till December 2019, sonographic signs of ovarian torsion in 113 women with suspected ovarian torsion on ultrasonography and subsequent surgical diagnosis were evaluated. Ultrasound findings were compared with surgical findings to determine the accuracy, sensitivity, specificity, and positive and negative predictive values of individual and combined ultrasound signs. Results: Diagnostic accuracy of ultrasound for ovarian torsion was 85.8%. Abnormal ovarian Doppler flow was the most accurate individual sonographic sign with accuracy, sensitivity, specificity and positive predictive value of 85.8%, 83.5%, 100% and 100% respectively followed by ovarian enlargement and ovarian edema. Combined ultrasound signs resulted in higher sensitivity and positive predictive values, and lower specificity and negative predictive values for ovarian torsion. Increasing the number of sonographic parameters increased the specificity but decreased sensitivity. High accuracy, sensitivity, positive predictive value, specificity and negative predictive value was seen when combination of three or two sonographic parameters was used as diagnostic criteria. Conclusion: Transvaginal sonography is a convenient, reliable and extremely useful imaging modality for preoperative diagnosis of ovarian torsion with high specificity, sensitivity, positive predictive value and diagnostic accuracy helping treating physicians to take prompt decisions regarding timely surgical intervention. However, due to low negative predictive values, absence of sonographic signs does not rule out ovarian torsion and high index of clinical suspicion remains of utmost importance.

scholarly journals Legal Implication of Ovarian Cysts in Prepuberal Girl

2020 ◽  
Vol 5 (7) ◽  
Keyword(s):  
Ovarian Cyst ◽  
Ovarian Function ◽  
Clinical Course ◽  
Lower Abdominal Pain ◽  
Ovarian Torsion ◽  
Ovarian Cysts ◽  
Legal Implications ◽  
Extra Weight ◽  
The Right ◽  
Legal Implication

Ovarian torsion is a condition that can occur in a normal ovary, but it is more likely to happen when the presence of a cyst or other tissues (tumor) in the ovary can displace it. The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments. Ovarian torsion can cause severe pain, more frequently on the right-hand side. However, in some cases, the clinical course is prolonged, as the torsion can be intermittent. Early diagnosis and surgery are essential to protect ovarian and tubal function and prevent severe morbidity ending with annessiectomy. The ovarian cyst is an insidious risk factor for ovarian torsion and can cause sudden lower abdominal pain and loss of ovarian function with possible legal implications and malpractice. A timely diagnosis of ovarian cyst is of paramount importance to prevent necrosis and preserve ovarian viability. To avoid such a dangerous complication, it is essential the preventive management of the cyst. A cyst becomes a problem when it does not go away or gets bigger. The treatment of ovarian cysts depends on several factors but the size of the cyst and its appearance need to be monitored.

scholarly journals Ischemia modified albumin in experimental ovarian torsion with and without controlled reperfusion

2019 ◽  
Vol 27 (1) ◽  
pp. 43-50
Author(s):  
Cornelia Lazăr ◽  
Marin Vozian ◽  
Valeriana Pantea ◽  
Ana Mișina ◽  
Olga Tagadiuc
Keyword(s):  
Ovarian Function ◽  
Ovarian Torsion ◽  
Female Rats ◽  
Ischemia Modified Albumin ◽  
Ischemia Group ◽  
Group 3 ◽  
Ischemic Diseases ◽  
Opening And Closing ◽  
Controlled Reperfusion ◽  
Group 1

Abstract Purpose: Ovarian torsion, being a gynecological emergency, requires to be rapidly diagnosed and treated with minimal consequences on ovarian function after the removal of torsion. As ischemia modified albumin (IMA) is considered a good biomarker in diverse ischemic diseases, the aim of our study was to determine the effect of different ovarian torsion/detorsion models on serum and ovarian homogenates levels of IMA in an experimental study. Methods: IMA was measured in the serum and ovarian homogenates of 7 groups of female rats (10 animals in each group): 1 - control (no intervention); 2 - sham (only laparotomy); 3 - ischemia group: 3 hours ovarian torsion (OT); 4 - 3 hours OT (ischemia), 1 hour simple reperfusion; 5 - 3 hours ischemia, 1 hour controlled reperfusion that was assured during the first two minutes by opening and closing the clips on the ovarian pedicles in 10 seconds intervals, followed by simple reperfusion; 6 - 3 hours ischemia, 24 hours simple reperfusion; 7 - 3 hours OT, 24 hours controlled reperfusion. The results were analyzed by Welch’s ANOVA and Spearman correlation. Results: Ischemia increases the IMA in both serum and ovarian homogenates compared to control and sham groups. The controlled reperfusion groups had a statistically significant lower IMA in serum compared to simple reperfusion groups. IMA was found to be higher in the ovarian homogenates of simple reperfusion compared to controlled reperfusion groups. Conclusion: Our results suggest that controlled reperfusion prevent the processes that increase the IMA in ovarian torsion.

scholarly journals Novel CYP19A1 Mutations Extend the Genotype-Phenotype Correlation and Reveal the Impact on Ovarian Function

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Valiyaparambil Pavithran Praveen ◽  
Asmahane Ladjouze ◽  
Kay-Sara Sauter ◽  
Annie Pulickal ◽  
Efstathios Katharopoulos ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Ovarian Tissue ◽  
Pubertal Development ◽  
Ambiguous Genitalia ◽  
Ovarian Torsion ◽  
Aromatase Activity ◽  
Loss Of Function ◽  
Polycystic Ovaries ◽  
Female Patients ◽  
The Impact

Abstract Context The steroidogenic enzyme aromatase (CYP19A1) is required for estrogen biosynthesis from androgen precursors in the ovary and extragonadal tissues. The role of aromatase, and thus estrogens, is best illustrated by genetic variations of the CYP19A1 gene leading to aromatase deficiency or excess. Objective The objective of this work is to characterize novel CYP19A1 variants. Design, setting, and patients Variants causing aromatase deficiency were suspected in four 46,XX children of African and Indian origin by careful clinical phenotyping. Sequencing of the CYP19A1 gene identified novel variants. Minigene experiments, aromatase activity assay, and computational, and histological analysis were used to characterize the variants. Main outcome measure and results CYP19A1 variants were found in all patients: a deletion in intron 9 leading to p.P423_H503del, a delins variant at p.P154, and point variants p.V161D, p.R264C, p.R375C. Except for R264C, all variants showed a loss of function. Protein structure and dynamics studies were in line with functional assays. The 2 female patients with delins variants manifested with ambiguous genitalia at birth. Histologic investigation revealed normal ovarian tissue on one side and a streak gonad on the other. Two female patients presented with abnormal pubertal development and polycystic ovaries. Conclusion In girls, aromatase deficiency usually manifests at birth, but diagnosis may also be made because of abnormal pubertal development or ovarian torsion due to (poly)cystic ovaries. The ovary harboring CYP19A1 variants may present as streak gonad or appears normal at birth, but is then at very high risk to produce cysts with aging and is therefore prone to ovarian torsion.

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