|
 
 |
| REVIEW ARTICLE |
|
| Year : 2017 | Volume
: 29
| Issue : 3 | Page : 143-147 |
|
A review of ovary torsion
Ci Huang1, Mun-Kun Hong2, Dah-Ching Ding2
1 Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
2 Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| Date of Submission | 29-Mar-2017 |
| Date of Decision | 07-Apr-2017 |
| Date of Acceptance | 02-May-2017 |
| Date of Web Publication | 14-Sep-2017 |
Correspondence Address:
Dah-Ching Ding
Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, Hualien
Taiwan
 Source of Support: None, Conflict of Interest: None  | 13 |
DOI: 10.4103/tcmj.tcmj_55_17
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
Keywords: Abdominal pain, Ovarian cyst, Ovarian torsion, Pelvic pain, Ultrasound
How to cite this article:
Huang C, Hong MK, Ding DC. A review of ovary torsion. Tzu Chi Med J 2017;29:143-7 |
| Introduction | |  |
Ovarian torsion, which affects females of all ages, is a gynecological emergency [1],[2],[3]. It refers to a complete or partial rotation of the adnexal supporting organ, resulting in ischemic changes in the ovary. Torsions more commonly involve both the ovary and Fallopian tube More Details, and there are fewer cases of isolated torsion involving either one (one in 1.5 million women) [4],[5],[6]. Torsion involving paratubal or paraovarian cysts has also been found [2],[7],[8]. Early diagnosis and surgery are essential to protect ovarian and tubal function and prevent severe morbidity [9],[10].
| Infundibulopelvic and Utero-ovarian Ligaments | | |
The infundibulopelvic ligaments suspend the movable ovary, allowing the ovary to position laterally or posteriorly to the uterus. The ovarian vessels travel along the infundibulopelvic ligaments which attach to the pelvic sidewall. Because adnexal tissue is not fixed, a big leading point, such as tumorous growth, can induce twisting. The other side of the ovary is connected to the uterus by the utero-ovarian (UO) ligament. The UO ligament is composed of muscular and fibrous tissue. The function of the UO ligament is to connect the ovary to the uterus and support it, and it also supplies blood from the uterine artery to the ovary [11].
| Pathogenesis | | |
Ovarian torsion occurs when an ovarian cyst or mass presents and rotates both the infundibulopelvic ligament and the UO ligament. The cyst or mass is usually a benign lesion over 5 cm in diameter [12],[13],[14],[15]. Torsion can also occur in normal ovaries, however, particularly in premenarchal girls who have elongated infundibulopelvic ligaments [16],[17],[18]. However, the occurrence of ovarian torsion may decrease thereafter because the ligament shortens when premenarchal girls mature to puberty.
| Epidemiology | | |
A 10-year review of 128 patients with adnexal torsion states that 2.7% of emergency surgery cases involved ovarian torsion [19]. Another 10-year study showed that 15% of 135 patients with surgically treated adnexal masses had torsion [20]. Totally, around 2%–15% of patients who had surgical treatment of adnexal masses had ovarian torsion. Most ovarian torsion occurs in the reproductive age group, and it is less common in premenarchal girls and postmenopausal women (17.2% of cases) [21].
Risk factors
More than 80% patients with ovarian torsion had ovarian masses of 5 cm or larger, indicating that the primary risk in ovarian torsion is an ovarian mass [12],[15],[22]. The sizes of ovarian masses are correlated with the risk of the torsion. Ovarian torsion has been reported to occur with masses from 1 to 30 cm (mean 9.5 cm) [15], but it can happen with any size mass. Ovulation induction for treatment of infertility may cause multiple large ovarian follicular cysts; the large cysts carry an increased risk of torsion [23].
Benign and malignant tumors in ovarian torsion
Ovarian torsion is more likely to occur with a benign tumor than in a malignancy. The incidence of ovarian torsion with ovarian malignancy was <2% in reported case series [13],[22],[24],[25].
Ovarian torsion in the premenarchal population
Compared with older women, premenarchal girls with ovarian torsion are more commonly found to have a normal ovary [26]. More than 50% of patients under 15 years old with torsion have normal ovaries [24],[27]. Torsion occurred more in patients with normal adnexa (7/11) than those with abnormal adnexa (4/46) [14].
Ovarian torsion in pregnancy
About 10%–22% of ovarian torsion occurred in pregnancy [15],[22],[24],[28]. The incidence is higher at 10–17 weeks of gestation with ovarian masses larger than 4 cm [29],[30]. Pregnant women with adnexal masses 4 cm or greater had a 1%–6% lower incidence of torsion compared with nonpregnant women [31],[32].
Summary of epidemiology and risk factors
The incidence of ovarian torsion ranges from 2% to 15% in patients who have surgical treatment of adnexal masses. Ovarian tumors larger than 5 cm carry a risk of ovarian torsion. About 10%–22% of ovarian torsion occurs in pregnant women.
| Clinical Presentation | | |
Ovarian torsion due to an adnexal mass causes various symptoms and signs on clinical presentation. The most common symptom is acute onset of lower abdominal pain, followed by nausea and vomiting [15],[22],[24],[33],[34],[35]. Some patients experience waves of nausea with or without vomiting [15],[22],[24],[33]. The abdominal pain is usually off and on with a sudden onset. Most reported patients presented for evaluation 1 or more days up as late as 210 days after pain onset [15],[22],[36],[37]. Premenarchal patients tended to mention diffuse pain because it was difficult for them to localize the pain [38]. The uncomfortable symptoms and signs were considered to be caused by the adnexal torsion. Ovarian torsion without infective disease resulting in a low-grade fever has been found in some patients [15],[22],[24],[33].
| Evaluation and Diagnosis | | |
On clinical presentation, the first approach to a patient is a medical history and physical examination. The medical history should include any recent diagnosis of an adnexal mass, recurrent abdominal pain, and low-grade fever. The physical examination should include a search for a pelvic mass or pain. Laboratory evaluation should include serum human chorionic gonadotropin, a hematocrit, white blood cell count, and electrolyte panel.
There is no serum marker for a diagnosis of adnexal torsion. Several serum markers can hint at an adnexal tumor type. Serum human chronic gonadotropin can reveal pregnancy or an ovarian germ cell tumor. CA-125 may indicate a malignant ovary tumor or endometrioma. Some studies have found an association between an increased level of serum interleukin-6 and ovarian torsion [39],[40], although further research such as oxidative stress during ovarian torsion is needed [41].
Imaging studies are the most important when evaluating a pelvic mass [42]. Ultrasonography is the first-line diagnostic assessment. A torsed ovary may be rounded and enlarged compared with the contralateral ovary, because of edema or vascular and lymph engorgement [43],[44]. An ultrasound can easily distinguish an ovarian mass by its components, location, density, Doppler flow, and size. There can be decreased or absent Doppler flow in the vessels of a torsed ovary [45],[46],[47]. One prospective study reported that Doppler flow has high sensitivity and specificity [48]; another retrospective study showed low sensitivity and high specificity in the diagnosis of ovarian torsion [26]. It is not the gold standard for diagnosis, but it is a good tool. Two other studies suggested that a whirlpool sign is highly sensitive for ovary torsion [49],[50]. The whirlpool sign shows a twisted vascular pedicle, and a Doppler sonogram reveals circular vessels within the mass. However, further study on the diagnosis of ovarian torsion is necessary to determine the usefulness of this sign in ovary torsion.
Magnetic resonance imaging (MRI) is expensive but helpful in diagnosing ovarian torsion if findings on ultrasound are equivocal [51],[52],[53],[54],[55],[56],[57]. MRI can demonstrate the components of a mass in more detail than an ultrasound. Computed tomography (CT), however, is not typically used in ovary torsion because of radiation and density, but patients with acute abdominal or pelvic pain need to undergo CT to exclude diagnoses such as appendicitis, diverticulitis, and others.
Finally, direct visualization is needed for a definitive diagnosis of ovary torsion. Hence, the diagnosis needs to be surgical proven for early rescue of ovary function.
| Management | | |
The gold standard to treat ovary torsion is surgery, and this is also the only way to confirm the torsion. There are two surgical methods, laparoscopy and laparotomy. A laparoscopic approach has become a popular procedure. However, if cancer of the ovary or fallopian tube is suspected, a laparotomy should be done [58],[59]. While performing the surgery, it is necessary to assess ovarian viability and preserve its function. The only way to determine the viability of a torsed ovary during surgery is by gross visual inspection. In the conventional view of point, dark and enlarged ovaries may have vascular and lymphatic congestion, and may seem nonviable. However, multiple studies have suggested that even those black or blue-like ovaries may retain ovarian function following detorsion [60],[61],[62],[63],[64],[65],[66],[67]. Postoperative follow-up with ultrasound showed over 80% of patients had normal follicular development after detorsion [55],[63],[66],[67]. Animal study showed that there may not be total occlusion of the artery in ovarian torsion even with venous and lymphatic congestion [68]. In recent years, the mainstay of the treatment for ovarian torsion has been surgical evaluation and preserving ovarian function. There are many ways to perform the surgery and detorsion and ovarian conservation are almost always recommended now rather than salpingo-oophorectomy [69]. An ovarian cystectomy is often performed for a benign ovarian mass. If malignancy is highly suspected, a salpingo-oophorectomy is needed. According to many observational studies, detorsion is associated with preserved ovarian function [60],[61],[62],[63],[64]. The earlier the approach to torsion, the higher is the chance to preserve function. An animal study showed that necrosis might develop after occlusion of ovarian vessels for 36 h or longer [68]. After the symptoms have developed, ovarian conservation reportedly decreases with time [27],[65]. No evidence suggests that detorsion increases adverse events postoperatively [70]. Management in pregnant women is similar to that in nonpregnant patients, and laparoscopic surgery is safe for torsion in pregnant women [28],[71],[72],[73]. Neonates with ovarian torsion often present with irritability and the condition can be treated with laparoscopic surgery [74],[75],[76].
| Prevention of Recurrence | | |
There is a risk of recurrence after detorsion, but the incidence and causes are unknown [14],[17],[77],[78],[79]. According to recent research, several methods can be used to decrease the risk of recurrence. One method is suppression of ovarian cysts by oral contraceptives [80],[81],[82],[83]. Another method is an oophoropexy [72],[84],[85]. However, both approaches lack long-term follow-up and systematic study.
| Conclusion | | |
Although the diagnosis of ovarian torsion is difficult and challenging, careful analysis of presenting symptoms (such as sudden onset of lower abdominal pain) is very critical. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery is the mainstay of diagnosis and treatment. Ovarian cystectomy, oophorectomy, or conservative treatment with detorsion can be the treatment of choice.
Acknowledgment
The authors would like to thank Dr. Jon-Son Kuo for English editing.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | McWilliams GD, Hill MJ, Dietrich CS 3 rd. Gynecologic emergencies. Surg Clin North Am 2008;88:265-83, vi.  |
| 2. | Muolokwu E, Sanchez J, Bercaw JL, Sangi-Haghpeykar H, Banszek T, Brandt ML, et al. The incidence and surgical management of paratubal cysts in a pediatric and adolescent population. J Pediatr Surg 2011;46:2161-3. |
| 3. | Huchon C, Fauconnier A. Adnexal torsion: A literature review. Eur J Obstet Gynecol Reprod Biol 2010;150:8-12. |
| 4. | Ding DC, Hsu S, Kao SP. Isolated torsion of the hydrosalpinx in a postmenopausal woman. JSLS 2007;11:252-4. |
| 5. | Antoniou N, Varras M, Akrivis C, Kitsiou E, Stefanaki S, Salamalekis E, et al. Isolated torsion of the fallopian tube: A case report and review of the literature. Clin Exp Obstet Gynecol 2004;31:235-8. |
| 6. | van der Zanden M, Nap A, van Kints M. Isolated torsion of the fallopian tube: A case report and review of the literature. Eur J Pediatr 2011;170:1329-32. |
| 7. | Schrager J, Robles G, Platz T. Isolated fallopian tube torsion: A rare entity in a premenarcheal female. Am Surg 2012;78:118-9. |
| 8. | Said MR, Bamigboye V. Twisted paraovarian cyst in a young girl. J Obstet Gynaecol 2008;28:549-50. |
| 9. | Argenta PA, Yeagley TJ, Ott G, Sondheimer SJ. Torsion of the uterine adnexa. Pathologic correlations and current management trends. J Reprod Med 2000;45:831-6. |
| 10. | Robertson JJ, Long B, Koyfman A. Myths in the evaluation and management of ovarian torsion. J Emerg Med 2017;52:449-56. |
| 11. | Anne A, Dalley A. Grant's Atlas of Anatomy. 13 th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. |
| 12. | Varras M, Tsikini A, Polyzos D, Samara CH, Hadjopoulos G, Akrivis CH, et al. Uterine adnexal torsion: Pathologic and gray-scale ultrasonographic findings. Clin Exp Obstet Gynecol 2004;31:34-8. |
| 13. | Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion – A 15-year review. J Pediatr Surg 2009;44:1212-6. |
| 14. | Pansky M, Smorgick N, Herman A, Schneider D, Halperin R. Torsion of normal adnexa in postmenarchal women and risk of recurrence. Obstet Gynecol 2007;109:355-9. |
| 15. | Houry D, Abbott JT. Ovarian torsion: A fifteen-year review. Ann Emerg Med 2001;38:156-9. |
| 16. | Celik A, Ergün O, Aldemir H, Ozcan C, Ozok G, Erdener A, et al. Long-term results of conservative management of adnexal torsion in children. J Pediatr Surg 2005;40:704-8. |
| 17. | Germain M, Rarick T, Robins E. Management of intermittent ovarian torsion by laparoscopic oophoropexy. Obstet Gynecol 1996;88:715-7. |
| 18. | Buss JG, Lee RA. Sequential torsion of the uterine adnexa. Mayo Clin Proc 1987;62:623-5. |
| 19. | Hibbard LT. Adnexal torsion. Am J Obstet Gynecol 1985;152:456-61. |
| 20. | Bouguizane S, Bibi H, Farhat Y, Dhifallah S, Darraji F, Hidar S, et al. Adnexal torsion: A report of 135 cases. J Gynecol Obstet Biol Reprod (Paris) 2003;32:535-40. |
| 21. | Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol 2006;49:459-63. |
| 22. | White M, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas 2005;17:231-7. |
| 23. | Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002;267:4-6. |
| 24. | Tsafrir Z, Azem F, Hasson J, Solomon E, Almog B, Nagar H, et al. Risk factors, symptoms, and treatment of ovarian torsion in children: The twelve-year experience of one center. J Minim Invasive Gynecol 2012;19:29-33. |
| 25. | Rotoli JM. Abdominal pain in the post-menopausal female: Is ovarian torsion in the differential? J Emerg Med 2017;52:749-52. |
| 26. | Bar-On S, Mashiach R, Stockheim D, Soriano D, Goldenberg M, Schiff E, et al. Emergency laparoscopy for suspected ovarian torsion: Are we too hasty to operate? Fertil Steril 2010;93:2012-5. |
| 27. | Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Arch Pediatr Adolesc Med 2005;159:532-5. |
| 28. | Ding DC, Chang YH. Laparoendoscopic single-site surgical cystectomy of a twisted ovarian dermoid cyst during early pregnancy: A case report and literature review. Gynecol Minim Invsive Ther 2016;5:173-7. |
| 29. | Johnson TR Jr., Woodruff JD. Surgical emergencies of the uterine adnexae during pregnancy. Int J Gynaecol Obstet 1986;24:331-5. |
| 30. | Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril 2009;91:1895-902. |
| 31. | Bromley B, Benacerraf B. Adnexal masses during pregnancy: Accuracy of sonographic diagnosis and outcome. J Ultrasound Med 1997;16:447-52. |
| 32. | Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME, et al. Adnexal masses in pregnancy: Surgery compared with observation. Obstet Gynecol 2005;105:1098-103. |
| 33. | Huchon C, Panel P, Kayem G, Schmitz T, Nguyen T, Fauconnier A, et al. Does this woman have adnexal torsion? Hum Reprod 2012;27:2359-64. |
| 34. | Karaman E, Beger B, Çetin O, Melek M, Karaman Y. Ovarian torsion in the normal ovary: A diagnostic challenge in postmenarchal adolescent girls in the emergency department. Med Sci Monit 2017;23:1312-6. |
| 35. | Rey-Bellet Gasser C, Gehri M, Joseph JM, Pauchard JY. Is it ovarian torsion? A systematic literature review and evaluation of prediction signs. Pediatr Emerg Care 2016;32:256-61. |
| 36. | Kirkham YA, Lacy JA, Kives S, Allen L. Characteristics and management of adnexal masses in a canadian pediatric and adolescent population. J Obstet Gynaecol Can 2011;33:935-43. |
| 37. | Sasso RA. Intermittent partial adnexal torsion after electrosurgical tubal ligation. J Am Assoc Gynecol Laparosc 1996;3:427-30. |
| 38. | Ashwal E, Hiersch L, Krissi H, Eitan R, Less S, Wiznitzer A, et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients. Obstet Gynecol 2015;126:514-20. |
| 39. | Cohen SB, Wattiez A, Stockheim D, Seidman DS, Lidor AL, Mashiach S, et al. The accuracy of serum interleukin-6 and tumour necrosis factor as markers for ovarian torsion. Hum Reprod 2001;16:2195-7. |
| 40. | Daponte A, Pournaras S, Hadjichristodoulou C, Lialios G, Kallitsaris A, Maniatis AN, et al. Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion. Fertil Steril 2006;85:1469-72. |
| 41. | Laganà AS, Sofo V, Salmeri FM, Palmara VI, Triolo O, Terzić MM, et al. Oxidative stress during ovarian torsion in pediatric and adolescent patients: Changing the perspective of the disease. Int J Fertil Steril 2016;9:416-23. |
| 42. | Dahmoush H, Anupindi SA, Pawel BR, Chauvin NA. Multimodality imaging findings of massive ovarian edema in children. Pediatr Radiol 2017;47:576-83. |
| 43. | Anthony EY, Caserta MP, Singh J, Chen MY. Adnexal masses in female pediatric patients. AJR Am J Roentgenol 2012;198:W426-31. |
| 44. | Wilkinson C, Sanderson A. Adnexal torsion – A multimodality imaging review. Clin Radiol 2012;67:476-83. |
| 45. | Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color doppler sonography: Depiction of twisted vascular pedicle. J Ultrasound Med 1998;17:83-9. |
| 46. | Albayram F, Hamper UM. Ovarian and adnexal torsion: Spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20:1083-9. |
| 47. | Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Sonographic findings of ovarian torsion in children. Pediatr Radiol 2007;37:446-51. |
| 48. | Nizar K, Deutsch M, Filmer S, Weizman B, Beloosesky R, Weiner Z. Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion. J Clin Ultrasound 2009;37:436-9. |
| 49. | Valsky DV, Esh-Broder E, Cohen SM, Lipschuetz M, Yagel S. Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion. Ultrasound Obstet Gynecol 2010;36:630-4. |
| 50. | Vijayaraghavan SB, Senthil S. Isolated torsion of the fallopian tube: The sonographic whirlpool sign. J Ultrasound Med 2009;28:657-62. |
| 51. | Born C, Wirth S, Stäbler A, Reiser M. Diagnosis of adnexal torsion in the third trimester of pregnancy: A case report. Abdom Imaging 2004;29:123-7. |
| 52. | Haque TL, Togashi K, Kobayashi H, Fujii S, Konishi J. Adnexal torsion: MR imaging findings of viable ovary. Eur Radiol 2000;10:1954-7. |
| 53. | Kawakami K, Murata K, Kawaguchi N, Furukawa A, Morita R, Tenzaki T, et al. Hemorrhagic infarction of the diseased ovary: A common MR finding in two cases. Magn Reson Imaging 1993;11:595-7. |
| 54. | Schlaff WD, Lund KJ, McAleese KA, Hurst BS. Diagnosing ovarian torsion with computed tomography. A case report. J Reprod Med 1998;43:827-30. |
| 55. | Kimura I, Togashi K, Kawakami S, Takakura K, Mori T, Konishi J. Ovarian torsion: CT and MR imaging appearances. Radiology 1994;190:337-41. |
| 56. | Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella T, et al. CT features of adnexal torsion. AJR Am J Roentgenol 2007;189:124-9. |
| 57. | Naffaa L, Deshmukh T, Tumu S, Johnson C, Boyd KP, Meyers AB, et al. Imaging of acute pelvic pain in girls: Ovarian torsion and beyond. Curr Probl Diagn Radiol 2017;46:317-29. |
| 58. | Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H, et al. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003;18:2599-602. |
| 59. | Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F, et al. Adnexal torsion: Cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol 2012;162:203-5. |
| 60. | Harkins G. Ovarian torsion treated with untwisting: Second look 36 hours after untwisting. J Minim Invasive Gynecol 2007;14:270. |
| 61. | Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril 1990;53:76-80. |
| 62. | Bider D, Mashiach S, Dulitzky M, Kokia E, Lipitz S, Ben-Rafael Z, et al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. Surg Gynecol Obstet 1991;173:363-6. |
| 63. | Oelsner G, Bider D, Goldenberg M, Admon D, Mashiach S. Long-term follow-up of the twisted ischemic adnexa managed by detorsion. Fertil Steril 1993;60:976-9. |
| 64. | Dolgin SE, Lublin M, Shlasko E. Maximizing ovarian salvage when treating idiopathic adnexal torsion. J Pediatr Surg 2000;35:624-6. |
| 65. | Aziz D, Davis V, Allen L, Langer JC. Ovarian torsion in children: Is oophorectomy necessary? J Pediatr Surg 2004;39:750-3. |
| 66. | Wang JH, Wu DH, Jin H, Wu YZ. Predominant etiology of adnexal torsion and ovarian outcome after detorsion in premenarchal girls. Eur J Pediatr Surg 2010;20:298-301. |
| 67. | Shalev J, Goldenberg M, Oelsner G, Ben-Rafael Z, Bider D, Blankstein J, et al. Treatment of twisted ischemic adnexa by simple detorsion. N Engl J Med 1989;321:546. |
| 68. | Taskin O, Birincioglu M, Aydin A, Buhur A, Burak F, Yilmaz I, et al. The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: An ischaemia-reperfusion rodent model. Hum Reprod 1998;13:2823-7. |
| 69. | Hubner N, Langer JC, Kives S, Allen LM. Evolution in the management of pediatric and adolescent ovarian torsion as a result of quality improvement measures. J Pediatr Adolesc Gynecol 2017;30:132-37. |
| 70. | Zweizig S, Perron J, Grubb D, Mishell DR Jr. Conservative management of adnexal torsion. Am J Obstet Gynecol 1993;168(6 Pt 1):1791-5. |
| 71. | Mathevet P, Nessah K, Dargent D, Mellier G. Laparoscopic management of adnexal masses in pregnancy: A case series. Eur J Obstet Gynecol Reprod Biol 2003;108:217-22. |
| 72. | Djavadian D, Braendle W, Jaenicke F. Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: Case report and review. Fertil Steril 2004;82:933-6. |
| 73. | Bisharah M, Tulandi T. Laparoscopic surgery in pregnancy. Clin Obstet Gynecol 2003;46:92-7. |
| 74. | Crombleholme TM, Craigo SD, Garmel S, D'Alton ME. Fetal ovarian cyst decompression to prevent torsion. J Pediatr Surg 1997;32:1447-9. |
| 75. | Alrabeeah A, Galliani CA, Giacomantonio M, Heifetz SA, Lau H. Neonatal ovarian torsion: Report of three cases and review of the literature. Pediatr Pathol 1988;8:143-9. |
| 76. | Bryant AE, Laufer MR. Fetal ovarian cysts: Incidence, diagnosis and management. J Reprod Med 2004;49:329-37. |
| 77. | Crouch NS, Gyampoh B, Cutner AS, Creighton SM. Ovarian torsion: To pex or not to pex? Case report and review of the literature. J Pediatr Adolesc Gynecol 2003;16:381-4. |
| 78. | Ozcan C, Celik A, Ozok G, Erdener A, Balik E. Adnexal torsion in children may have a catastrophic sequel: Asynchronous bilateral torsion. J Pediatr Surg 2002;37:1617-20. |
| 79. | Grunewald B, Keating J, Brown S. Asynchronous ovarian torsion – The case for prophylactic oophoropexy. Postgrad Med J 1993;69:318-9. |
| 80. | Functional ovarian cysts and oral contraceptives. negative association confirmed surgically. A cooperative study. JAMA 1974;228:68-9. |
| 81. | Caillouette JC, Koehler AL. Phasic contraceptive pills and functional ovarian cysts. Am J Obstet Gynecol 1987;156:1538-42. |
| 82. | Grimes DA, Godwin AJ, Rubin A, Smith JA, Lacarra M. Ovulation and follicular development associated with three low-dose oral contraceptives: A randomized controlled trial. Obstet Gynecol 1994;83:29-34. |
| 83. | Mishell DR Jr. Noncontraceptive benefits of oral contraceptives. J Reprod Med 1993;38 (12 Suppl):1021S-9S. |
| 84. | Kaleli B, Aktan E, Gezer S, Kirkali G. Reperfusion injury after detorsion of unilateral ovarian torsion in rabbits. Eur J Obstet Gynecol Reprod Biol 2003;110:99-101. |
| 85. | Dolgin SE. Acute ovarian torsion in children. Am J Surg 2002;183:95-6. |
| This article has been cited by | | 1 |
Ovarian cysts in pregnancy: a narrative review |
|
| Sachintha Senarath,Alex Ades,Pavitra Nanayakkara | | Journal of Obstetrics and Gynaecology. 2020; : 1 | | [Pubmed] | [DOI] | | | 2 |
An Unusual Presentation of Recurrent Ovarian Torsion in an Adolescent Female |
|
| Natashia Jeter,Bryar Thompson | | Journal of Gynecologic Surgery. 2020; | | [Pubmed] | [DOI] | | | 3 |
A case report of ovarian torsion following ovarian transposition for cervical cancer |
|
| Rebecca Simstein,William Merenich,Jenny Graber,Michael Ferrell | | Emergency Radiology. 2020; | | [Pubmed] | [DOI] | | | 4 |
ABDOMINAL EMERGENCIES |
|
| Arthur J. Pesch,Nicole M. Kapral,Rachita Khot | | Seminars in Roentgenology. 2020; | | [Pubmed] | [DOI] | | | 5 |
Effects of Prostaglandin Analogue Iloprost Treatment on Distant Organ Damage Following Ovarian Ischemia/Reperfusion Injury in Rats: An Experimental Study |
|
| Öznur Uludag,Mevlüt Dogukan,Mehmet Duran,Ebru Annac | | Cureus. 2020; | | [Pubmed] | [DOI] | | | 6 |
Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review |
|
| Rawad Halimeh,Serge Tomassian,Maria El Hage,Nicole Metri,Marianne Bersaoui,Rafi Daou,Elie Anastasiadis | | Case Reports in Obstetrics and Gynecology. 2019; 2019: 1 | | [Pubmed] | [DOI] | | | 7 |
The protective effect of propolis on rat ovary against ischemia-reperfusion injury: Immunohistochemical, biochemical and histopathological evaluations |
|
| Kubra Koc,Huseyin Serkan Erol,Suat Colak,Salim Cerig,Serkan Yildirim,Fatime Geyikoglu | | Biomedicine & Pharmacotherapy. 2019; 111: 631 | | [Pubmed] | [DOI] | | | 8 |
Imaging in pediatric ovarian tumors |
|
| Abdelrahman K. Hanafy,Bilal Mujtaba,Sireesha Yedururi,Corey T. Jensen,Ramon Sanchez,Mary T. Austin,Ajaykumar C. Morani | | Abdominal Radiology. 2019; | | [Pubmed] | [DOI] | | | 9 |
Evaluation of the Results of Ovarian Preservation and Avoiding Oophorectomy in Pediatric Ovarian Torsion |
|
| Noora Bigdeli,Bahar Ashjaei,Maryam Ghavami-Adel,Hedayatollah Nahvi | | Iranian Journal of Pediatrics. 2019; In Press(In Press) | | [Pubmed] | [DOI] | | | 10 |
EFFECT OF CRYOPRESERVED PLACENTAL EXPLANTS ON THE OVARY RESTORATION AFTER TORSION TREATMENT |
|
| V. Yu. Prokopiuk,O. O. L?ginova,O. Prokopiuk,E. Somova | | World of Medicine and Biology. 2018; 14(63): 150 | | [Pubmed] | [DOI] | | | 11 |
A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015 |
|
| Ci Huang,Mun-Kun Hong,Tang-Yuan Chu,Dah-Ching Ding | | PeerJ. 2018; 6: e5995 | | [Pubmed] | [DOI] | | | 12 |
Magnetic resonance imaging findings in ovarian torsion post in vitro fertilization |
|
| Ishaq S. Al Salmi,Faten Al-Douri,Ehsan A. Haider,Terence M. Menezes | | Radiology Case Reports. 2018; 13(6): 1154 | | [Pubmed] | [DOI] | |
|
 |
|
|
|
Search Pubmed for