Conservative management of adnexal torsion in premenarchal girls

Study Objective. To evaluate treatment of premenarchal girls with torsion of the adnexa. Design. Retrospective review of medical records (Canadian Task Force classification II-2). Setting. Tertiary care, university-affiliated hospital. Patients. Eight premenarchal girls (age range 3-12 yrs) with twisted adnexa. Intervention. Laparoscopic detorsion and follow-up with B scan and Doppler ultrasound imaging. Measurements and Main Results. Duration of complaints ranged from 8 to 72 hours (mean 34.6 hrs) and the interval from admission to surgery ranged from 6 to 24 hours (mean 18.7 hrs). Four patients had torsion of normal-appearing adnexa. The other four had ovarian neoplasms. Two had cystic mature teratomas (dermoid cysts) and one a serous cystadenoma that required additional operation. The fourth girl had a simple ovarian cyst that was aspirated laparoscopically. Seven girls (87%) had normal-appearing ovaries on follow-up ultrasound. In one patient, a small ovary was seen, with no intraovarian blood flow on color Doppler. Conclusion. Although the diagnosis of torsion of the adnexa in premenarchal girls is difficult and usually delayed, laparoscopic detorsion seems to be an effective adnexa-sparing approach. We suggest that laparoscopy should be the treatment of choice and that detorsion, rather than adnexectomy, be performed more often in these patients.