Speakers - 2026

Title: Ovarian torsion in girls

Abstract

We examined and treated 45 girls from 2 to 17 years old with a diagnosis of torsion of the uterine appendages. All the girls were admitted to the hospital with suspected acute appendicitis. The duration of the disease is from 4 hours to 5 days. During the examination, all had sharp and cramping pains in the lower abdomen on the right or left; nausea, vomiting in 42 children, pallor of the face in 36, forced position of the child in 36. There were no other characteristic symptoms. The diagnosis was established by ultrasound examination by the following signs: an increase in size, a change in the echostructure of the ovary, a decrease or absence of blood flow, in 12 children the symptom of "whirlpool" was noted.  Laparoscopy: organ-preserving treatment was performed in 41 children, the rest underwent adnexectomy.  In 35 children, the appearance of the ovary was similar to necrosis, despite this, the ovary was preserved. Subsequently, in 3 children, blood flow was not detected on ultrasound and ovariectomy was performed in 5-7 days. Ovariopexy after detorsion is performed by everyone. Relapse in 3 girls within 1 to 3 years. In 12 children with the presence of a volumetric formation in the twisted ovary, only detorsion and ovariopexy were performed. 1 month after the planned examination (MRI of the pelvic organs, tumor markers, examination by an oncologist), a second operation was performed to remove the ovarian formation in 8 children. Ovarian teratoma was detected and morphologically confirmed. In 4 children, with a second ultrasound after 1 month, the ovarian cyst regressed and surgery was not required.  

Blood flow in the ovary was restored on the 1st day in 25 children, on the 2nd day in 10, on the 3rd day in 3, and on the 4th day in 2.

What will the audience take away from presentation?

• All the girls were admitted to the hospital with suspected acute appendicitis. During the examination, none of them had symptoms of passive muscle tension and symptoms of peritoneal irritation. There was only a pain symptom in the lower abdomen, and 75% of the children had vomiting at the height of the pain syndrome, a forced position of the body and a sharp pallor of the face.
• Ultrasound was informative only by the end of the 1st day of the disease. In the first hours, the blood flow in the affected ovary was determined, which interfered with the timely diagnosis. An increase in size, a change in the echostructure of the ovary allow you to suspect torsion.
• The appearance of a twisted ovary after detorsion did not always correspond to the degree of morphological changes. Despite the crimson and blue color of the uterine appendages, we performed an organ-preserving operation - detorsia with ovariopexy.
• If a tumor-like formation is found in a twisted ovary, it is not recommended to remove it immediately. After a routine examination (MRI of the pelvic organs, tumor markers, examination by an oncologist), a second operation is performed to excise it. 
• We consider the use of ICG technology as a tool for objective intraoperative assessment of ovarian viability after detorsion to be promising.