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Purpose:  Conservative surgical management of adnexal torsion in pre- and post-menarchal girls by de-torsion and adnexal conservation is the current standard of care. The aim of this study is to investigate the long-term outcome of adnexal torsion in this population in terms of ultrasound appearance and ovarian volume., Methods:  Patients who were surgically treated for adnexal torsion and were < 18 years old at time of surgery were prospectively invited for ultrasound follow-up. The ultrasound exam included measurements of ovarian volume and grayscale appearance including identification of ovarian follicular activity., Results:  84 cases of torsion in this population were identified, and 37 of them were included in the study. Of those, the affected ovary could not be demonstrated on follow-up scan in six (16.2 %) cases. A difference of ≥ 2 cm 3 in ovarian volume between the affected and non-affected ovaries was diagnosed in 12 (32.4 %) cases, but follicular activity was observed in 10 of those. Thus, possible ovarian injury (including cases of non-demonstrated ovary and volume difference of ≥ 2 cm 3 between the affected and non-affected ovaries) was found in 18 (48.6 %) cases. Of the clinical and surgical parameters (including age at time of torsion, duration of pain prior to admission, cystectomy procedure and intraoperative "bluish" appearance of the ovary), only the presence of fever on admission was significantly associated with possible ovarian injury (p = 0.01)., Conclusion:  Long-term ultrasound follow-up of pre- and post-menarchal girls with a history of adnexal torsion may identify patients with adversely affected ovarian volume. The significance of this finding in terms of fertility is unknown., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To investigate the accuracy of torsion diagnosis in the pediatric and adolescent population., Methods: This retrospective study included 87 patients <18years who presented with acute pelvic pain and were operated for suspected adnexal torsion from January 2009 to September 2016., Results: Adnexal torsion was found in 53 of 87 (60.9%) cases operated for suspected torsion. The rate of accurate torsion diagnosis was significantly higher among pre-menarchal (21/21, 100%) compared with post-menarchal girls (32/66, 48.5%) (p<0.001). Patients with torsion were more likely to report nausea or vomiting (73.6% compared with 32.3%, p<0.001) and had higher rates of peritoneal irritation signs on exam (15.1% compared with 0.0%, p=0.02). On the pre-operative ultrasound, patients with torsion were characterized by higher rates of enlarged ovary showing signs of edema (49.1% compared with 8.8%, p<0.001) and free pelvic fluid (45.3% compared with 17.6%, p<0.001). In post-menarchal girls without adnexal torsion, the leading diagnosis was hemorrhagic corpus luteum cyst (found in 18/33, 78.3%) cases., Conclusions: Various clinical and ultrasound findings may point to the correct diagnosis of torsion in the pediatric and adolescent population. However, none of the clinical and ultrasound characteristics are sufficient to confirm or disprove the pre-operative diagnosis, and young patients with the clinical suspicion of adnexal torsion should undergo laparoscopy., Level of Evidence: Level II., Type of Study: Clinical retrospective study., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Accessory fallopian tube is a rare anatomical variation, which might rarely cause gynecological complications such as infertility, ectopic pregnancy, cystic swelling, and pyosalpinx. It is usually diagnosed by surgeons during diagnostic laparoscopy for other purposes. We present a rare case of isolated accessory tube torsion in a young adolescent., Case: A 16-year-old virgin teen presented with a 24-hour history of aggravating right lower-quadrant abdominal pain and nausea without vomiting or fever. On examination she had right lower quadrant abdominal tenderness with no peritoneal signs. On pelvic ultrasound a right corpus luteum cyst was suspected, but right adnexal torsion could not be ruled out. On laparoscopy, torsion of the right accessory tube was diagnosed. Because of its ischemic and bluish appearance it was removed. The postoperative course was uneventful. Pathology confirmed the diagnosis., Summary and Conclusion: Torsion of an accessory fallopian tube is rare. An English literature search showed that the current case is the third reported overall and the first in a young adolescent. Because of the rarity of this congenital variation, and the low suspicion index for its existence, the diagnosis of accessory tube is often missed. Preventive removal of such findings should be considered but weighed against its possible surgical complications., (Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Objective: To compare adnexal torsion characteristics and torsion recurrence rates in a pre- and postmenarchal pediatric and adolescent population., Design: Retrospective cohort study., Setting: University-affiliated medical center., Patient(s): Females <18 years old with surgically diagnosed adnexal torsion., Intervention(s): Adnexal detorsion, cystectomy, salpingectomy, or salpingo-oophorectomy by laparoscopy or laparotomy. Oophoropexy using the utero-ovarian ligament plication technique was performed in cases of recurrent torsion of normal adnexa., Main Outcome Measure(s): The clinical presentation, laboratory and ultrasound characteristics, surgical findings, surgical procedures, pathologic diagnosis, and torsion recurrence rates were analyzed and compared between pre- and postmenarchal patients., Result(s): Twenty premenarchal and 24 postmenarchal patients were identified. The clinical presentation, laboratory findings, and ultrasound characteristics were similar between the two groups, except for a higher prevalence of paraovarian cysts on preoperative ultrasound in the postmenarchal compared with in the premenarchal group (20.8% vs. 0%). For the whole cohort, torsion of normal adnexa constituted 25.0% (11/44) of cases, while torsion of "pathologic" adnexa constituted 75.0% (33/44) of torsion cases. Torsion recurrence was significantly more common among girls whose first torsion episode occurred in the premenarchal period compared with in postmenarche (35% vs. 4.2%). On multivariate logistic regression analysis, torsion recurrence was significantly associated with premenarchal status (odds ratio [OR] = 12.7; 95% confidence interval [CI], 1.1-152.0) and with torsion involving normal adnexa (OR = 19.1; 95% CI, 2.3-154.5)., Conclusion(s): Recurrent torsion is common in patients whose first torsion episode occurred in the premenarchal period and involved otherwise normal adnexa. Ovarian fixation procedures may be considered in patients at risk for torsion recurrence., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: We sought to investigate and compare the clinical presentation, ultrasound findings, surgical characteristics, and causes of adnexal torsion among three groups: pediatric and adolescent population, reproductive-age women, and pregnant women., Material and Methods: Two hundred twenty-seven surgically confirmed episodes of adnexal torsion in 199 patients treated in our department from January 2008 to December 2014 were retrospectively analyzed., Results: Abdominal pain duration of >24 hours before emergency room presentation was more common in pediatric and adolescent patients compared with reproductive-age and pregnant women (42.3% vs. 28.4% and 15.5%, respectively, p = 0.04). However, there was no difference between the groups in the time interval from their emergency room admission to surgery. Torsion of "normal adnexa" occurred in 11/44 (25.0%) of pediatric and adolescent patients, 30/99 (30.3%) of reproductive-age patients, and 12/56 (21.4%) of pregnant patients, while torsion involving multicystic ovaries occurred in 0%, 4%, and 32.1%, respectively, torsion involving paraovarian cysts occurred in 20.5%, 14.1%, and 1.8%, respectively, and torsion involving benign dermoid cysts occurred in 4.5%, 15.2%, and 5.4%, respectively (p < 0.001). Torsion involving supposedly functional ovarian cysts occurred in 45.5%, 34.3%, and 69.6%, respectively (p < 0.001). The torsion recurrence rates were 18.2% in the pediatric subjects, 19.2% in reproductive-age women, and 10.7% in pregnant women (p = 0.3)., Conclusions: The presentation of adnexal torsion is similar in pediatric and reproductive-age and pregnant women, although the underlying adnexal pathology may be different. Functional ovarian cysts cause the majority of torsion cases in pregnant women. Recurrence of torsion may occur in any age group.

Study Objective: To assess the efficacy of oophoropexy in obviating recurrent torsion and its possible long-term effects., Design: Case series and review of the literature (Canadian Task Force classification III)., Setting: University hospital., Patients: Women who underwent oophoropexy for recurrent torsion of normal adnexa between 2003 and 2008., Measurements and Main Results: Retrieved information included the indication for oophoropexy, surgical methods, recurrence, and follow-up. Seven women underwent oophoropexy during the study period because of recurrent torsion of normal adnexa. One additional patient had experienced 3 torsion events of cystic adnexa. Surgical methods included suturing of the ovary to the pelvic sidewall or to the round ligament and plication of the utero-ovarian ligaments. Recurrence occurred in 1 of 6 patients for whom follow-up was available. All 6 patients reported spontaneous menstruation, and 2 conceived spontaneously and gave birth. Ultrasound at long-term follow-up (9-58 months) demonstrated normal ovaries., Conclusion: Oophoropexy seems to be efficacious in preventing recurrent torsion. It is our impression that plication of the utero-ovarian ligaments has advantages over other approaches insofar as surgical feasibility and anatomical conservation., (Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To investigate the phenomenon of recurrent adnexal torsion during the same pregnancy, describe its risk factors, and suggest possible management of this entity., Design: Retrospective case-control study (Canadian Task Force classification II-3)., Setting: Gynecologic endoscopy unit in a university hospital., Patients and Interventions: Pregnant women with surgically proved adnexal torsion were retrospectively identified from 1993 to 2007. Details of clinical presentation, method of conception, preoperative ultrasound findings, and operative findings were analyzed., Intervention: Comparison of characteristics of patients with recurrent episodes of adnexal torsion during the same pregnancy vs a single episode of torsion., Measurements and Main Results: Thirty-three pregnant women with 38 episodes of adnexal torsion were included in the study. Seventeen pregnancies (51.5%) were spontaneously conceived. Twenty-eight women had a single episode of torsion, and 5 women (15.1%) had recurrent episodes of torsion during the same pregnancy. No significant differences were found between the 2 groups in age, method of conception, and gestational age at time of torsion. However, ultrasound studies demonstrated that multicystic ovaries were significantly more common in women with recurrent torsion compared with women with a single episode of torsion (80% vs 25%; p =.02). The interval between the first and second episodes of torsion ranged from 1 to 4 weeks., Conclusion: Pregnant women are at risk for recurrent torsion, especially when the ovaries are enlarged and ultrasound studies demonstrate multiple cysts. Cyst aspiration may prevent recurrent torsion during the same pregnancy.

Objective: Torsion of normal adnexa is a rare event involving steadily increasing congestion and ischemia of the ovary. We investigated whether this process can be characterized by sonographic features., Methods: Twelve menstrually cycling women with 14 separate episodes of laparoscopic-proven torsion of normal adnexa were identified retrospectively, and the results of their preoperative gray-scale ultrasound examinations and Doppler flow evaluations were analyzed. The cases were classified into 'short-term' (< 24 h; range, 3-24 h) and 'prolonged' (> 24 h; range, 1-10 days) duration of torsion according to the reported period of abdominal pain before admission. Absence of any additional adnexal pathology was confirmed by both intraoperative inspection and postoperative follow-up ultrasound examinations., Results: The median age of the cohort was 24.0 (interquartile range (IQR), 20.5-28.7) years, and parity ranged from 0 to 3. All affected ovaries were significantly enlarged compared with non-affected ones (median cross-sectional area, 18.1 (IQR, 12.4-26.4) cm(2) vs. 4.3 (IQR, 2.9-6.2) cm(2), P < 0.01). We could distinguish two distinct sonographic patterns of torted ovaries: there were numerous small peripheral follicles in the ovarian parenchyma in nine cases, and there was a solid-appearing mass with hypo- and hyperechogenic foci in five cases. Comparison of the ultrasound images of patients with short-term vs. long-term abdominal pain revealed that the solid-appearing ovary was more common in the latter group (0/6 vs. 5/8, P = 0.03), while there was no significant difference between groups in the presence of free pelvic fluid or median ovarian cross-sectional area. Intraovarian blood flow was diminished or absent in five of the eight patients in whom color Doppler imaging was performed., Conclusions: Ultrasound images of twisted normal adnexa may vary according to the duration of the condition, reflecting the pathological series of events of increased ovarian congestion and necrosis. Recognition of the different sonographic features of twisted normal adnexa may assist in the correct diagnosis of these patients., ((c) 2008 ISUOG. Published by John Wiley & Sons, Ltd.)