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Purpose: In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis. Methods: A retrospective analysis (January, 2015- April, 2019) utilizing hospital archives was conducted on patients diagnosed with ovarian torsion, post-surgery. Inclusion criteria encompassed patients who underwent CT examinations within one week of diagnosis. A large array of CT findings encompassing midline orientation, uterine deviation, intraovarian hematoma/mass, and multiple others were systematically documented. Results: 90 patients were diagnosed with ovarian torsion- 53 (59%) had CT within one week of diagnosis, 41(77%) underwent a CT with IV contrast and 12 (23%) without IV contrast. Mean age was 43 years (range 19–77 years), with near equal distribution of involvement of each ovary. Mean maximum ovarian diameter was 11.7 ± 6.3 cm (4.2–34.8 cm). Most common imaging features include the presence of thickened pedicle (43/53, 81%), midline ovary (41/53, 77%), presence of thickened fallopian tube (31/49, 63%), and ipsilateral uterine deviation (33/53, 62%). Based on contemporaneous imaging report, torsion was diagnosed in 25/ 53 studies giving a sensitivity of 47%. Conclusion: Enlarged ovarian dimensions (> 3.0 cm), thickened vascular pedicle or fallopian tube, midline ovarian disposition with ipsilateral uterine deviation, and the presence of a whirlpool sign emerged as predominant CT imaging features in surgically confirmed ovarian torsion cases, serving as pivotal diagnostic aides for radiologists. Concomitant pelvic free fluid and intraovarian hematoma signify necrotic changes, indicative of ischemic severity and disease progression. [ABSTRACT FROM AUTHOR]

With the development of assisted reproductive technology (ART), ovarian hyperstimulation syndrome (OHSS) as a main iatrogenic complication is also inevitable, which further increases the risk of ovarian torsion. The clinical symptoms and imaging characteristics of the patient with OHSS combined with ovarian torsion are relatively atypical, which means that the early identification and diagnosis of this acute abdomen is difficult. We report a case of OHSS combined with ovarian torsion before egg retrieval during ART treatment. The conservative treatment after egg retrieval was ineffective, and ultimately surgical treatment was still inevitable. This case suggests that the understanding of OHSS complicated with ovarian torsion should be strengthened during ART treatment, so as to achieve the early identification, early diagnosis and early treatment of this acute abdomen. [ABSTRACT FROM AUTHOR]

Simple Summary: Genital tract disorders are among the most prevalent conditions affecting female pet rabbits (Oryctolagus cuniculus). However, ovarian diseases are relatively rare, constituting only 3.3% of reproductive conditions in this species. These may include ovarian cysts, neoplasia, and necrosis. This study presents the first documented case of spontaneous ovarian torsion in rabbits. A female pet rabbit presented for routine clinical examination exhibited a large abdominal mass, the nature of which remained ambiguous upon diagnostic imaging. Computed tomography revealed a mass exhibiting specific signs indicative of torsion of the supporting ligaments of the right ovary. Confirmation of the diagnosis was achieved during laparotomy, where twisting of the right ovarian pedicle was observed. The rabbit was neutered, and the mass underwent histological examination, revealing predominantly necrotic areas with no evidence of neoplastic cells. Ovarian torsion (OT) is a condition that can affect both humans and animals, although it is less common in the latter, with very few cases documented in the literature. To our knowledge, no previous reports have documented the occurrence of this condition in rabbits. In this study, we present the first documented case of spontaneous OT in a 2-year-old female intact rabbit. The patient was brought to the clinic for a routine check-up, during which a firm, large abdominal mass was palpated. Subsequent ultrasound examination of the abdomen revealed the presence of a large, hypoechoic, non-vascularized mass occupying the majority of the caudal abdomen. A computed tomography (CT) scan further confirmed the presence of a heterogeneous mass exhibiting the Whirlpool sign, which is characteristic of organ torsion. Upon laparotomy, an enlargement of the right ovary was observed, characterized by twisting of the ovarian pedicle, consistent with the mass detected via ultrasound and CT scan. Ovariohysterovaginectomy was performed, and the mass was subsequently analyzed. Microscopic analysis of the mass revealed predominantly necrotic tissue, with only a few ovarian epithelial cells present. The underlying cause of the OT described in this study remains unclear. However, it is plausible that a previous neoplastic condition or ovarian necrosis led to an increase in the size and weight of the mass, ultimately resulting in the twisting of the supporting structures. [ABSTRACT FROM AUTHOR]

Synopsis: This case involved a 10‐year‐old female with recurrent abdominal pain misdiagnosed as 'ama‐afo'. Intraoperative findings showed a left‐sided strangulated/gangrenous tubo‐ovarian mass twisted four times on its pedicle. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric ovarian torsion (OT) is an emergency condition that remains challenging to diagnose because of its overall unspecific clinical presentation. The aim of this study was to determine the diagnostic value of clinical, ultrasound, and inflammatory laboratory markers in pediatric OT. Methods: We performed a retrospective multicentric case–control study in patients with clinical and ultrasound suspicion of OT, in whom surgical examination was performed between 2016–2022 in seven pediatric hospitals. Patients were divided into two groups according to intraoperative findings: OT group (ovarian torsion), defined as torsion of the ovarian axis at least 360°, and non-OT group (no torsion). Demographics, clinical, ultrasound, and laboratory features at admission were analyzed. The diagnostic yield analysis was performed using logistic regression models, and the results were represented by ROC curves. Results: We included a total of 110 patients (75 in OT group; 35 in non-OT group), with no demographic or clinical differences between them. OT-group patients had shorter time from symptom onset (8 vs. 12 h; p = 0.023), higher ultrasound median ovarian volume (63 vs. 51 mL; p = 0.013), and a significant increase in inflammatory markers (leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, C-reactive protein) when compared to the non-OT group. In the ROC curve analysis, the neutrophil-to-lymphocyte ratio (NLR) presented the highest AUC (0.918), with maximum sensitivity (92.4%) and specificity (90.1%) at the cut-off point NLR = 2.57. Conclusions: NLR can be considered as a useful predictor of pediatric OT in cases with clinical and ultrasound suspicion. Values above 2.57 may help to anticipate urgent surgical treatment in these patients. [ABSTRACT FROM AUTHOR]

In 2015, the U.S. News and World Report (USNWR) implemented a quality metric to expedite surgery for testicular torsion (TT), but not ovarian torsion (OT). This study examined OR timing among children with suspected TT and OT before and after this metric. A single-center retrospective cohort study of children (1–18yr) who underwent surgery for suspected gonadal torsion was performed. Time to OR (TTOR) from hospital presentation to surgery start was calculated. An interrupted time series analysis identified changes in TTOR for suspected TT versus OT after the 2015 USNWR quality metric. Overall, 216 patients presented with TT and 120 with OT. Median TTOR for TT was 147 min (IQR:99–198) versus 462 min (IQR:308–606) for OT. Post-quality metric, children with TT experienced a 27.8 min decrease (95% CI:-51.7,-3.9, p = 0.05) in annual median TTOR. No significant decrease was observed for children with OT (p = 0.22). Children with history of a known ovarian mass (N = 62) experienced a shorter TTOR compared to those without (422 vs 499min; p = 0.04). Implementation of a national quality metric for TT expedited surgical care for children with TT, but not children with OT. These findings highlight the need for equitable quality metrics for children presenting with suspected gonadal torsion. III. Retrospective Comparative Study, Observational Cohort Study. • Since 2015, national quality metrics have encouraged the expedited surgical care of children with suspected testicular torsion in order to improve gonadal salvage. However, similar metrics for ovarian torsion are lacking. • Following implementation of the U.S. News and World Report quality metric for expedited care of testicular torsion, time to surgery decreased significantly. • However, children with suspected ovarian torsion did not experience a significant change in time to surgery. • This highlights the need for equitable quality metrics in pediatric gonadal torsion. [ABSTRACT FROM AUTHOR]

Objective: Ovarian torsion (OT) represents a severe gynecological emergency in female pediatric patients, necessitating immediate surgical intervention to prevent ovarian ischemia and preserve fertility. Prompt diagnosis is, therefore, paramount. This retrospective study set out to assess the utility of combined clinical, ultrasound, and laboratory features in diagnosing OT. Methods: The authors included 326 female pediatric patients aged under 14 years who underwent surgical confirmation of OT over a five-year period. Logistic regression analysis was employed to pinpoint factors linked with OT, and the authors compared clinical presentation, laboratory results, and ultrasound characteristics between patients with OT (OT group) and without OT (N-OT group). The authors conducted receiver operating characteristic (ROC) curve analysis to gauge the predictive capacity of the combined features. Results: Among 326, OTwas confirmed in 24.23 % (79 cases) of the patients. The OT group had a higher incidence of prenatal ovarian masses than the N-OT (22 cases versus 7 cases) (p < 0.0001). Similarly, the authors observed significant differences in the presence of lower abdominal pain, suspected torsion on transabdominal ultrasound, and a high neutrophil-lymphocyte ratio (NLR > 3) between the OT and non-OT groups (p > 0.05). Furthermore, when these parameters were combined, the resulting area under the curve (AUC) was 0.868, demonstrating their potential utility in OT diagnosis. Conclusion: This study demonstrates a prediction model integrating clinical, laboratory, and ultrasound findings that can support the preoperative diagnosis of ovarian torsion, thereby enhancing diagnostic precision and improving patient management. Future prospective studies should concentrate on developing clinical predictive models for OT in pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose: The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved. Methods: Children with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge. Results: A total of 7008 patients, ages 1–20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001). Conclusion: The rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical and pathological differences between pregnant and non -pregnant women with adnexal torsion (AT). Methods: A retrospective analysis was conducted on the clinical data of 376 AT patients who were hospitalized in the Department of Obstetrics and Gynecology, Peking University Third Hospital from January 2017 to November 2023, including 72 pregnant women with AT and 304 non -pregnant women with AT. Based on gestational weeks, pregnant women with AT were divided into the first trimester group (≤14 weeks) with 47 cases and the second and third trimester group (＞14 weeks) with 25 cases. A comparative analysis of the clinical data between these groups was performed. Results: ① The proportion of vomiting, abdominal pain time ＜24 hours, persistent abdominal pain, the count of white blood cell and the percentage of neutrophil in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). ② The rates of laparotomy, conservative surgery and postoperative pathology of luteal cyst in pregnant women with AT were significantly higher than those in non-pregnant women with AT (P＜0.05). The diameter of adnexal mass, the proportion of mature teratoma, mucinous cystadenoma and endometriosis cyst by postoperative pathology in pregnant women with AT were significantly lower than those in non-pregnant women with AT (P＜0.05). ③ Compared to the second and third trimester AT group, in the first trimester AT group, the proportion of assisted reproductive technology, laparoscopic surgery and conservative surgery, and the diameter of adnexal mass were higher, the proportion of pathological cysts and the degree of torsion were significantly lower (P＜0.05). Conclusions: The presence of symptoms such as lower abdominal pain, nausea and vomiting during pregnancy necessitates consideration of AT, especially in early pregnancy or following assisted reproductive technology, the pathology is often corpus luteum cysts. The treatment of AT during pregnancy, whether laparoscopic or open surgery, is safe and reliable, without adversely impacting pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Adnexal torsion requires treatment to limit ischemic injury and tissue loss. Optimal time to surgical intervention has not been established. We compared outcomes of ovarian loss amongst pediatric patients. Methods: We conducted a retrospective review of 88 patients with adnexal torsion from March 2014 through April 2021. Rates of ovarian loss were compared for patients who underwent surgery within and beyond 60 minutes from diagnosis. Results: Most patients underwent surgery more than 60 minutes from the time of diagnosis (83%; median time 116 minutes). Comparing patients with and without ovarian loss, there was no statistically significant difference in time to surgery from time of diagnosis (P =.618). Patients with ovarian loss had a longer duration of symptoms (24 vs 96 hours; P =.017). Conclusions: While surgical repair of adnexal torsion may be urgent, this study suggests that duration of symptoms should be considered when assessing a patient's likelihood of ovarian loss. [ABSTRACT FROM AUTHOR]

A 21-year-old captive female Humboldt penguin (Spheniscus humboldti) was in good health until the day before the animal died. However, the animal suddenly exhibited symptoms of vomiting and anorexia, and died in shortly thereafter. The autopsy revealed a blood clot in the abdominal air sac and 280 mL of dark red fluid in the body cavity. The ovary was twisted around a blood vessel. Based on the findings described, it was considered that the cause of death was hypovolemic shock due to massive intracoelomic hemorrhage by vascular collapse resulting from ovarian torsion. This is the first report of ovarian torsion in penguins. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical & Pharmaceutical Sciences is the property of Arab Journal of Sciences & Research Publishing (AJSRP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ovarian torsion, the twisting of the ovary on its supporting tissues, occurs primarily in premenopausal women, causing acute abdominal or pelvic pain. Without prompt diagnosis and surgical intervention, adnexal torsion may lead to ovarian infarction and a resulting reduction in fertility. Radiologic methodologies including ultrasound, color Doppler ultrasound, and magnetic resonance imaging (MRI) can play key roles in the diagnosis of this entity by allowing for the visualization of blood flow to the ovary.

Although total oophorectomy (TO) was historically performed in cases of nonviable-appearing ovaries, considerable evidence has demonstrated equivalent outcomes after ovarian sparing surgery (OSS) as well as long-term fertility preservation benefits. This study sought to compare outcomes of OSS and TO for patients with ovarian torsion. Females <21 years old admitted for ovarian torsion were identified from the Nationwide Readmissions Database (2016–2018) and stratified by OSS or TO. Propensity score-matched analysis (PSMA) utilizing >50 covariates (demographics, medical comorbidities, ovarian diagnoses, etc.) was constructed between those receiving TO and OSS. There were 3,161 females (median 15 [12–18] years) with ovarian torsion, and concomitant pathologies included cysts (42%), benign masses (25%), and malignant masses (<1%). Open approaches were more common (52% vs. 48% laparoscopic), and ovarian resection (OSS or TO) was performed in 87% (39% OSS and 48% TO). OSS was more commonly performed with laparoscopic detorsions (60% vs. 40% TO), while TO was more frequent in open operations (59% vs. 41% TO; both p < 0.001). No differences in overall readmissions (7% OSS vs. 8% TO) or readmissions for recurrent torsion (<1% overall) and ovarian masses (<1%) were observed (both groups <1%; p = 0.612). After PSMA, laparoscopy was still utilized less frequently with TO (39% vs. 53%; p < 0.001) despite similar rates of malignant masses. Overall, these data offer additional support for the current practice guidelines that give preference to OSS as the primary method of treatment for pediatric ovarian torsion in the majority of cases. III. Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Torsion occurs as a complication in 10% of cases of ovarian tumors. It predominantly occurs in benign ones, while malignant tumors are less prone to torsion. Sertoli-Leydig cell tumors are highly unusual sex cord-stromal tumors of the ovary, accounting for less than 0.2% of all ovarian cancers.A 39-year-old patient presented to the emergency department with a Sertoli-Leydig cell tumor diagnosed due to ovarian torsion. The clinical presentation was characterized by abdominal pain. Ultrasound indicated signs of torsion, and torsion of the right ovary was subsequently confirmed during laparotomy. A salpingo-oophorectomy was performed, and histological examination revealed a moderately differentiated Sertoli-Leydig cell tumor.Sertoli-Leydig cell tumors often present with hormone-related or non-hormonal symptoms. Surgery plays a crucial role in both diagnosis and treatment. Postoperative treatment is not necessary for well-differentiated Sertoli-Leydig cell tumors in stage IA-IB. However, patients with grade 2–3 disease, advanced stage, or heterologous elements may consider adjuvant treatment.As these tumors are rare, this case contributes to the documentation of Sertoli-Leydig cell tumors, with a case diagnosed due to ovarian torsion. The case highlights the importance of establishing international registries of Sertoli-Leydig cell tumor cases for standardized management.

Objective We aimed to determine whether ovarian-preserving surgery for adnexal torsion helps preserve ovarian function without increasing the risk of postoperative complications. Methods We retrospectively evaluated 71 women who were surgically diagnosed with adnexal torsion between January 2015 and December 2019 at Severance Hospital, Yonsei University College of Medicine (ovarian preservation group, 56; oophorectomy, 15). Serum anti-Müllerian hormone (AMH) levels measured within 6 months before surgery were compared to levels measured 6–24 months after surgery. Surgical findings and postoperative complications were compared between the groups. Results There was a borderline significant difference in the decrease in serum AMH levels between the oophorectomy group and ovarian preservation group before and after surgery. There were no significant differences between the groups in terms of fever, infection, or duration of admission. Discoloration of the twisted ovary was found in 27.3% and 33.3% of the patients in the ovarian preservation and oophorectomy groups, respectively. There was no difference in the decrease in serum AMH levels between patients with and those without discoloration. Conclusion Ovarian-preserving surgery may not increase postoperative complications in patients with adnexal torsion, even if a twisted mass is suspected to be necrotic. Moreover, the ovarian reserve may not be affected by torsion if the ovary is preserved. Conservative ovarian surgery can be safely performed to preserve the reproductive potential of women with adnexal torsion and cystic masses.

Ovarian torsion (OT) is a condition that can affect both humans and animals, although it is less common in the latter, with very few cases documented in the literature. To our knowledge, no previous reports have documented the occurrence of this condition in rabbits. In this study, we present the first documented case of spontaneous OT in a 2-year-old female intact rabbit. The patient was brought to the clinic for a routine check-up, during which a firm, large abdominal mass was palpated. Subsequent ultrasound examination of the abdomen revealed the presence of a large, hypoechoic, non-vascularized mass occupying the majority of the caudal abdomen. A computed tomography (CT) scan further confirmed the presence of a heterogeneous mass exhibiting the Whirlpool sign, which is characteristic of organ torsion. Upon laparotomy, an enlargement of the right ovary was observed, characterized by twisting of the ovarian pedicle, consistent with the mass detected via ultrasound and CT scan. Ovariohysterovaginectomy was performed, and the mass was subsequently analyzed. Microscopic analysis of the mass revealed predominantly necrotic tissue, with only a few ovarian epithelial cells present. The underlying cause of the OT described in this study remains unclear. However, it is plausible that a previous neoplastic condition or ovarian necrosis led to an increase in the size and weight of the mass, ultimately resulting in the twisting of the supporting structures.

Objective To explore the risk factors and predictive values of ovarian torsion (OT) necrosis in children. Methods To summarize the clinical data of 73 children with ovarian torsion diagnosed during operation in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology from May 2014 to May 2014, and to 2023. According to the results of pathological examination, they were assigned into two groups of torsion necrosis (n=27) and non-necrosis (n=46). The age, affected side, malignant behavior and vomiting, fever, time from abdominal pain to operation, platelet, lymphocyte, neutrophil, percentage of Neutrophil, C-reaction protein (CRP), white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reaction protein (LCR) and the diameter of adnexal masses were compared between the two groups. Univariate Logistic regression was used to analyze the risk factors of ovarian torsion necrosis in children. Multivariate Logistic regression was used to analyze the independent risk factors, receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index for torsion necrosis of ovary in children. Results No significant inter-group differences existed in age[(7.21±3.65)year vs. (8.80±4.17)year], The affected side (left/right){[9(34.62%)/17(65.38%)]vs. [21(44.68%)/26(55.32%)]}, platelet[(289.18±94.57)×109/L vs. (300.06±79.05)×109/L], lymphocyte[1.93 (1.36, 2.74)×109/L vs. 1.60 (1.00, 2.46)×109/L], neutrophil[(72.25±14.23)% vs. (69.30±18.69)%], neutrophil-to-lymphocyte ratio (NLR)[6.18 (3.68, 8.79) vs. 5.02 (2.38, 8.49)], platelet-to-lymphocyte ratio (PLR)[117.31 (101.27, 199.98) vs. 181.99 (104.22, 282.81)]or lymphocyte to C-reaction protein (LCR)[0.39 (0.05, 1.45) vs. 0.10 (0.02, 1.73)], the diameter of adnexal masses[5.00 (3.97, 6.33)cm vs. 4.67 (3.38, 6.17)cm](P>0.05). Significant inter-group differences existed in degree of OT[720.00 (720.00, 855.00)° vs. 720.00 (360.00, 720.00)°], nausea and vomiting[21(80.77%) vs. 27(57.45%)], fever[9(34.62%) vs. 2(4.26%)], time from abdominal pain to operation[72.00 (31.50, 96.00)h vs. 24.00 (15.84, 45.60)h], neutrophil[10.29 (6.30, 11.61)×109/L vs. 5.98 (3.67, 9.04)×109/L], C-reaction protein (CRP)[9.40 (0.78, 36.70)mg/L vs. 0.84 (0.78, 2.27)mg/L]and white blood cell (WBC)[13.25 (7.92, 16.89)×109/L vs. 8.28 (6.21, 11.87) ×109/L](P < 0.05). The results of ROC showed that the time from abdominal pain to operation had the highest predictive value for ovarian torsion necrosis, the best cut-off was 26.7 h, the area under the ROC curve (AUC) was 0.755, the sensitivity and specificity were 84.6% and 66.0%. The second is the degree of ovarian torsion, the best cut-off value was 405° with an AUC of 0.695, the sensitivity and specificity were 88.5% and 42.6%. Finally for fever, the AUC was 0.652, the sensitivity and specificity were 34.6% and 95.7%. Combining those three parameters, the AUC was 0.870 with a sensitivity of 69.2% and a specificity of 93.6%. Conclusions Time from abdominal pain to operation, degree of OT and fever may effectively predict the occurrence of OT necrosis in children. [ABSTRACT FROM AUTHOR]

Acute abdominal pain is common and accounts for 5%–10% of all emergency department admissions. The extensive nature of the differentials can make the definitive diagnosis challenging, particularly in women of childbearing age. There is often a conundrum as to whether the emergency is of gynaecological or surgical origin: delay in diagnosis can result in significant morbidity and mortality. This article explores the history, examination and investigation of women presenting with acute abdominal pain. It considers common gynaecological causes, including those found in pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: Ovarian torsion is a gynecologic emergency that can cause loss of ovarian function. The aim of the study was to evaluate the ovarian reserve of the patients who were operated for detorsion because of ovarian torsion. Materials and Methods: The medical records of the patients who underwent detorsion for ovarian torsion in our clinic between January 2013 and June 2017 were investigated. Ovarian reserve parameters including ovarian volume, antral follicle count and ovarian artery resistance index (RI) were evaluated by ultrasonography in post-operational period. Patients that had oophorectomy due to torsion or who had another ovarian surgery before or after torsion and pregnant women were not included in the study. The ovarian volume, antral follicle count and ovarian artery RI in the operated side were compared with the contralateral ovary. Results: Thirty-four women meeting the inclusion criteria were examined by ultrasonography in the early follicular phase of their cycles. Antral follicle count, ovarian volume and ovarian artery RI were decreased significantly (p<0.001, p<0.001 and p<0.001, respectively) in the operated ovary compared to the contralateral ovary. Sixteen patients who were treated by detorsion, underwent cystectomy at the same time. No significant difference was observed in ovarian reserve of the patients who had cystectomy together with detorsion compared to those who were operated only with detorsion. Conclusion: Antral follicle count, ovarian volume and ovarian artery RI were significantly decreased after detorsion operation in the operated side compared to the contralateral ovary. [ABSTRACT FROM AUTHOR]

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

Postmenopausal ovarian masses are not uncommon. Most of them are malignant due to inflammation and adhesion with the surrounding structures; these masses are fixed and torsion is not a usual phenomenon. We present a 73-year-old postmenopausal woman, parity five and five living issues with an acute abdomen. The examination revealed a 28-30-week size abdominal pelvic mass, which was confirmed to be ovarian in origin, with characteristics that indicated torsion on ultrasound Doppler. She underwent an emergency laparotomy with a total abdominal hysterectomy and bilateral salpingo-ophrectomy. Histopathology confirmed the diagnosis of serous cystadenoma. Ovarian torsion is a crucial differential diagnosis in postmenopausal adnexal masses presenting with acute abdomen. A high index of suspicion is required to diagnose and promptly manage women to improve the outcome. [ABSTRACT FROM AUTHOR]

Juvenile granulosa cell tumors (JGCTs) are rare, though carry significant burden of morbidity and mortality. A 15-yearold menstruating female with abdominal pain was diagnosed with a large 22.3 cm pelvic mass. CA-125 and LDH were elevated. Exploratory laparotomy was undertaken due to lesion size, and left salpingo-oophorectomy with omentectomy was completed. Pathology confirmed JGCTs with focal disruption, consistent with Stage IC disease. Six weeks post-operatively, the patient experienced recurrent abdominal pain and ultrasound revealed a 7.9 cm right ovarian cystic structure. Given size and nodularity, management was discussed with a multidisciplinary team. Serial ultrasounds demonstrated resolution of the cyst. Workup for ovarian masses in pediatric patients has added complexity of fertility preservation. Once ovarian torsion is ruled out, imaging and laboratory studies are completed to characterize the mass. In pediatric patients with cancer of the Mullerian structures and risk of infertility, decision-making can be challenging and is best managed with a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Objective: Ovarian torsion is a gynecological disorder that causes ischemia-reperfusion injuries in the ovary. Our study investigated berberine's short- and long-term effects on ovarian ischemia-reperfusion injuries. Methods: This study included 28 Wistar albino female rats weighing 180 to 220 g, which were divided into four groups: sham (S), torsion/detorsion (T/D), torsion/detorsion+single dose berberine (T/D+Bb), and torsion/detorsion+15 days berberine (T/D+15Bb). The torsion and detorsion model was applied in all non-sham groups. In the T/D+Bb group, a single dose of berberine was administered, while in the T/D+15Bb group, berberine was administered over a period of 15 days. After the rats were euthanized, their ovaries were excised. The left ovaries were used for histopathologic evaluation, which included ovarian injury scoring and follicle count, while the right ovaries were used for biochemical analyses (tissue transforming growth factor-ß [TGF-ß] and alpha-smooth muscle actin [a-SMA] levels). Results: The histopathologic evaluation scores for the ovaries were significantly lower in the T/D+B group (p<0.05) and the T/D+15B group (p<0.005) than in the T/D group. The follicle counts in the T/D group were lower than those in both the sham and treated groups (p<0.005). The TGF-ß levels were significantly lower in the T/D+15B group (p<0.005), whereas the a-SMA levels did not show a significant difference. Conclusion: Both short- and long-term berberine use could potentially have therapeutic effects on ovarian torsion. Long-term berberine use exhibited anti-inflammatory effects by reducing TGF-ß levels, thereby preventing ischemia-reperfusion injuries. Therefore, we suggest that long-term berberine use could be beneficial for ovarian torsion. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The utility of incidental appendectomy (IA) during many ovarian operations has not been evaluated in the pediatric population. This study sought to compare outcomes after ovarian surgery with IA in the pediatric population. Females (≤20 y old) undergoing ovarian surgeries (oophorectomy, detorsion and/or drainage) were identified from the Nationwide Readmissions Database (2016-2018). Those with appendicitis were excluded. A propensity score-matched analysis (PSMA) with 46 covariates (demographics, comorbidities, hospitalization factors, etc.) was performed between those receiving ovarian surgery with or without IA. There were 13,202 females (median age 17 [IQR 14-20] y old) who underwent oophorectomy (90%), detorsion (26%), and/or ovarian drainage (13%). There were more episodes of torsion in the PSMA cohort receiving ovarian surgery alone (17% versus 10% IA; P = 0.016), while other indications (ovarian mass, cyst) were similar. Open (66% versus 34% laparoscopic) IAs were more frequent. Length of stay (LOS) was longer for those undergoing IA (3 [2-4] versus 2 [2-4] days ovarian surgery alone; P < 0.001). There was a higher rate of postoperative GI complications in the IA cohort. Subgroup analysis of those undergoing laparoscopic operations demonstrated no difference in LOS or postoperative complications between patients undergoing IA or not. These data indicate that IA in pediatric ovarian operations is associated with longer LOS and higher GI postoperative complications. However, laparoscopic IA was not associated with higher cost, complications, LOS, or readmissions. This suggests that IA performed during ovarian surgeries in select patients may be cost-effective and worthy of future study. [ABSTRACT FROM AUTHOR]

Ovarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT. The diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management. Case report: A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully. Clinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes. [ABSTRACT FROM AUTHOR]

Radiology plays an essential role in the management of benign gynaecological conditions and includes: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities, their recommended roles in the imaging and imaging findings of common female pelvic pathology. [ABSTRACT FROM AUTHOR]

Introduction: Prenatal ovarian torsion (POT) is a clinical condition that has been described before, but is little known and up until now lacks clear guidelines on management. Prenatal discovery of an abdominal mass or cyst can lead to a lot of stress and anxiety with parents. Knowing that POT is a benign condition with marked sonographic-pathologic correlations, our aim is to define the clinical entity and radiological features of a POT with the largest population to date and set up clear guidelines on its management. Materials and methods: We retrospectively collected data from three different pediatric surgical units over a period of 10 years (between 2008-2018). All patients treated for POT were included. Postnatal radiological imaging as well as clinicopathological information was collected and correlated with our diagnostic criteria. Results: We recovered data from a total of 35 patients. A fluid-debris level on ultrasonography (US) was shown to be a specific feature of torsion and was present in all patients. All patients underwent laparoscopic resection of the cyst at a mean age of 73 days. Upon laparoscopy, 16 patients showed signs of adhesions to the cyst. Pathological findings showed the lack of any remaining ovarian tissue in all of the cases. Conclusions: Prenatal ovarian torsion is a condition with distinctive radiological features, the main being a fluid-debris level on sonography. Laparoscopic resection of the cyst has proven to be safe and should be considered in all patients diagnosed with POT.

Introduction: Ovarian torsion is a rare gynecological surgical emergency. It typically occurs with a sudden onset of unilateral lower abdominal pain. However, ovarian torsion with epigastric or periumbilical pain in pediatric patients has not been thoroughly reported. Case presentation: A 7-year-old girl presented with a 2-day history of frequent vomiting and acute abdominal pain. The abdominal pain was mild, intermittent, and extended from the epigastric to the umbilical region. Physical examination revealed localized tenderness in the epigastric to the umbilical region. No abnormal findings were observed on abdominal or pelvic ultrasonography. Contrast-enhanced computed tomography (CT) of the abdomen revealed no bowel obstruction, free air, appendicitis, pancreatitis, urinary tract stones, large cysts, masses in the uterus, uterine adnexa, or aorta or mesenteric artery abnormalities. Frequent vomiting and mild epigastric pain improved gradually from day 5 of hospitalization. However, on day 7, the abdominal pain and vomiting recurred and moved from the epigastric region to the middle of the lower abdomen and persisted. Finally, the abdominal pain moved to the right lower quadrant and worsened. Abdominal and pelvic ultrasound and Magnetic Resonance Imaging (MRI) performed on day 11 revealed right ovarian torsion. An elective oophorectomy was performed to remove the right ovary. Her postoperative period was good. Conclusion: This case highlights the need to consider ovarian torsion as a differential diagnosis of epigastric pain in pediatric patients.

Adnexal torsion is an emergency commonly presenting in women of reproductive age. Timely diagnosis and management are needed to preserve the ovary. Recurrence is more uncommon. This article presents a case of recurrent torsion, and reviews the literature to highlight the significance of early diagnosis and management. The case is presented of a nulliparous 31-year-old woman who presented on five occasions with symptoms of acute pain and vomiting. Adnexal torsion was suspected on clinical assessment and ultrasound scan. She was found to have left-sided isolated fallopian tube torsion twice, and tubo-ovarian torsion on two occasions. Detorsion was performed four times. Bilateral oophoropexy was performed during an emergency laparoscopy on the fourth presentation. The left ovary was conserved, but viability was doubted. She presented four weeks later with similar symptoms. An intraoperative finding was of an auto-amputated left ovary with no attachment to infudibulopelvic ligament. This ovary was removed. Operative management was performed promptly, but planned oophoropexy was delayed, and an earlier procedure may have resulted in conservation of the ovary. There is no standardised management for prevention of recurrent ovarian torsion. The benefits of oophoropexy to prevent further torsion versus risks lack evidence. There is also debate as to the method by which oophoropexy is done. There is no consensus or guideline regarding the best management approach for recurrent adnexal torsion. Further research is needed to obtain evidence to support clinicians in discussing management options with their patients.

While mature cystic teratomas are relatively common ovarian neoplasms typically comprising of multiple embryologic cell types, a specific monodermal subtype involving thyroid tissue, struma ovarii, can rarely be seen. This case reviews typical imaging characteristics with MRI and ultrasound of struma ovarii and details possible complications from these masses with intraoperative and histologic correlation.

Abstract Background Early management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population. Methods This was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children’s hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized. Results There were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%). Conclusions Ovarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome.

Introduction: Pediatric ovarian torsion (OT) is an emergency condition that remains challenging to diagnose because of its overall unspecific clinical presentation. The aim of this study was to determine the diagnostic value of clinical, ultrasound, and inflammatory laboratory markers in pediatric OT. Methods: We performed a retrospective multicentric case–control study in patients with clinical and ultrasound suspicion of OT, in whom surgical examination was performed between 2016–2022 in seven pediatric hospitals. Patients were divided into two groups according to intraoperative findings: OT group (ovarian torsion), defined as torsion of the ovarian axis at least 360°, and non-OT group (no torsion). Demographics, clinical, ultrasound, and laboratory features at admission were analyzed. The diagnostic yield analysis was performed using logistic regression models, and the results were represented by ROC curves. Results: We included a total of 110 patients (75 in OT group; 35 in non-OT group), with no demographic or clinical differences between them. OT-group patients had shorter time from symptom onset (8 vs. 12 h; p = 0.023), higher ultrasound median ovarian volume (63 vs. 51 mL; p = 0.013), and a significant increase in inflammatory markers (leukocytes, neutrophils, neutrophil-to-lymphocyte ratio, C-reactive protein) when compared to the non-OT group. In the ROC curve analysis, the neutrophil-to-lymphocyte ratio (NLR) presented the highest AUC (0.918), with maximum sensitivity (92.4%) and specificity (90.1%) at the cut-off point NLR = 2.57. Conclusions: NLR can be considered as a useful predictor of pediatric OT in cases with clinical and ultrasound suspicion. Values above 2.57 may help to anticipate urgent surgical treatment in these patients.

Intrauterine ovarian torsion is the most common complication of ovarian cysts in fetuses. This pathology is asymptomatic in the postnatal period, thus, it is difficult to diagnose especially in cases then torsion signs were not revealed before birth. This review presents the criteria used in pre- and postnatal diagnosis of ovarian torsion. The main ultrasound markers were identified, as well as the possibilities of using MRI were considered. Timely diagnosis of this pathology in prenatal period contributes to more careful examination of the child after birth. This will determine the management tactics, preserve girl's reproductive function, and avoid any complications from other organs and systems.

The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging since both symptoms and physical examination are nonspecific. In most cases, the patient presents abdominal pain, followed by nausea and vomiting. Imaging tests, such as ultrasound, are very useful to elucidate the cause of the symptoms in those patients.

Background: Early management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population. Methods: This was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children's hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized. Results: There were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%). Conclusions: Ovarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In this study, we aimed to determine whether a patient presenting to the emergency room with abdominal pain and for whom ultrasound access is challenging until an ultrasound is performed, is suffering from ovarian torsion or acute appendicitis. We sought to make this determination based on hematological indices and to investigate the diagnostic value of the direct bilirubin-to-lymphocyte ratio (DLR) in this context. PATIENTS AND METHODS: This study encompasses female patients who presented with abdominal pain to Çam and Sakura Training and Research Hospital between the years 2015 and 2023 and were diagnosed with either acute appendicitis or ovarian torsion. Patients' files were screened retrospectively. Key information, including patients' ages, the onset time of symptoms (duration of symptoms), and laboratory values, was meticulously recorded. The patients were divided into two groups: those with ovarian torsion (Group 1) and those with acute appendicitis (Group 2). RESULTS: The study comprised two distinct patient groups with a total of 159 patients: Group 1 (n=57), representing ovarian torsion, and Group 2 (n=102) representing acute appendicitis. No differences were found in terms of age, symptom duration, White Blood Cell (WBC) Count, Platelet (PLT), CRP (C-reactive protein), and Platelet-to-lymphocyte ratio (PLR) (p>0.05 for each comparison). Direct bilirubin (DB), indirect bilirubin (IB), and total bilirubin (TB) were higher in Group 2 than in Group 1 (p=0.011, p<0.001, p=0.044, respectively). Neutrophil-to-Lymphocyte Ratio (NLR) and Direct Bilirubin-to-Lymphocyte Ratio (DLR) were higher in Group 2 than in Group 1 (p=0.013, p=0.002, respectively). The NLR was analyzed with a cut-off value of 4.1 (AUC: 0.642; sensitivity 82%, specificity 52%). The PLR was analyzed with a cut-off value of 116 (AUC: 0.670; sensitivity 92%, specificity 42%). The DLR was analyzed with a cut-off value of 0.14 (AUC: 0.741; sensitivity 93%, specificity 55%). CONCLUSIONS: This research highlighted the potential of the DLR index in differentiating between ovarian torsion and acute appendicitis, revealing that DLR levels were notably higher in appendicitis patients. [ABSTRACT FROM AUTHOR]

Ovarian suspension surgery can preserve ovarian function and improve quality of life in young patients with cervical cancer. In view of the fact that there is no unified standard surgical method at home and abroad, postoperative ovarian torsion, ovarian cyst and other related complications occasionally occur. A retrospective analysis was performed on a patient with stage ⅠA1 cervical cancer admitted to Gansu Provincial Maternity and Child -Care Hospital in 2018. She underwent laparoscopic radical hysterectomy + bilateral ovary suspension surgery. She was re-admitted 3 years after the operation due to lower abdominal pain. The imaging assessment was recurrence and metastasis of cervical cancer. After discussion by multidisciplinary team (MDT), laparotomy was performed to clarify the nature of the tumor. Postoperative pathological diagnosis was a case of ovarian torsion and necrosis. The selection of ovarian suspension location, intraoperative precautions, and postoperative complications were further analyzed in the light of the literature, in order to provide reference and experience in diagnosis and treatment for standardized surgical operations, early identification, and reasonable treatment of related complications. [ABSTRACT FROM AUTHOR]