Pediatric Adnexal Torsion: Not Just a Postmenarchal Problem

• Published in: The Journal of emergency medicine 2017-02, Vol.52 (2), p.169-175
• Main Authors: Schuh, Abigail M., MD, Klein, Eileen J., MD, MPH, Allred, Rebecca J., MD, Christensen, Ana, MPH, Brown, Julie C., MD, MPH
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; adnexal; Adnexal Diseases - epidemiology; Adnexal Diseases - surgery; Adolescent; Child; Child, Preschool; Cohort Studies; Emergency; Female; Hospitals, Pediatric - organization & administration; Humans; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Menarche - physiology; Necrosis - mortality; ovarian; ovary; pediatric; Retrospective Studies; Teratoma - epidemiology; torsion; Torsion Abnormality - epidemiology; Torsion Abnormality - surgery
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.08.020

Abstract Background Pediatric adnexal torsion is rare, can be challenging to recognize, and may result in ovarian loss. Objective We sought to identify and compare the defining characteristics of adnexal torsion in premenarchal and postmenarchal girls. Methods A retrospective cohort study was performed at a tertiary care children's hospital, including patients diagnosed postnatally with adnexal (ovarian or tubal) torsion between 1997 and 2013. Proportions were compared using relative risk regression. Results Adnexal torsion was found in 59 premenarchal and 43 postmenarchal girls. Abdominal pain was the most common chief complaint (54%). History included reports of pain (96%), vomiting (67%), and fever (19%). Excluding 12 patients with isolated tubal torsion and 19 with a teratoma, there were no statistically significant differences in ovarian loss in premenarchal vs. postmenarchal girls (47% and 25% respectively; relative risk [RR] = 1.8 [95% confidence interval {CI} 0.9–3.8]), left- vs. right-sided torsion (47% and 32%; RR = 1.5 [95% CI 0.8–2.7]), pain duration ≤ 2 days vs. > 2 days (31% and 41%; RR = 0.8 [95% CI 0.4–1.5]; n = 64) and severe pain vs. mild to moderate (38% and 33%; RR = 1.1 [95% CI 0.7–1.5]; n = 56). Conclusions The diagnosis of pediatric adnexal torsion is difficult and often delayed. Pain and tenderness may not be isolated to a unilateral lower quadrant. Although traditionally considered a postmenarchal problem, in a pediatric academic emergency department adnexal torsion occurred with similar frequency in premenarchal and postmenarchal girls. The potential for organ salvage means that adnexal torsion should be considered in all females presenting with acute abdominal pain regardless of age or menstrual history.