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.