Adnexa torsion in children: Earlier diagnosis and treatment by laparoscopy

Background. - Experience with adnexa torsion in children, a rare but potentially severe pathology, is still disappointing despite constant radiological progress. Patients and methods. - The files of 19 patients with adnexial torsion treated between 1985 and 1995 were retrospectively reviewed and compared to those reported. Results. - Eight adnexectomies, six oophorectomies, five detorsions with cystectomy and one salpingectomy were performed. There were only five salvaged adnexa in this series. Three tumors were found; all other cases, except three, were torsions induced by voluminous functionnal cysts. Discussion and conclusion. - Clinical context (sudden right pelvic pain without fever) seems important to note. Sonographic examination is first necessary, but its results are not accurate enough to confirm the torsion. Endo-rectal ultrasonography should become the best diagnostic method in cases of complicated ovaries. In order to increase the percentage of salvaged adnexa, the authors, recommend a laparoscopic approach in emergency when clinical examination was doubtfull.