Adnexal torsion. Organ-sparing tactics
Background. Adnexal torsion (AT) occurs in 15% of children. The choice of surgical tactics is based on visual assessment of the color of the uterine appendages. Ovariectomy is chosen when the twisted ovary is found to have a violet or blue-black color that remains after untwisting (detorsion). However, articles describing the favorable outcomes of preservation of even a seemingly nonviable ovary indicate that the blue-black color is not always confirmed by the morphological signs of necrosis, and in the late period there is recovery of blood flow and folliculogenesis in the untwisted ovary.Batyrova Z.K., Chundokova M.A., Uvarova E.V., Kumykova Z.Kh., Khashchenko E.P., Chuprynin V.D., Lunkov S.S., Kiseleva I.A., Latypova N.Kh., Buralkina N.A.
Description. The paper describes two most illustrative clinical cases of girls with AT, in which the blue-black color suggested the absence of ovarian viability, but the long-term results of detorsion testified that a surgeon’s initial opinion is faulty.
Conclusion. Pain complaints in the AT area is an encouraging clinical sign of viability of the ovary, which allows the choice of organ-sparing tactics even with its blue-black color, low vulnerability, and a lack of blood flow. Recovery of blood flow in the uterine appendage during the first 7 days after detorsion, as evidenced by pelvic Doppler ultrasound, should be considered to be a significant prognostic factor in the similar clinical picture of AT.
Keywords
adnexal torsion
girls
organ-sparing treatment
laparoscopy
Supplementary Materials
- Fig. 1. Patient A. Laparoscopic picture of torsion of the left appendages of the uterus
- Fig. 2. Patient B. Laparoscopy. Torsion of the right appendages of the uterus
- Fig. 3. Patient V. Ultrasound with color Doppler mapping, the 5th day. Single pixels in the right ovary
References
1. Hanaa El-Ebeisssy, Rafik Shalaby, Ahmed Abd El Ghafar Helel. Laparoscopic management of ovarian torsion in children and adolescent. J. Am. Sci. 2014; 10(7): 56-61.
2. Коровин С.А., Дзядчик А.В., Галкина Я.А., Соколов Ю.Ю. Лапароскопические вмешательства у девочек с перекрутами придатков матки. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2016; 6(2): 73-9. [Korovin S.A., Dzyadchik A.V., Galkina J.A., Sokolov U.U. Laparoscopic intervention in girls with adnexal torsion. Russian bulletin of pediatric surgery, anesthesiology and resuscitation. 2016; 6(2): 73-79. (in Russian)]
3. Краснопеева Ю.В., Порицкий Е.А., Антоненко Ф.Ф., Хамошина М.Б. Оптимизация хирургической тактики при перекруте кисты яичника у детей и подростков. Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук. 2006; 1: 72-5. [Krasnopeeva U.V., Poritskiy E.A., Antonenko F.F., Khamoshina M.B., Optimization of surgical tactic for ovarian cysts torsion in children and adolescents. Bulletin of the East Siberian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences. 2006. 1: 72-75. (in Russian)]
4. Милюкова П.П., Умань Н.В., Юрков Г.С. Диагностика и лечение нарушения кровообращения придатков матки у девочек. Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук. 2008; 3: 106-7. [Milukova P.P., Uman N.V., Urkov G.S. Diagnosis and treatment of adnexal torsion in girls. Bulletin of the East Siberian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences. 2008. 3: 106-107. (in Russian)]
5. Четин М.В., Акопов А.Г., Волков Д.В., Шухина М.И., Османов О.Н., Шакирова А.Р. Лапароскопия при острой гинекологической патологии у девочек. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2012; 2(1): 72-5. [Chetin M.V., Akopov A.G., Volkov D.V., Shukhina M.I., Osmanov O.N., Shakirova A.R. Laparoscopy in acute gynecological pathology in girls. Russian bulletin of pediatric surgery, anesthesiology and resuscitation. 2012. 2(1): 72-75. (in Russian)]
Received 16.06.2017
Accepted 23.06.2017
About the Authors
Batyrova Zalina Kimovna, PhD, researcher, Department of Pediatric and adolescent gynecology of Research Center of Obstetrics, Gynecology, and Perinatology,Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388542. Е-mail: linadoctor@mail.ru
Chundokova Madina Arsenovna, Doctor of Medical Sciences, Professor, pediatric surger of N.F. Filatov City Children’s Hospital Thirteen.
103001, Russia, Moscow, Sadovo-Kudrinskaya str. 15. Tel.: +79166702008. E-mail: cmadina@yandex.ru
Uvarova Elena Vitalievna, Doctor of Medical Sciences, Professor, Head of the Department of Pediatric and adolescent gynecology, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388509. E-mail: elena-uvarova@yandex.ru
Kumykova Zaira Khasanovna, PhD, senior researcher, Department of Pediatric and adolescent gynecology, Research Center of Obstetrics,
Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388542. E-mail: zai-kumykova@yandex.ru
Khashenko Elena Petrovna, researcher, Department of Pediatric and adolescent gynecology, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388542. Е-mail: khashchenko_elena@mail.ru
Chuprynin Vladimir Dmitrievich, PhD, Head of the Department of General Surgery, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954387833. E-mail: v_chuprynin@oparina4.ru
Lunkov Stanislav Sergeevich, doctor at the Department of ultrasound diagnostic, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381177. E-mail: s_lunkov@oparina4.ru
Kiseleva Irina Anatolievna, PhD, senior researcher, at the Department of Pediatric and adolescent gynecology, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388542. E-mail: i_kiseleva@oparina4.ru
Latypova Nailja Khusainovna, PhD, doctor, Department of Pediatric and adolescent gynecology, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954388542. E-mail: nlatipova@mail.ru
Buralkina Natalya Aleksandrovna, Doctor of Medical Sciences, Senior Researcher, Department of General Surgery, Research Center of Obstetrics,
Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954387833. E-mail: n_buralkina@oparina4.ru
For citations: Batyrova Z.K., Chundokova M.A., Uvarova E.V.,
Kumykova Z.Kh., Khashchenko E.P., Chuprynin V.D., Lunkov S.S., Kiseleva I.A.,
Latypova N.Kh., Buralkina N.A. Adnexal torsion. Organ-sparing tactics.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (9): 148-52. (in Russian)
http://dx.doi.org/10.18565/aig.2017.9.148-52
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