Torsion in Adolescents Flashcards
Most common pathologies in adolescents w/ torsion?
Benign function cysts
Benign Teratomas
What percentage with adolescents with torsion have no cyst at all?
46% of cases have no masses on ovaries
Should you ever remove the ovary?
No, unless unavoidable (necrotic ovary falling apart) - otherwise leave ovary in regardless of its appearance
Should you do a cystectomy at time of detorsion for adolescent?
Does not need to be performed - because it may cause additional trauma. Surgeon can consider incision and drainage for large cyst
Follow-up for cyst left in situ in adolsecent?
Repeat US at 6-12 weeks
In adolescent, is torsion more likely on the right or left side?
Right side! (64% of cases)
- left side has descending colon
What factors predispose adolescents to torsion?
- Congenitally long ovarian ligaments
- excessive laxity of pelvic ligaments
- relatively small uterus that allows more space for adnexa to twist
US findings suggestive of adnexal torsion?
- Enlarged heterogenous ovary (torsed ovaries usually 12x the volume of contralateral side)
- Asymmetric ovaries
- Multiple peripheral follicles
- Whirlpool sign (coiled vascular pedicle)
Imaging of choice for adolescent with suspected torsion?
TRANSABDOMINAL ultrasound
Most predictive factors that an adolescent is torsed?
- Vomiting
- Adnexal size/ratio to contralateral side
Is the appearance of the ovary a reliable indicator of ovarian viability?
NO!!! multiple studies report future ovarian function despite a grossly ischemic appearance at the time of surgery
Also at “second look” surgeries - ovaries are normal appearing after 36 hours
Laparoscopic operating on adolescents
- Less abdominal wall tissue integrity
- More at risk for vascular injury
- placement of trocars
- consider fascial closure because more at risk for herniation compared to adults
- Insufflation requires lower pressure (12 mmHg)
