Poster Session

P88. Optimization of surgical management of adnexal torsion in girls

Salome Kiebashvili (UA), Iryna Tuchkina (UA), Olga Ghatenko (UA), Guz Iryna (UA)

[Kiebashvili] Kharkiv National Medical University, [Tuchkina] Department of Obstetrics and Pediatrics Gynecology of Kharkiv national Medical University, [Ghatenko] , [Iryna]

Context. According to statistical data, among gynecological emergencies that require rendering urgent medical aid, adnexal torsion occupies the 5th place and may occur in any age. The question of surgical management choice has been debated due to the risk of thromboembolism subsequent to detorsion, dissemination in case of a malignancy, malignant transformation of the affected ovary against the background of prolonged ischemia. However, on the basis of the international experience, at present time, it is reasonable to apply a conservative therapeutic approach. After detorsion, based on microscopic findings, the recovery of tissue viability is carefully evaluated and in case of suspected necrosis adnexectomies or ovariectomies are performed. Objective. A study of the incidence of adnexal torsion in girls and adolescent girls in the process of female reproductive system development and optimization of their surgical management. Patients and methods. The study involved examination of 30 girls and adolescent girls. The patients were divided into two groups. Group 1 comprised 11 girls aged 2-12, Group 2 included 19 adolescent girls aged 13-17. All the patients underwent comprehensive clinical, laboratory and instrumental examination with a thorough evaluation of their case histories. Results. In Group 1: 8 patients were diagnosed with an isolated ovarian torsion, 1 – with a twisted ovarian cyst, 1 – with a twisted paratubal cyst, 1 with an ovarian teratoma torsion. In Group 2: 7 patients were diagnosed with an isolated ovarian torsion, 6 – with a twisted ovarian cyst, 4 – with a twisted paratubal cyst, 2 – with a torsion of the ovary and Fallopian tube. The clinical symptoms of the adnexal torsion were non-specific and corresponded to the clinical presentation of the acute abdomen. 29 laparoscopic surgeries were performed, as well as 1 laparotomy (in case of a twisted right ovarian teratoma). The detorsion of the adnexa with the subsequent recovery of their viability was performed in 19 patients (65.5%), radical surgical treatment – in 10 patients (34.5%). Conclusions. The patients of Group 1 were diagnosed with the torsion of intact adnexa significantly more often then those of Group 2: 72.2% and 47.4%, respectively (p < 0.05). As for Group 2, the torsion of compromised adnexa predominated. Minimally invasive surgical procedure, laparoscopy with organ-saving operations, should be considered the treatment of choice with regard to upcoming maternity.