Ovarian torsion in pediatric and adolescent patients

A systematic review

Roshni Dasgupta, Elizabeth Renaud, Adam B. Goldin, Robert Baird, Danielle B. Cameron, Meghan A. Arnold, Karen A. Diefenbach, Ankush Gosain, Julia Grabowski, Yigit S. Guner, Timothy Jancelewicz, Akemi Kawaguchi, Dave R. Lal, Tolulope A. Oyetunji, Robert L. Ricca, Julia Shelton, Stig Somme, Regan Williams, Cynthia D. Downard

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion. Methods: Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence. Results: Ninety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3 months postprocedure but sooner if there is a concern for malignancy. Conclusion: There appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion. Type of study: Systematic review of level 3–4 studies. Level of evidence: 3–4

Original languageEnglish (US)
Pages (from-to)1387-1391
Number of pages5
JournalJournal of pediatric surgery
Volume53
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Ovary
Pediatrics
Thromboembolism
Neoplasms
Evidence-Based Practice
Recovery of Function
Oocytes
Fertility
Databases
Guidelines
Pregnancy
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Dasgupta, R., Renaud, E., Goldin, A. B., Baird, R., Cameron, D. B., Arnold, M. A., ... Downard, C. D. (2018). Ovarian torsion in pediatric and adolescent patients: A systematic review. Journal of pediatric surgery, 53(7), 1387-1391. https://doi.org/10.1016/j.jpedsurg.2017.10.053

Ovarian torsion in pediatric and adolescent patients : A systematic review. / Dasgupta, Roshni; Renaud, Elizabeth; Goldin, Adam B.; Baird, Robert; Cameron, Danielle B.; Arnold, Meghan A.; Diefenbach, Karen A.; Gosain, Ankush; Grabowski, Julia; Guner, Yigit S.; Jancelewicz, Timothy; Kawaguchi, Akemi; Lal, Dave R.; Oyetunji, Tolulope A.; Ricca, Robert L.; Shelton, Julia; Somme, Stig; Williams, Regan; Downard, Cynthia D.

In: Journal of pediatric surgery, Vol. 53, No. 7, 01.07.2018, p. 1387-1391.

Research output: Contribution to journalArticle

Dasgupta, R, Renaud, E, Goldin, AB, Baird, R, Cameron, DB, Arnold, MA, Diefenbach, KA, Gosain, A, Grabowski, J, Guner, YS, Jancelewicz, T, Kawaguchi, A, Lal, DR, Oyetunji, TA, Ricca, RL, Shelton, J, Somme, S, Williams, R & Downard, CD 2018, 'Ovarian torsion in pediatric and adolescent patients: A systematic review', Journal of pediatric surgery, vol. 53, no. 7, pp. 1387-1391. https://doi.org/10.1016/j.jpedsurg.2017.10.053
Dasgupta R, Renaud E, Goldin AB, Baird R, Cameron DB, Arnold MA et al. Ovarian torsion in pediatric and adolescent patients: A systematic review. Journal of pediatric surgery. 2018 Jul 1;53(7):1387-1391. https://doi.org/10.1016/j.jpedsurg.2017.10.053
Dasgupta, Roshni ; Renaud, Elizabeth ; Goldin, Adam B. ; Baird, Robert ; Cameron, Danielle B. ; Arnold, Meghan A. ; Diefenbach, Karen A. ; Gosain, Ankush ; Grabowski, Julia ; Guner, Yigit S. ; Jancelewicz, Timothy ; Kawaguchi, Akemi ; Lal, Dave R. ; Oyetunji, Tolulope A. ; Ricca, Robert L. ; Shelton, Julia ; Somme, Stig ; Williams, Regan ; Downard, Cynthia D. / Ovarian torsion in pediatric and adolescent patients : A systematic review. In: Journal of pediatric surgery. 2018 ; Vol. 53, No. 7. pp. 1387-1391.
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AU - Renaud, Elizabeth

AU - Goldin, Adam B.

AU - Baird, Robert

AU - Cameron, Danielle B.

AU - Arnold, Meghan A.

AU - Diefenbach, Karen A.

AU - Gosain, Ankush

AU - Grabowski, Julia

AU - Guner, Yigit S.

AU - Jancelewicz, Timothy

AU - Kawaguchi, Akemi

AU - Lal, Dave R.

AU - Oyetunji, Tolulope A.

AU - Ricca, Robert L.

AU - Shelton, Julia

AU - Somme, Stig

AU - Williams, Regan

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N2 - Objective: Ovarian torsion in pediatric patients is a rare event and is primarily managed by pediatric general surgeons. Torsion can be treated with detorsion of the ovary or oopherectomy. Oopherectomy is the most common procedure performed by pediatric general surgeons for ovarian torsion. The purpose of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee was to examine evidence from the medical literature and provide recommendations regarding the optimal treatment of ovarian torsion. Methods: Using PRISMA guidelines, six questions were addressed by searching Medline, Cochrane, Embase Central and National clearing house databases using relevant search terms. Risks of ovarian detorsion including thromboembolism and malignancy, indications for oophoropexy, benefits of detorsion including recovery of function and subsequent fertility, and recommended surveillance after detorsion were evaluated. Consensus recommendations were derived for each question based on the best available evidence. Results: Ninety-six studies were included. Risks of ovarian detorsion such as thromboembolism and malignancy were reviewed, demonstrating minimal evidence for unknowingly leaving a malignancy behind in the salvaged ovary and no evidence in the literature of thromboembolic events after detorsion of a torsed ovary. There is no clear evidence supporting the benefit of oophoropexy after a single episode of ovarian torsion. The gross appearance of the ovary does not correlate with long-term ovarian viability or function. Pregnancies have occurred in patients after detorsion of an ovary both spontaneously and with harvested oocytes from previously torsed ovaries. The consensus recommendation for imaging surveillance following ovarian detorsion is an ultrasound at 3 months postprocedure but sooner if there is a concern for malignancy. Conclusion: There appears to be overwhelming evidence supporting ovarian detorsion rather than oopherectomy for the management of ovarian torsion in pediatric patients. Ovarian salvage is safe and is the preferred treatment for ovarian torsion. Most salvaged ovaries will maintain viability after detorsion. Type of study: Systematic review of level 3–4 studies. Level of evidence: 3–4

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