Clinical and radiologic factors associated with adnexal torsion in premenarchal and menarchal children and adolescents
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Oct 2022 · 1 min read
In brief
In brief
Retrospective study of 291 pediatric patients identifies vomiting, enlarged adnexal volume, and absent arterial Doppler flow as key predictors of adnexal torsion, though no single factor is diagnostic. Clinicians should interpret multiple clinical and radiologic factors together when evaluating this gynecologic emergency in premenarchal and menarchal patients.
Written by the GCMD Library team from the article.
Background: Adnexal torsion is a gynecologic emergency in children and adolescents but remains a challenging diagnosis, with no consistent clinical or radiologic diagnostic criteria. Our objective was to identify risk factors associated with adnexal torsion in premenarchal and menarchal patients with surgically confirmed torsion compared with those without torsion.
Methods: We conducted a retrospective chart review of all patients who underwent surgery between January 2016 and December 2019 for possible adnexal torsion. Data on demographics, clinical characteristics, radiologic variables, and operative findings were compared using descriptive statistics. Independent predictors of torsion were then examined in multivariate logistic regression models.
Results: Of the 291 patients who underwent surgery, 168 (57.7%) had torsion. Patients with torsion were younger than those without torsion (11.9 vs. 14.2 years, P < .01). Vomiting was significantly associated with torsion for all patients (P < .001). Large adnexal volume and absent arterial Doppler flow were associated with torsion for the total population and menarchal subgroup. A logistic regression model for the total population that controlled for age and menarchal status found that vomiting (adjusted odds ratio [aOR] 5.92, 95% confidence interval [CI] 2.87-12.22), highest adnexal volume category (aOR 4.92, 95% CI 2.25-10.75), and absent arterial Doppler flow (aOR 2.674, 95% CI 1.28-5.60) were associated with torsion.
Conclusions: Vomiting, enlarged adnexal volume, and absent arterial Doppler flow were associated with adnexal torsion. However, no single risk factor accurately diagnosed torsion, and multiple factors should be interpreted together.
DOI: 10.1016/j.jpedsurg.2022.08.008