Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion in girls and adolescents

Author:

Tuchkina I.O.1ORCID,Kiebashvili S.V.1ORCID,Piontkovska O.V.2ORCID,Romanova N.V.2ORCID

Affiliation:

1. Kharkiv National Medical University, Kharkiv, Ukraine

2. Kharkiv Regional Children's Clinical Hospital No.1, Kharkiv, Ukraine

Abstract

Clinical-ultrasound and clinical-morphological characteristics of adnexal torsion to the improvement of early diagnosis and development of optimal ways of organ-preserving surgical tactics of treatment have been determined. An analysis was carried out of 71 patients with adnexal torsion (group 1– 30 girls of 2–12 years, group 2 – 41 adolescents of 13–17 years). The main clinical signs of adnexal torsion were nonspecific and similar to the well-known clinic of acute abdomen. Ultrasound examination with color doppler mapping (CDM) allowed to suspect adnexal torsion in 44 (62 %) patients. The main echographic features of adnexal torsion were: ovarian enlargement, non-typical location and a change in the structure of ovary, the presence of a free liquid in the cavity of a small pelvis or in the abdominal cavity, «a symptom of springs» (a twisted vascular leg), a decrease or absence of blood flow in CDM. The torsion of intact uterine appendages is installed in 29 patients (twice as often in group 1). In 42 cases were detected the torsion of the uterine appendages, compromised by the presence of tumors and tumor-like formations (twice as often in group 2). In both groups, 36 (50.7 %) organ-preserving and 35 (49.3 %) radical operations were carried out. According to the results of morphological examination of the removed tissues, the following data were obtained: follicular cysts – 15, paratubal cysts – 8, corpus luteum cysts – 8, teratomas – 5, serous cystadenomas – 2, mucinous cystadenoma – 1, paraovarian cysts – 3. Differential diagnosis of adnexal torsion in girls and adolescents should include a thorough collection of anamnestic data, taking into account the features of the clinical course of the disease, the results of a comprehensive examination with an assessment of ultrasound data from CDM, computer and magnetic resonance imaging, which will contribute to the advanced adequate selection of tactics of urgent gynecological intervention. The method of choice for the treatment of adnexal torsion is a minimally invasive surgical intervention – a laparoscopy with organ-preserving operations. Keywords: adnexal torsion, girls, ultrasound and morphological characteristics.

Publisher

Kharkiv National Medical University

Subject

General Earth and Planetary Sciences,General Environmental Science

Reference8 articles.

1. Tuchkina, I., Gnatenko, O., & Kiebashvili, S. (2016). Рerekrut pridatkov matki kak odna iz prichin abdominalnoho bolevoho sindroma u devochek i devushek [Uterine adnexa torsion as the cause of abdominal pain in girls and young women]. Zbirnyk naukovykh prats Asotsiatsii akusheriv-hinekolohiv Ukrainy – Scientific digest of Association of obstetricians and gynaecologists of Ukraine, (2(38)), 372–376. Retrieved from http://aagu.com.ua/publisher/downloads/zbirnyk_2(38)2016.pdf [in Russian].

2. Stanković, Z. B., Sedlecky, K., Savić, D., Lukač, B. J., Mažibrada, I., & Perovic, S. (2017). Ovarian preservation from tumors and torsions in girls: prospective diagnostic study. J. Pediatr. Adolesc. Gynecol., 30(3), 405–412. DOI: 10.1016/j.jpag.2017.01.008, PMID: 28137453.

3. Tuchkina I., Paschenko Y., Piontkovskaya O. et al. (2018). Urgent conditions in pediatric and adolescent gynecology. Gynecological Endocrinology: the 18th World Congress, Florence, Italy (Pp. 239). Florence.

4. Tuchkina, I. O., & Gnatenko, O. V. (2016). Patent na korisnu model № 114692 Ukraina, МPК A61B 8/00, G01N 33/50, A61B 6/03. Sposib vyboru likuvalnoi taktyky dlia molodykh zhinok ta divchat-pidlitkiv z symptomamy hostroho zhyvota [Patent for utility model No. 114692. Ukraine, IPC A61B 8/00, G01N 33/50, A61B 6/03. A method of choosing treatment tactics for young women and adolescent girls with symptoms of acute abdomen]. Applicant and patent holder Kharkiv National Medical University, № application u 2016 10730; stated on 25.10.16; published on 10.03.17, bulletin № 5. Retrieved from https://uapatents.com/4-114692-sposib-viboru-likuvalno-taktiki-dlya-molodikh-zhinok-ta-divchat-pidlitkiv-z-simptomami-gostrogo-zhivota.html [in Ukrainian].

5. Korovin, S. A., Dzyadchik, A. V., Galkina, Ya. A., & Sokolov, Yu. Yu. (2016). Laparoskopicheskiie vmeshatelstva u devochek s perekrutami pridatkov matki [Laparoscopic treatment in girls with adnexal torsion]. Rossiiskii vestnik detskoi khirurhii, anesteziolohii i reanimatolohii – Russian Bulletin of Pediatric Surgery, Anesthesiology and Critical Care Medicine, 6(2), 73–79. DOI: 10.17816/psaic252 [in Russian].

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