Chang Yi-Jung, Yan Dah-Chin, Kong Man-Shan, Wu Chang-Teng, Chao Hsun-Chin, Luo Chih-Cheng, Hsia Shao-Hsuan
Division of Pediatric Critical Care, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Pediatr Emerg Care. 2008 Aug;24(8):534-7. doi: 10.1097/PEC.0b013e318180fd8b.
Adnexal torsion is an acute abdominal condition often confused with other diseases in children. The objective of this study is to evaluate the diagnosis and characteristics of adnexal torsion in children.
We reviewed the medical records of all cases of children whose adnexal torsion diagnosis was proven by surgery from 1992 to 2005. Neonatal cases were excluded.
A total of 49 cases were included in this study, with a mean age of 12.5 years. Sixteen (32.6%) cases were premenarchal girls, who were more likely to have adnexal torsion missed at first clinical diagnosis when compared with postmenarchal girls (P = 0.032). Presenting symptoms included severe abdominal pain (32%) and a history of recurrent pain of more than 2 weeks (14.2%). Abdominal gray-scale ultrasound (US) in 43 patients revealed 41 cases that were suggestive of ovarian pathology and identified 3 torsions. Seventeen patients had both US and abdominal computed tomography, but no definitive adnexal torsion was diagnosed with the combined studies. When multiple radiographic studies were used, there was a significantly longer time from studies to operation as compared with US alone.
Ultrasound usually plays an important, but not definitive, role in diagnosis. Multiple radiographic studies with combined computed tomography and US did not provide a diagnostic advantage over US alone. Most pediatric adnexal torsion occurs in postmenarchal patients, but the potential exists for this diagnosis in premenarchal girls. Adnexal torsion should be considered in any girl with an abdominal mass and any degree of abdominal pain.
附件扭转是一种急性腹部疾病，在儿童中常与其他疾病相混淆。本研究的目的是评估儿童附件扭转的诊断及特征。
我们回顾了1992年至2005年所有经手术证实为附件扭转的儿童病例的医疗记录。排除新生儿病例。
本研究共纳入49例病例，平均年龄12.5岁。16例（32.6%）为月经初潮前女孩，与月经初潮后女孩相比，她们在首次临床诊断时更易漏诊附件扭转（P = 0.032）。主要症状包括严重腹痛（32%）和超过2周的反复疼痛史（14.2%）。43例患者的腹部灰阶超声（US）显示41例提示卵巢病变，其中3例发现扭转。17例患者同时进行了超声和腹部计算机断层扫描，但联合检查未确诊附件扭转。与单独使用超声相比，使用多种影像学检查时，从检查到手术的时间明显更长。
超声在诊断中通常起重要但非决定性作用。计算机断层扫描和超声联合的多种影像学检查相比单独使用超声并无诊断优势。大多数儿童附件扭转发生在月经初潮后患者，但月经初潮前女孩也有诊断为附件扭转的可能。任何有腹部肿块和任何程度腹痛的女孩都应考虑附件扭转。
