Department of Pediatrics, Children's Hospital, Changhua Christian Hospital, Taiwan.
Pediatr Neonatol. 2012 Feb;53(1):55-9. doi: 10.1016/j.pedneo.2011.11.011. Epub 2012 Jan 17.
Abdominal pain is one of the most common complaints made by patients visiting emergency departments; however, ovarian torsion is an uncommon cause of abdominal pain, especially in young children. Early diagnosis is essential in order to salvage the ovaries. We performed a retrospective analysis of patients under 18 years of age who visited Changhua Christian Hospital with adnexal torsion between June 2003 and June 2010.
Medical records were reviewed for age, associated symptoms, past and present medical histories, physical findings, diagnostic tests performed, clinical course, pathological findings, and diagnoses.
A total of 21 patients were identified and included in the analysis; their mean (SD) age was 13.62 (3.75) years. Abdominal pain was the universal symptom. Vomiting or nausea was the second most common symptom (33.3%). The average period between symptom onset and diagnosis was 3.29 (6.39) days. Right-side adnexal torsion occurred in 14 patients, and left-side torsion in seven patients. Ovarian cysts, most often dermoid cysts (e.g., teratomas), were found in 16 patients (76%). Except for one conservatively treated case and one malignant case (adult granulose cell tumor), the other results of the pathological examination were as follows: eight dermoid cysts, two cystadenomas, one follicular cyst, and eight simple cysts.
Although it is uncommon, adnexal torsion should be included in the differential diagnosis of lower abdominal pain in all girls, regardless of age. Sonography is helpful for making such a diagnosis. Time is a critical factor, and early laparoscopy or laparotomy may save a viable ovary.
腹痛是患者就诊于急诊的最常见症状之一；然而，卵巢扭转是一种罕见的腹痛原因，尤其是在年幼的儿童中。早期诊断对于保留卵巢至关重要。我们对 2003 年 6 月至 2010 年 6 月期间因附件扭转就诊于彰化基督教医院的 18 岁以下患者进行了回顾性分析。
对患者的年龄、伴随症状、既往和现病史、体格检查结果、进行的诊断性检查、临床病程、病理结果和诊断进行了回顾性分析。
共确定了 21 例患者，并将其纳入分析；平均（SD）年龄为 13.62（3.75）岁。腹痛是普遍的症状。呕吐或恶心是第二常见的症状（33.3%）。症状发作到诊断的平均时间为 3.29（6.39）天。14 例患者发生右侧附件扭转，7 例患者发生左侧附件扭转。16 例患者（76%）发现卵巢囊肿，最常见的是皮样囊肿（例如，畸胎瘤）。除了 1 例保守治疗的病例和 1 例恶性病例（成人颗粒细胞瘤）外，其余病理检查结果如下：8 例皮样囊肿、2 例囊腺瘤、1 例滤泡囊肿和 8 例单纯囊肿。
尽管罕见，但在所有女孩出现下腹痛时，都应将附件扭转纳入鉴别诊断，不论年龄大小。超声检查有助于做出这种诊断。时间是一个关键因素，早期腹腔镜或剖腹探查术可能挽救有活力的卵巢。
