Rey-Bellet Gasser Celine, Gehri Mario, Joseph Jean-Marc, Pauchard Jean-Yves
From the Divisions of *Pediatric Emergency Medicine, †Pediatric Medicine, and ‡Pediatric Surgery, Department of Pediatrics, Children's Hospital, Lausanne, Switzerland.
Pediatr Emerg Care. 2016 Apr;32(4):256-61. doi: 10.1097/PEC.0000000000000621.
This study aimed to identify, through systematic literature review, the most reliable clinical, biological, and radiological signs of ovarian torsion in the pediatric population and to compare their diagnostic value.
This is a systematic review of the literature, searching MEDLINE, EMBASE, and Cochrane Databases for articles published between January 1990 and January 2014.
From the 946 references initially identified, 14 retrospective publications fulfilled the inclusion criteria, involving a total of 663 episodes of ovarian torsion. Sudden onset abdominal pain with nausea and/or vomiting is the most frequent symptom of ovarian torsion. It can occur at any age, not only in menarchal or perimenarchal patients. Abdominal tenderness is present in 88.4% of patients, whereas only 24% have a palpable mass. Blood tests are commonly requested (51.4% of cases) but are not diagnostic. Abnormalities on plain abdominal radiograph include masses, calcifications, and ossified images. Ultrasound has a sensitivity for ovarian torsion of 79% and computerized tomographic scan of 42.2%. There is a significant diagnostic delay at 101.8 hours (median).
Abdominal pain in children and adolescents is difficult to evaluate, and the diagnosis of ovarian torsion remains a challenge. Because of its potential complications, we need effective clinical tools. From our review of the literature, it was not possible to develop a diagnostic algorithm. Further research is needed to improve our practice and shorten the delay to diagnosis. Considering the low incidence of ovarian torsion, a multicenter prospective study would be required.
本研究旨在通过系统的文献综述，确定儿科人群中卵巢扭转最可靠的临床、生物学和放射学征象，并比较它们的诊断价值。
这是一项对文献的系统综述，检索了MEDLINE、EMBASE和Cochrane数据库中1990年1月至2014年1月发表的文章。
从最初识别的946篇参考文献中，14篇回顾性出版物符合纳入标准，共涉及663例卵巢扭转病例。突发腹痛伴恶心和/或呕吐是卵巢扭转最常见的症状。它可发生于任何年龄，不仅是初潮期或围初潮期患者。88.4%的患者有腹部压痛，而只有24%的患者可触及肿块。通常会进行血液检查（51.4%的病例），但不具有诊断性。腹部平片异常包括肿块、钙化和骨化影像。超声对卵巢扭转的敏感性为79%，计算机断层扫描为42.2%。诊断延迟中位数为101.8小时。
儿童和青少年的腹痛难以评估，卵巢扭转的诊断仍然是一项挑战。由于其潜在的并发症，我们需要有效的临床工具。从我们的文献综述来看，无法制定出诊断算法。需要进一步研究以改进我们的实践并缩短诊断延迟。考虑到卵巢扭转的低发病率，需要进行多中心前瞻性研究。
