Torsion of the adnexa in children: the value of laparoscopy.

Experience with adnexal torsion in neonates and children is often disappointing. Delay between the first symptoms and operation is important, and adnexal loss the rule. The authors reviewed their experience and the literature to assess the appropriate diagnostic and therapeutic approach. Diagnostic procedures (standard ultrasonography [US], color Doppler US, computed tomography, magnetic resonance imaging, endorectal US, and diagnostic laparoscopy) are discussed; for neonates and premenarcheal girls a specific surgical approach is proposed. Twenty-seven adnexal torsions treated between 1985 and 1995 in the same institution were retrospectively reviewed. Neonatal (7) and premenarcheal cases (20) were separated. The neonatal cases (7) were all operated upon: 4 adnexectomies, 2 oophorectomies, and 1 detorsion with cystectomy were performed. In the premenarcheal group (20) 8 adnexectomies, 6 oophorectomies, 5 detorsions with cystectomy, and 1 salpingectomy were performed. There were only 6 salvaged adnexa in this series. In the neonatal group, US seemed accurate in predicting complicated cases. Prenatal puncture of large (>40 mm) ovarian cysts is possible. The authors advocate a laparoscopic approach in the first days of life of all uncomplicated cysts independent of size in order to increase the percentage salvaged. In ultrasonic complicated cases a delayed operation is proposed in the premenarcheal group, endorectal US will probably become the diagnostic method of choice for complicated ovaries; other methods were disappointing. In order to increase adnexal salvage, the authors recommend a laparoscopic approach in the emergency situation if a clinical examination is positive as well as better medical (pediatricians, gynecologists) and general (girls, parents) information. They suggest controlateral oophoropexy in cases of torsion of a normal adnexum.