Study Objective. To evaluate treatment of premenarchal girls with torsion o
f the adnexa.
Design. Retrospective review of medical records (Canadian Task Force classi
fication II-2).
Setting. Tertiary care, university-affiliated hospital.
Patients. Eight premenarchal girls (age range 3-12 yrs) with twisted adnexa
.
Intervention. Laparoscopic detorsion and follow-up with B scan and Doppler
ultrasound imaging.
Measurements and Main Results. Duration of complaints ranged from 8 to 72 h
ours (mean 34.6 hrs) and the interval from admission to surgery ranged from
6 to 24 hours (mean 18.7 hrs). Four patients had torsion of normal-appeari
ng adnexa. The other four had ovarian neoplasms. Two had cystic mature tera
tomas (dermoid cysts) and one a serous cystadenoma that required additional
operation. The fourth girl had a simple ovarian cyst that was aspirated la
paroscopically. Seven girls (87%) had normal-appearing ovaries on follow-up
ultrasound In one patient, a small ovary was seen, with no intraovarian bl
ood flow on color Doppler.
Conclusion. Although the diagnosis of torsion of the adnexa in premenarchal
girls is difficult and usually delayed, laparoscopic detorsion seems to be
an effective adnexa-sparing approach. We suggest that laparoscopy should b
e the treatment of choice and that detorsion, ra ther than adnexectomy, be
performed more often in these patients.