weekly_question 10/10/2021

[Admin]

A 12-year old female presents with 12 hour history of abdominal pain and vomiting. The most definitive method to exclude ovarian torsion is

A Doppler flow study.

B abdominal computerized tomography scan.

C physical exam.

D laparoscopy.

E ultrasound.

[Admin]

correct answer
D laparoscopy.

Ovarian torsion is often a challenging diagnosis because the symptoms are nonspecific and imaging studies inconclusive. There is considerable overlap in the clinical presentation of appendicitis and ovarian torsion. It is therefore imperative that a high index of suspicion be maintained in females presenting with abdominal pain. Although similar in incidence to testicular torsion, the intervals to diagnostic imaging and operation are more than 2.5 X longer for ovarian torsion with worse gonadal salvage rates.

Various methods have been proposed to improve the diagnosis or exclusion of ovarian torsion. Unfortunately, physical exam, ultrasound, Doppler interrogation, and CT scans are not reliable. A composite index was developed incorporating both clinical and radiographic elements (ovarian ratio, ovarian volume, nausea and duration of pain) to more accurately predict and possibly exclude those with very low likelihood. Nonetheless, liberal use of diagnostic laparoscopy must be employed to improve ovarian salvage.

Since the pathology is predominantly benign, the edematous detorsed ovary should be preserved if at all possible. Unfortunately, recent data from a large population-based study (Nationwide Inpatient Sample) suggests that in the United States oophorectomy is performed in almost 80% of females less than 18 years of age with ovarian torsion. At nonteaching hospitals the rates were significantly higher (89.3%) than at teaching hospitals (79.5%).

In comparing pediatric surgeons to gynecologists, pediatric surgeons performed the majority of procedures for ovarian torsion in patients less than 18 years of age and were more likely to use laparoscopy. However, their oophorectomy rate was 38% compared to 27% for gynecologists (p< .01).

[Magdilolah]

D.
the ultrasound may indicate large ovary and the doppler may also suggest decreased blood flow but the dehinitive diagnosis is laparoscopy as it is diagnostic and therapeutic

[Admin]

correct answer
D laparoscopy.

Ovarian torsion is often a challenging diagnosis because the symptoms are nonspecific and imaging studies inconclusive. There is considerable overlap in the clinical presentation of appendicitis and ovarian torsion. It is therefore imperative that a high index of suspicion be maintained in females presenting with abdominal pain. Although similar in incidence to testicular torsion, the intervals to diagnostic imaging and operation are more than 2.5 X longer for ovarian torsion with worse gonadal salvage rates.

Various methods have been proposed to improve the diagnosis or exclusion of ovarian torsion. Unfortunately, physical exam, ultrasound, Doppler interrogation, and CT scans are not reliable. A composite index was developed incorporating both clinical and radiographic elements (ovarian ratio, ovarian volume, nausea and duration of pain) to more accurately predict and possibly exclude those with very low likelihood. Nonetheless, liberal use of diagnostic laparoscopy must be employed to improve ovarian salvage.

Since the pathology is predominantly benign, the edematous detorsed ovary should be preserved if at all possible. Unfortunately, recent data from a large population-based study (Nationwide Inpatient Sample) suggests that in the United States oophorectomy is performed in almost 80% of females less than 18 years of age with ovarian torsion. At nonteaching hospitals the rates were significantly higher (89.3%) than at teaching hospitals (79.5%).

In comparing pediatric surgeons to gynecologists, pediatric surgeons performed the majority of procedures for ovarian torsion in patients less than 18 years of age and were more likely to use laparoscopy. However, their oophorectomy rate was 38% compared to 27% for gynecologists (p< .01).