The evaluation, diagnosis and management of adnexal torsion in pediatric and adolescent patients

Adnexal torsion is a surgically diagnosed gynecological emergency with 30% of cases occurring in females under the age of 20. The most common ovarian pathologies observed in adolescents with adnexal torsion are benign teratomas and benign functional ovarian cysts. However, in 46% of cases, torsioned ovaries are normal, without a mass or cyst. The torsion of malignant ovarian masses is extremely rare in this population. Torsion often presents with sudden-onset, intermittent abdominal pain, nausea and vomiting. It should be noted that there are no sufficient clinical or imaging criteria available, and Doppler ultrasound alone is not a guide to clinical decision-making to confirm the pre-operative diagnosis of adnexal torsion. If ovarian torsion is suspected, prompt intervention with diagnostic laparoscopy is recommended to preserve ovarian and tubal function. In 50% of cases, adnexal torsion is not found during laparoscopy; however, other gynecologic pathologies are identified and treated. When adnexal torsion is detected, detorsioning is recommended, regardless of ovarian appearance. The purpose of this review is to guide clinicians regarding the current management and ovarian-sparing surgery of adolescent and pediatric patients with adnexal torsion.