Clinical and sonographic predictors of adnexal torsion in pediatric and adolescent patients

Objective: To investigate the accuracy of torsion diagnosis in the pediatric and adolescent population. Methods: This retrospective study included 87 patients < 18 years who presented with acute pelvic pain and were operated for suspected adnexal torsion from January 2009 to September 2016. Results: Adnexal torsion was found in 53 of 87 (60.9%) cases operated for suspected torsion. The rate of accurate torsion diagnosis was significantly higher among pre-menarchal (21/21, 100%) compared with post-menarchal girls (32/66, 48.5%) (p < 0.001). Patients with torsion were more likely to report nausea or vomiting (73.6% compared with 32.3%, p < 0.001) and had higher rates of peritoneal irritation signs on exam (15.1% compared with 0.0%, p = 0.02). On the pre-operative ultrasound, patients with torsion were characterized by higher rates of enlarged ovary showing signs of edema (49.1% compared with 8.8%, p < 0.001) and free pelvic fluid (45.3% compared with 17.6%, p < 0.001). In post-menarchal girls without adnexal torsion, the leading diagnosis was hemorrhagic corpus luteum cyst (found in 18/33, 78.3%) cases. Conclusions: Various clinical and ultrasound findings may point to the correct diagnosis of torsion in the pediatric and adolescent population. However, none of the clinical and ultrasound characteristics are sufficient to confirm or disprove the pre-operative diagnosis, and young patients with the clinical suspicion of adnexal torsion should undergo laparoscopy. Level of evidence: Level II. Type of study: Clinical retrospective study.