At surgery 520 degree torsion was noted, de-torsion was done and right ovary is salvaged.
Twisting of the vascular pedicle of the ovary, fallopian tube or both resulting in ischemia and ultimately hemorrhagic infarction.
Twisted adnexa range from 7-200 cc volume with a mean of 24 cc.
Peripheral cysts ranging from 8-12 mm reflecting ovarian congestion and transduation of fluid into follicles.
Sonographic whirlpool sign in the twisted vascular pedicle of the ovary is a definitive sign of ovarian torsion.May be achieved with endovaginal scanning.
Normal Doppler exam is frequently seen in cases of surgically confirmed adnexal torsion.
Theories include dual blood supply from ovarian and uterine arteries, venous thrombosis with secondary arterial compromise, intermittent torsion, partial torsion which only impairs venous outflow.
Torsion of normal adnexal structures is more common in pediatrics than adults.
Peditric adnexae are more mobile than adults.
Torsion is more frequent in the region of mesosalpinx.
Intrinsic ovarian or tubal disease, tumors, cysts, trauma or recent surgery also predispose to torsion.
Ovarian stimulation is a risk factor and 20% of cases in pregnant women.
5th leading diagnosis in emergent gynecologic surgery.
Asynchronous bilateral ovarian torsion seen in 5-10%.
Mean age 10-11 years.
10% occur neonatally. Treatment is urgent surgical de-torsion.
Oophoropexy is controversial.
Contralateral oophoropexy is gaining acceptance when unilateral oophrectomy is performed.
Take Home Message; Ovarian tumors are very rare in newborn period.