Laparoscopic Organ Saving Treatment of Multiple Tight Ovarian Torsion Among Girls

Ara Drampyan, PhD, Marina Khachaturyan, Zara Manukyan, Ashot Drampyan. Institute of Perinatology Obstetrics & Gynecology

Ovarian torsion is one of the most frequent complications of benign tumors and cystic formations in girls. This is due to topographic features of the internal genital organs and more active life in childhood. Usually,laparoscopic detorsion of adnexies and cystectomy is performed in cases without severe swelling,necroses, ovariectomy is performed if there is tight torsion with difficult venous flow and tissue oedema ,with the presence of hemorrhage, the appearance of necrotic changes.

However, the ovariectomy in a young girls will certainly lead to dysfunction of the other ovary, its cystic degeneration,hormonal and reproductive dysfunction . The aim of our study was to examine the features of diagnosis and clinical course of multiple tight intact ovarian torsion in children and the possibility of organsaving endosurginal operations in this cases. Under our control there were 15 girls aged 13-17 years with a tight multiply torsion of the ovary. All patients complained on the sudden acute pain in low abdomen. Attention is drawn to the fact that regardless of the intensity of pain there was absence symptoms of peritoneal irritation among girls. In all cases, the abdomen was soft on palpation with varying degrees of pain.During the recto-abdominal investigation at all girls in the projection of the adnexies on the side of the lesions palpated tight elastic consistency, moderately painful formation, with clear outlines, located in the pelvis.
Sonography do not reveal any abnormalities of the uterus .Ultrasound picture of ovarian torsion in all cases were different and reflected the histological changes of ovarian tissue in each individual patient.
The laparoscopy revealed tight ovarian torsion (from 360o to 1080o), which led to the development severe oedema of ovaries and fallopian tubes. Adnexal detorzio and cystectomy was performed in all cases. Postoperative period was normal, without any complications.Follow up after 1 month, 6 months and 1 year after surgery didn,t reveal any pathology on the side of the operated adnexes, indicating that morphofunctional regeneration of ovaries, despite the signs of necrosis at the time of surgery.
Thus, the clinical manifestations of tight torsion intact ovaries and ovarian formations in children, vary from blurred to sharp expressed. Preoperative diagnosis is the result of clinical and ultrasound investigations. Adnexal detorsio and laparoscopic organsaving operations can performed in cases with tighed,multiple torsions of intact ovary and ovarian formations,Long –term results confirm risk and appropriates of organsaving laparoscopic operations.