Effect of protection of enoxaparin against experimental ischemia/reperfusion injury in the rat ovary on in vitro fertilization outcomes

SUMMARY OBJECTIVE: The study aimed to investigate the protection of enoxaparin (E) against experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries on in vitro fertilization outcomes. METHODS: In total, 56 adult female Sprague-Dawley albino rats were randomly assigned to 6 groups of 8 animals each: Sham, Ischemia, I/R, Sham+E, I+E, and I/R+E. Ischemia groups were subjected to bilateral adnexal torsion for 3 h. In contrast, I/R and I/R+E groups received subsequent detorsion for 3 h. Enoxaparin (0.5 mg/kg s.c.) was administered 30 min prior to ischemia (I+platelet-rich plasma) or reperfusion (I/R+I+platelet-rich plasma). Ovaries were stimulated through intraperitoneal injection of 150-300 internal units IU/kg pregnant mare serum gonadotropin. Anti-Müllerian hormone levels were measured before and after surgery in all groups. RESULTS: When the number of metaphase II oocytes was evaluated, statistically significant differences were observed between the I and I+E (p=0.001) and I/R and I/R+E (p=0.000) groups. When both I and I+E groups and I/R and I/R+E groups were compared, it was found that E application increased the number of fertilized oocytes. The number of embryos on the second day was higher in the I/R+E group than that in the I/R group. Statistically significant differences were found in the number of grade 1 embryos between the I/R and I/R+E groups (p=0.003). In comparing anti-Müllerian hormone values within the group, the highest decrease was observed in the I and I/R groups. CONCLUSION: Enoxaparin effectively minimizes ovarian damage and preserves ovarian reserve following ovarian torsion.

Step-by-step instructions for detecting whirlpool sign in adnexal torsion / Journal of Rural Medicine

Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst.Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed.Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases.Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.

Tasas de Egreso Hospitalario por Torsión Ovárica en el período 2018-2021 en Chile según grupo etario: Un estudio descriptivo / Ovarian Torsion Hospital Discharge Rates in the period 2018-2021 in Chile according to age group: A descriptive study

Introducción: La torsión ovárica (TO) es la rotación completa o parcial del ovario por sobre su propio pedículo vascular. El objetivo es comparar descriptivamente las tasas de egreso hospitalario (TEH) por TO en el período 2018-2021 en Chile. Materiales y métodos: Estudio descriptivo, transversal. Los datos de egresos hospitalarios por TO en Chile entre 20182021 (n=1.599) según grupo etario y días de estadía hospitalaria se obtuvieron del Departamento de Estadísticas e Información de Salud. Se calculó la TEH. No se requirió comité de ética. Resultados: Se determinó una TEH por TO de 4,33/100.000 habitantes entre los años 2018 y 2021, siendo el año 2021 la mayor con 5,92. Los grupos etarios de 10-14 y 15-19 años registraron las mayores TEH de 8,5 y 7,55, respectivamente. El promedio de días de estadía hospitalaria por TO entre los años 2018-2021 fue de 2,15 días, siendo el año 2018 el mayor con 2,3 días. Pacientes de 80 años y más presentaron la mayor duración de estancia hospitalaria con 3,37 días. Discusión: La TEH por TO en Chile aumentó durante los últimos años. En 2020-2021 las mayores TEH por TO se encontraron entre los 10-19 años, probablemente por aumentos en la prevalencia de síndrome de ovario poliquístico en Chile. Los grupos de mayor edad registraron la mayor duración de estancia hospitalaria, pudiendo deberse a una mayor susceptibilidad a complicaciones postquirúrgicas. Considerando la escasa fuente de información al respecto, nuestro estudio permite dar a conocer un perfil epidemiológico nacional actualizado.

Introduction: Ovarian Torsion (OT) is complete or partial rotation of the ovary above its vascular pedicle. The objective is to descriptively compare the Hospital Discharge Rates (HDR) for OT in the period 2018-2021 in Chile. Material and methods: Descriptive, cross-sectional study. The data of hospital discharge for OT in Chile between 20182021 (n=1,599) according to age group and days of hospital stay were obtained from the Department of Health Information Statistics. HDR was calculated. No ethics committee was required. Results: An HDR for OT of 4.33/100.000 population was determined between the years 2018 and 2021, with 2021 being the highest with 5.92. The age groups of 10-14 and 15-19 years old registered the highest HDR of 8.5 and 7.55, respectively. The average number of days of hospital stay for OT between the years 2018-2021 was 2.15 days, with 2018 being the longest year with 2.3 days. Patients 80 years and older had the longest hospital length of stay with 3.37 days. Discussion: The HDR for OT in Chile has increased in recent years. In 2020-2021 the highest HDR for OT were found between 10-19 years old, probably due to increases in the prevalence of polycystic ovary syndrome in Chile. The oldest age groups recorded the longest average hospital length of stay, which may be due to increased susceptibility to postoperative complications. Considering the limited source of information in this regard, our study allows us to present an updated national epidemiological profile.

Profile of Girls With Adnexal Torsion: Single Center Experience

Objective: To compare features of pre-menarchal and post-menarchal patients with adnexal torsion. Methods: We reviewed hospital records to note examination findings, laboratory work-up, imaging results, operative findings and course during hospital stay for 56 girls aged from 7 days to 17 years with adnexal torsion presenting between January, 2012 and December, 2020. Results: 31 girls were pre-menarchal. Pain was the most common symptom. There were significant differences in the volume of the ovary visualized in ultrasound in amenorrheic and menstruating girls [median (IQR) 78234 (39600, 183600) mm3 vs 243432 (158661, 388800) mm3; P=0.004]. Pain was the most common symptom. Over the years, there was an increase in laparoscopic procedures, and efforts to preserve the ovary after the torsion. Conclusions: The differential diagnosis in the case of abdominal pain should include adnexal torsion both in non-menstruating and menstruating girls

A rare case report of ovarian torsion with sigmoid volvulus

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively.

Paediatric ovarian torsion: a case report and review of literature

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.

Role of diagnostic laparoscopy in chronic and recurrent pain abdomen

Background: Chronic and recurrent abdominal pain of unknown origin represents a significant problem in surgical patients and poses a diagnostic dilemma. With advances in optics, laparoscopy allows visualisation of entire peritoneal cavity and further makes histological diagnosis possible. The rapidly increasing popularity of laparoscopy may be attributed to several factors including its applicability in both emergency and elective settings, high diagnostic yield, therapeutic management in the same setting, low patient morbidity, reduced hospital stays and expenditure. The objective of the study was to evaluate the role of diagnostic laparoscopy in chronic and recurrent pain abdomen.Methods: We conducted a prospective descriptive study on 50 patients who suffered from chronic and recurrent pain in abdomen for more than 3 months with inconclusive clinical or radiological diagnosis. All patients were subjected to diagnostic laparoscopy and findings were noted down. Therapeutic procedures were conducted at the same setting wherever indicated. Histopathological evaluation reports were followed up.Results: Out of 50 patients, laparoscopy established diagnosis in 44 patients, proving diagnostic efficacy at 88%. The most common finding at diagnostic laparoscopy was appendicitis (28%), followed by adhesions (24%). Other findings were tuberculosis (16%), pelvic inflammatory disease (8%), endometriosis (3%), partial torsion of ovarian cyst (4%), cholecystitis (2%). However, diagnostic laparoscopy showed normal study in 6 patients (12%). Appendicectomy followed by adhesiolysis were the most common procedures performed.Conclusions: Recurrent appendicitis is the most common cause of chronic and recurrent pain abdomen. Diagnostic laparoscopy is a safe and effective modality for both diagnostic and therapeutic management of such patients.

Conservative management of ovarian torsion in pregnancy

Adnexal torsion or other cyst accidents encountered during pregnancy carries a risk to intrauterine foetus. Delays or misdiagnosis can result in the loss of the affected ovary and subsequent reduced reproductive capacity. In this report, a 23-year-old second gravida with viable 9 weeks pregnancy with acute pain abdomen; presented in OPD and sent to labor room. Emergency laprotomy was done with provisional diagnosis of left adnexal torsion. We did detorsion and cystectomy followed by ovarian reconstruction. Repeat scan shows continuing intrauterine pregnancy. So, timely diagnosis and intervention reduces risk to ovary; along with some risk of the antepartum surgical intervention. Also, in place of oophorectomy; de-torsion is more conservative surgical approach that should be considered in all young women with ovarian torsion.

Cases of management of paediatric tubo-ovarian torsion

Ovarian torsion is the fifth most common cause of gynaecologic surgical emergency. It warrants early diagnosis as timely surgical management will avoid the further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation. This leads to delay in surgical exploration and loss of ovarian function. In these cases, the ovary and often the ipsilateral fallopian tube twist with the vascular pedicle, resulting in vascular compromise. Unrelieved torsion leads to haemorrhagic infarction. We encountered 3 cases of ovarian torsion in paediatric age group during a period of 12 months. All cases presented with acute pain abdomen for 3-7 days period with loss of appetite and unable to pass motion with varied disappearance of pain. On ultrasound all the cases were diagnosed with ovarian cyst with torsion and underwent laparoscopic cystectomy. This case series is written just to show the results of de-torsion and conserving the fallopian tube and ovary after vascular damage. This type of conservative management may give chance to ovary to return to viability. This was seen in all 3 cases dealt by us on repeat scan on follow up. Even on de-torsion if ovary does not regain its colour immediately it should be conserved, and cystectomy should be performed rather than oophorectomy. Conservative surgery, in the form of ovarian de-torsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.

Hotdog in bun: a recent technique for oophoropexy

Ovarian torsion is an acute gynaecological emergency. It may present at any age group, however it is more common in the reproductive years. The patient may present with a myriad of clinical features which are often non-specific posing a diagnostic dilemma. Ultrasonography is the best initial modality of imaging. Once diagnosed a surgical approach is the mainstay of treatment. Preservation of ovaries and preventing recurrence in young patients is crucial. We present a case of a young adolescent girl diagnosed with an ovarian torsion who was managed laparoscopically. Oophoropexy was done to avoid future recurrence by an emerging method called the “Hotdog in bun” technique.

A new biomarker for the early diagnosis of ovarian torsion: SCUBE-1 / 대한생식의학회지

OBJECTIVE: Prompt diagnosis and management are essential for saving the adnexal organs from infarction in cases of ovarian torsion (OT). This study aimed to determine the diagnostic significance of signal peptide, complement C1r/C1s, Uegf, and Bmp1 (CUB), and epidermal growth factor-like domain-containing protein-1 (SCUBE-1) levels in cases of OT, an emergent ischemic condition, and the relationship of SCUBE-1 with oxidative stress parameters. METHODS: This prospective study was conducted among 15 OT patients and 20 age- and gravidity-matched healthy women. SCUBE-1 serum concentrations were determined by using enzyme-linked immunosorbent assays. In addition, oxidative stress was evaluated by measuring the serum levels of advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), and glutathione (GSH). RESULTS: The SCUBE-1 titers were significantly higher in the patients with OT than in the controls (p=0.008). In addition, serum FRAP and GSH levels were significantly lower in the OT patients than in the controls (p 0.05). Furthermore, there were no correlations between SCUBE-1 levels and age, gravidity, parity, cyst size, and AOPP, FRAP, or GSH levels (p>0.05). CONCLUSION: We believe that SCUBE-1 may be a promising biomarker for the early diagnosis of OT.

O papel da videolaparoscopia nas emergências ginecológicas e obstétricas / The role of videolaparoscopy in gynecological and obstetric emergencies

Introdução: A videolaparoscopia (VLP) tem sido cada vez mais empregada na prática clínica uma vez que auxilia, tanto no diagnóstico, quanto no manejo de diversas condições ginecológicas. Essa revisão tem como objetivo esclarecer a importância da VLP nas principais emergências ginecológicas. Métodos: Foi realizada uma revisão da literatura no mês de maio de 2018 nos bancos de dados Pubmed, Medline e Portal Periódico Capes. Foram incluídos no estudo os artigos que abordavam o uso de VLP no manejo de emergências e foram excluídos os relatos de caso. Resultados: A VLP é importante na medida em que permite a visualização direta das condições que constituem emergências ginecológicas, contribuindo dessa forma para o seu diagnóstico definitivo e precoce. A abordagem VLP frequentemente está relacionada a uma menor morbidade nesses casos. Na torção ovariana a VLP é útil tanto para identificar a viabilidade do ovário acometido quanto para desfazer a torção. No abscesso tubo ovariano, entretanto, estudos indicam que não há superioridade da técnica laparoscópica em relação à laparotomia no manejo cirúrgico desses pacientes. Na rotura de cisto ovariano, a VLP é o método preferencial nas patologias benignas, enquanto a laparotomia é o método de escolha na suspeita de lesões malignas. Na gestação ectópica, a VLP pode ser empregada nos casos de instabilidade hemodinâmica, gravidez tubária rota e quando há ascensão dos títulos de ß-hCG nas dosagens séricas associada à massa de 5 cm. Conclusão: A combinação entre o conhecimento adequado das patologias ginecológicas, a correta indicação do método VLP e a habilidade do cirurgião são fatores determinantes no sucesso terapêutico desse método.

Introduction: Video-laparoscopy (VLP) has been increasingly used in clinical practice since it assists in the diagnosis and management of various gynecological conditions. This review aims to clarify the importance of VLP in major gynecological emergencies. Methods: A literature review was performed in the month of May, 2018 in Pubmed, Medline and Capes Periodical Portal databases. The articles that addressed the use of VLP in emergency management were included in the study and the case reports were excluded. Results: VLP is important because it allows direct visualization of conditions that constitute gynecological emergencies, thus contributing to its definitive and early diagnosis. The VLP approach is often related to lower morbidity in these cases. In ovarian torsion the VLP is useful both to identify the viability of the affected ovary and to undo the torsion. In the ovarian tube abscess, however, studies indicate that there is no superiority of the laparoscopic technique in relation to laparotomy in the surgical management of these patients. In ruptured ovarian cyst, VLP is the preferred method in benign pathologies, while laparotomy is the method of choice in the suspicion of malignant lesions. In ectopic pregnancy, VLP may be used in cases of hemodynamic instability, tubal rupture, and when there is a rise in ß-hCG serum levelst associated with a 5 cm mass. Conclusion: The combination of adequate knowledge of the gynecological pathologies, the correct indication of VLP and the surgeon's ability are determining factors in the therapeutic success of this method. Keywords: videolaparoscopy,

Assisted diagnostic value and precise surgery significance of MSCT angiography in torsion of ovarian tumors in children / 局解手术学杂志

Objective To study the assisted diagnostic value and significance in precise surgery of MSCT angiography in torsion of ovar-ian tumors in children. Methods The dual-phase enhanced MSCT images data of 15 children patients with ovarian tumor torsion which were confirmed by surgery were retrospectively analyzed. Showed the vascular changes around the ovaries and judged the ovarian tumors arise and torsion side with the vascular reconstruction methods of multi-planar reconstruction (MPR),maximum intensity projection (MIP),volume rendering ( VR) ,then compared with the operation situation. Results Among the 15 cases aged from 2 months to 11 years old who were de-tected with MSCT scanning and angiography, there were 11 cases of benign tumor (9 cases of ovarian teratoma and 2 cases of serous cystade-noma) and 4 cases of malignant tumor (3 cases of yolk sac tumor and 1 case of malignant mixed germ cell tumor). MSCTA displayed that o-varian vessels changes were abnormal thickening and twisting of distal feeding artery and tumor vascular network formation;and there were thickening, tortuosity, increased density and a few visible‘whirl sign’ in draining veins. Preoperative MSCTA displayed ovarian tumor blood supply arteries were found 5 cases of downlink of ovarian artery and 10 cases of asscending branches of uterine artery. There were 4 cases of ovarian tumor originated from the left ovary combined with reverse and 11 cases originated from the right ovary combined with reverse, which were consistent with intraoperative findings. Intraoperative MSCTA provide information which helped accurate chose of the surgical incision, precise abruption of tumor blood vessels and resection of the tumor and ovarian lesions, thus saved the operation time and reduced the blood loss. Conclusion MSCT angiography can not only provide diagnosis information of torsion of ovarian tumors in children,but also more impor-tantly,it has an important assisted significance in precision surgery.

Clinical Characteristics and Management of Adnexal Torsion.

Adnexal torsion is a gynaecologic surgical emergency. Misdiagnosis or delay may lead to loss of the adnexa and may compromise fertility. Aim: To determine the most relevant findings for the diagnosis of adnexal torsion and the results of laparoscopic surgery. Methodology: A retrospective cohort study of 266 patients who underwent surgical treatment for adnexal torsion in our department from January 1994 to January 2014. Clinical, biological, ultasonographic, therapeutic and histological findings were analysed as well as risk factors and prognosis. Results: The mean age of patients was 33.1 years. Adnexal torsion occurred during pregnancy in 21 patients (7.8%). Abdominal pain was present in 91.7%, vomiting in 63.9% and fever in 19.1% of the cases. Ultrasonographic findings were: ovarian cysts (54.1%), complex mixed echogenicity masses (40.2%) and ovarian enlargement (5.6%). The pain-to-surgery interval varied from 4 hours to 26 hours. At surgery, the mean number of spiral turns was 2. Treatment was carried out by laparotomy in 87 patients (32.7%). The mean size of the adnexa treated by laparotomy was 10.7 cm. Laparoscopic surgery was performed in 137 patients (51.5%). The mean size of the adnexa treated by laparoscopy was 6.9 cm. Laparoscopic treatment was conservative in 77.3% of the cases. Conclusion: Adnexal torsion is a common gynaecologic emergency. Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and sonographic investigation. The prognosis of adnexal torsion was potentially increased by the interval period before surgery. Laparoscopic treatment is the gold standard if possible.

Tubercular Pyosalpinx Mimicking Ovarian Torsion.

Ovarian torsion is a gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females. Whereas Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent . In this case study, suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.

Ultrasonic diagnosis of pediatric ovarian torsion / 中华超声影像学杂志

Objective To evaluate the value of ultrasonography in the diagnosis of pediatric ovarian torsion (OT).Methods Ultrasonography was performed in 38 OT,and 52 non-OT children.Bilateral ovarian area was measured.The larger area was defined as S1,whereas,the smaller area was defined as S2.S1/S2 ratio was calculated.Follicles around ovaries,ovarian blood flow,and pelvic effusion were also observed during the ultrasonographic scanning.ROC curve was employed to evaluate the clinical value of ultrasonography in pediatric OT diagnosis.Results ①S1/S2 ratio,incidence of follicles around ovaries and of no ovarian blood flow were all higher in OT compared to non-OT children (P =0.000).While pelvic effusion showed no significant difference between the two groups (P =0.004).②Using S1/S2 ratio to diagnose OT,the area under the ROC curve was 0.925 (0.865-0.986),the best cutoff point was 1.6,sensitivity was 97％ and specificity was 88％.Patients were divided into two groups based on the cutoff point of 1.6,the area under the ROC curve of S1/S2 was 0.924(0.847-0.969),of follicles around ovarian was 0.896(0.781-0.931),and of no ovarian blood flow was 0.911 (0.831-0.961),indicating S1/S2 held the highest diagnostic value.Conclusions Ultrasonography is an accurate method in the early diagnosis of pediatric ovarian torsion,with S1/S2 ratio holding the highest diagnostic value in this application.

Successful laparoscopic surgery for 14-month-old infant with ovarian torsion

The prevalence of ovarian torsion is 4.9 among 100,000 females between ages 1 to 20 years. The diagnosis of ovarian torsion in children, especially in infants, is very difficult. Since they cannot explain related symptoms accurately, and reproductive organs lie high in the abdomen, physical examination shows unclear findings. For these reasons, we use imaging studies, such as ultrasonography and magnetic resonance imaging, to diagnose ovarian torsion. However, it is of limited value to diagnose by using these modalities alone. Therefore, clinical suspicion is important for diagnosis. Though pediatric laparoscopic surgery was introduced 20 years ago, it has been widely performed since the mid 1990s with the development of 3-mm instruments. In addition, usually the pediatric operation is done in the pediatric surgery office, even though it is a gynecologic procedure. In addition, laparotomy is still more frequently conducted in current clinical practice, although the frequency of laparoscopic surgery has increased. However, it is thought that expert gynecologic surgeons can perform pediatric laparoscopic operations if they pay attention to some precautions. We report herein the case of a 14-month-old infant who underwent emergency laparoscopic untwisting of ovarian torsion successfully without complications by a gynecologic surgeon, with a brief review of the literature.

The Diagnosis and Treatment of 64 Children with Ovarian Torsion / 天津医药

Objective To evaluate the clinical features and key points in treatment of ovarian torsion in children. Methods The clinical data of 64 children with ovarian torsion, hospitalized in our hospital from January 2005 to October 2012, were analyzed retrospectively. The clinical manifestations in children of all ages were summarized. The anal examina-tion, B ultrasound examination, CT examination were used for the early diagnosis of ovarian torsion. All children were per-formed laparoscopic surgical exploration. All children were found the typical lower abdominal cramps. The B ultrasound and CT examination showed non-homogeneous mass in pelvic, which suggested the early diagnosis of ovarian torsion. The detec-tion rate of anal examination reached 70.3%(45/64). Results All patients were performed laparoscopic surgical explora-tion. Five patients were treated with ovariectomy. The rest were treated conservatively. The postoperative follow-up was good. Conclusion Ovarian torsion in children was likely to be misdiagnosed. Doppler, CT, anal examination and laparo-scopic operation were important for the early diagnosis and treatment of ovarian torsion.

Ovarian metastasis from pulmonary adenocarcinoma

Metastatic ovarian cancer is not an uncommon finding. Such tumors almost always originate from female genital tract, colon, stomach, or breast. Lung cancer is not a common origin of ovarian metastases. Of all metastatic ovarian tumors, approximately 0.3% arise from lung cancer. Ovarian torsion is not an uncommon finding, but ovarian torsion with cancer is rare. Here, we report a 44-year-old woman who was previously diagnosed with advanced stage lung cancer and who emergently visited our hospital for abdominal pain. An imaging work-up revealed, ovarian torsion and exploratory laparotomy was performed. Pathological examination led to the diagnosis ovarian metastasis from lung cancer. This is the first case of ovarian metastasis from lung cancer, ovarian torsion.

Torção ovariana: ensaio iconográfico com enfoque em achados de ressonância magnética e tomografia computadorizada / Ovarian torsion: pictorial essay focused on magnetic resonance imaging and computed tomography findings

O objetivo deste artigo é descrever os principais achados em tomografia computadorizada e ressonância magnética da torção ovariana. Dois examinadores em consenso selecionaram e analisaram casos ilustrativos, obtidos entre janeiro de 2010 e dezembro de 2011, de pacientes submetidas a tomografia computadorizada e ressonância magnética, com dor abdominal aguda comprovadamente decorrente de torção ovariana, destacando os principais aspectos de imagem. O crescente papel da tomografia computadorizada e da ressonância magnética na avaliação de paciente com abdome agudo de origem ginecológica requer que o radiologista se familiarize com os aspectos de imagem das suas principais causas, utilizando estas ferramentas diagnósticas em conjunto com a ultrassonografia.

The present article is aimed at describing the key findings of ovarian torsion at computed tomography and magnetic resonance imaging. Two investigators have consensually selected and analyzed magnetic resonance imaging and computed tomography images acquired in the period from January 2010 to December 2011 of patients with proven acute abdominal pain resulting from ovarian torsion, highlighting the main imaging findings. The increasing role of computed tomography and magnetic resonance imaging in the assessment of patient with acute abdomen of gynecological origin demands radiologists' familiarity with the imaging findings related to the main causes of such condition through the use of these diagnostic tools in association with ultrasonography.