[Epidemiological and therapeutic management of adnexal torsion in adolescent: retrospective study of 22 cases]

Adnexal torsion is a real surgical emergency. It may occur in girls and teenagers. It may involve the ovary, the fallopian tube or both. The main symptom is acute pelvic pain. Diagnosis is based on clinical examination and sonography. Prognosis depends on the rapidity of the surgical management. To analyse the clinical features and the management of adnexal torsion in teenagers. 22 observations of young patients, who underwent surgery for adnexal torsion in our department of obstetrics and gynaecology between January 2000 and December 2007, were retrospectively analysed. A review of literature is discussed. The mean age of the cohort was 16.3 years [range 13-19years]. Clinically, most children presented with a sudden onset of a low abdominal pain [19 cases], a low-grade fever [8 cases], nausea and vomiting [11 cases]. Ultrasound scans showed pelvic or pelvi-abdominal masses in all cases. Laparoscopy was realized in 54, 54 per cent of patients [12 cases]. Adnexal necrosis was occurred in 6 cases. Adnexal torsion was severe in 4 cases and slight in 12 cases. A Conservative treatment could be realized in 16 cases [72,72 per cent]. No major postoperative complication was noted. Histopathology concluded to benign tumour in 15 cases. Adnexal torsion is an uncommon cause of severe lower abdominal pain in young girls and teenagers. Accurate and early diagnosis is necessary after the onset of clinical symptoms in order to preserve the viability of the ovary. Ultrasound scans are useful in these situations. Surgical investigation either by laparotomy or by laparoscopy is necessary for the diagnosis and the treatment. A conservative treatment should be tried as possible in these young patients

[Medical interruption of pregnancy for severe Takayasu's disease, about two cases]

Takayasu's arteritis is a rare clinical entity characterized by a progressive obliteration of the aortic arch and the main vessels arising from it. The association with a pregnancy may lead to some maternal and fetal complications. Nevertheless, a normal outcome of pregnancy is not rare if a careful follow-up is provided. We report the observations of two patients who underwent a medical interruption of pregnancy in the department of obstetrics and gynecology "A" of Charles Nicolle hospital in Tunis because of a severe multi-visceral localization of Takayasu's arteritis. The aim of our study is to stress on the maternal and foetal prognostic factors of this association