Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pa
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ORIGINAL ARTICLE
Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway Emily C. Alberto1 · Jun Tashiro1 · Yinan Zheng1 · Anthony Sandler1 · Timothy Kane1 · Veronica Gomez‑Lobo2,3 · Mikael Petrosyan1 Accepted: 9 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Adnexal torsion is a gynecologic emergency, requiring intervention for tissue preservation. At our institution, torsion is managed by pediatric surgeons or gynecologists. We evaluated differences between specialties to streamline evaluation for children with gynecological emergencies, develop a clinical pathway, and prevent care delays. Methods A retrospective review of adolescents undergoing intervention for adnexal torsion from 2004–2018 was performed. Differences in time to intervention, operation duration, the procedure performed, and length of stay (LOS) between the specialties were analyzed. Results Eighty-six patients underwent 94 operations for presumed adnexal torsion with 87 positive cases. Pediatric surgeons performed 60 operations and 34 cases were performed by gynecologists. Preservation of fertility was the goal in both cohorts and the rate of oophoropexy, cystectomy, and oophorectomy were similar between the cohorts (p = 0.14, p = 1.0, p = 0.39, respectively). There was no difference in intra-operative time (p = 0.69). LOS was shorter in the gynecology cohort (median 1 day [1–2] vs. 2 days [2–3], p > 0.001). Conclusions Adnexal torsion is a time-sensitive diagnosis requiring prompt intervention for ovarian or fallopian tube preservation. A multidisciplinary institutional care pathway should be developed and implemented. Keywords Adnexal disease · Adolescent · General surgery · Gynecology · Ovarian torsion
Introduction Adnexal torsion is rare cause of acute abdominal pain in adolescent females with ovarian torsion occurring in only 4.9 of 100,000 children younger than 20 years old [1, 2]. Isolated fallopian tube torsion is even rarer [3]. Torsion can often be attributed to malignancy, but in adolescents, torsed adnexa is usually secondary to a benign etiology (e.g., cyst or benign neoplasm) [1, 4, 5]. Ovarian torsion may be associated with a normal ovary in up to 25% of cases [1]. Torsion * Mikael Petrosyan [email protected] 1
Department of Surgery, Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010, USA
2
Departement of Surgery/Pediatric Gynecology, Children’s National Hospital, Washington DC, USA
3
Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver Institute for Child Health and Human Development, Bethesda, MD, USA
of the ovary or fallopian tube is a gynecologic emergency. It can lead to venous congestion and adnexal necrosis if not corrected in time [1, 4, 6, 7]. The most common procedure performed in the past for a torsed ovary was an oophorectomy. In recent years however, the trend has shifted towards adnexal preservation even when the ovary or fallopian tube do
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