Adnexal Torsion in Adolescents – a Retrospective Analysis from a Tertiary Centre in Latvia
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Date
2023
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētījuma mērķis - izanalizēt datus par dzemdes piedēkļu torsiju biežākiem simptomiem, pielietotām diagnostikas metodēm un ārstēšanas taktiku Bērnu klīniskajā universitātes slimnīcā, akcentējot diagnostikas un terapijas stratēģiju nepilnības. Metodes — valsts līmeņa pediatrijas centrā tika veikta medicīnisko ierakstu retrospektīva analīze - tika apstrādāti 61 gadījumi ar aizdomām un/vai apstiprinātu dzemdes piedēkļu torsiju. Rezultāti - 85,5% gadījumos sākotnējā diagnoze tika noteikta pareizi. Pacienta vecums būtiski ietekmēja laiku līdz operācijai (P = 0, 016). Sāpes vēderā bija visizplatītākais simptoms (90,6%), kam sekoja slikta dūša (58,5%) un vemšana (52,8%). Tikai 62,3% torsijas pacientu bija paaugstināts leikocītu skaits un 69,4% nebija paaugstinātas ķermeņa temperatūras. Jo īsāks bija simptomu ilgums, jo lielāka iespēja, ka tika veikta orgānu glābšanas procedūra (P=0,021). Ultraskaņas jutība pareizas diagnozes noteikšanā bija 71,4%. Gandrīz trešdaļā torsijas gadījumu ultraskaņā netika konstatēts dzemdes piedēkļu veidojums (26,5%). Ja ultraskaņā bija aizdomas par torsiju, laiks līdz operācijai bija ievērojami īsāks (P<0,001), asins plūsmas esamība olnīcā pagarināja laiku līdz operācijai (P = 0,026). Orgānu saudzējoša operācija tika veikta 73,6% gadījumos. Secinājums – medicīnas speciālistiem nevajadzētu izslēgt dzemdes piedēkļu torsijas diagnozi, ja pacientam nav drudža vai leikocitozes, kā arī ja ir neizmainīta dzemdes piedēkļu ultraskaņas atradne. Operācijas kavēšanās palielina neatgriezenisku išēmisku bojājumu risku, kas veicina reproduktīvo orgānu zudumu jeb neauglību.
Objective - To review the data of cases of adnexal torsion in the paediatric population in a national level centre in Latvia and examine the pitfalls of diagnostic and therapeutic strategies. Methods - A retrospective review of medical records was performed on 61 cases of suspected and/or confirmed adnexal torsion in a national-level paediatric centre. Results - In 85.5% of cases the initial diagnosis was made correctly. The age of the patient was a significant contributor to a shorter time until surgery (P=0.016). Abdominal pain was the most common symptom (90.6%), followed by nausea (58.5%) and vomiting (52.8%). Only 62.3% of the torsion patients had an elevated WBC and 69.4% had no elevated body temperature. The shorter the duration of symptoms, the more likely it was that the organ salvage procedure was performed (P=0.021). The sensitivity of ultrasound for the correct diagnosis was 71.4%. In almost a third of the torsion cases, no pelvic lesion was detected on ultrasound (26.5%). When ultrasound suspected torsion, the time before the operation was significantly shorter (P<0.001), and the presence of blood flow in the ovary extended the time until surgery (P=0.026). Organ-sparing surgery was performed in 73.6% of the cases. Conclusion - Medical professionals should not exclude the diagnosis of adnexal torsion in the absence of fever or leucocytosis, as well as in the case of normal adnexa on ultrasound. A delay in surgery increases the risk of irreversible ischemic damage leading to organ loss.
Objective - To review the data of cases of adnexal torsion in the paediatric population in a national level centre in Latvia and examine the pitfalls of diagnostic and therapeutic strategies. Methods - A retrospective review of medical records was performed on 61 cases of suspected and/or confirmed adnexal torsion in a national-level paediatric centre. Results - In 85.5% of cases the initial diagnosis was made correctly. The age of the patient was a significant contributor to a shorter time until surgery (P=0.016). Abdominal pain was the most common symptom (90.6%), followed by nausea (58.5%) and vomiting (52.8%). Only 62.3% of the torsion patients had an elevated WBC and 69.4% had no elevated body temperature. The shorter the duration of symptoms, the more likely it was that the organ salvage procedure was performed (P=0.021). The sensitivity of ultrasound for the correct diagnosis was 71.4%. In almost a third of the torsion cases, no pelvic lesion was detected on ultrasound (26.5%). When ultrasound suspected torsion, the time before the operation was significantly shorter (P<0.001), and the presence of blood flow in the ovary extended the time until surgery (P=0.026). Organ-sparing surgery was performed in 73.6% of the cases. Conclusion - Medical professionals should not exclude the diagnosis of adnexal torsion in the absence of fever or leucocytosis, as well as in the case of normal adnexa on ultrasound. A delay in surgery increases the risk of irreversible ischemic damage leading to organ loss.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Dzemdes piedēkļu torsija. Olnīcu torsija. Olnīcu torsija pusaudžiem. Pusaudži. Pediatrija. Dzemdes piedēkļu patoloģija. Ķirurģija., Adnexal Torsion. Adolescent. Paediatrics. Adnexal Diseases. Surgery.