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Ovarian torsion is rare in the pediatric population. Delayed diagnosis can significantly impact fertility. The aim of this review is to highlight current knowledge regarding clinical presentation, diagnosis, surgical management, and follow-up in the pediatric population. Whilst the presentation is often very unspecific, most children will present with sudden severe unilateral pelvic pain associated with vomiting. A key diagnostic test is pelvic ultrasonography, which may help demonstrate an asymmetric enlarged ovary with peripherally displaced follicles. In the pediatric population, ovarian torsion may occur in a normal ovary. However, underlying lesions can be found in half of cases. Benign neoplasms (teratomas or cystic lesions) represent the commonest etiology, with the risk of malignancy being less than 2%. Surgical management should be focused on fertility preservation. This is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence. Follow-up studies demonstrate excellent recovery rates of detorsed ovaries including those with ischemic appearances. What is Known: • Ovarian torsion is a rare diagnosis in the pediatric population. • Aspecific symptoms and differential diagnoses lead to missed or delayed diagnosis increasing the risk of oophoprectomy and further infertility. What is New: • Reviewing the latest knowledge about clinical presentation, diagnostic, surgical management, and follow-up of ovarian torsion in the pediatric population. • Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.

Ovarian torsion is a rare, frequently misdiagnosed condition that carries with it a high rate of morbidity. This review highlights the pearls and pitfalls of ovarian torsion, including presentation, evaluation, and management in the emergency department (ED) based on current evidence. Ovarian torsion is one of the most common gynecological surgical emergencies and occurs with complete or partial rotation of the ovary along the supporting ligaments, obstructing vascular flow. Several risk factors include the presence of an ovarian mass or cyst. The most common population affected includes reproductive aged women, though cases also occur in premenarchal females, pregnant women, and postmenopausal women. Abdominal or pelvic pain is common but is not always sudden in onset or severe. Nausea and vomiting occur in 70%. Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Computed tomography with intravenous contrast can assist with diagnosis. Treatment includes emergent gynecologic consultation for surgical detorsion, along with symptomatic therapy in the ED. An understanding of ovarian torsion can assist emergency clinicians in diagnosing and managing this disease.

Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. However, the mechanisms of their formation and development are poorly understood. This review summarizes the current clinical and biomechanical studies on the initiation, development and treatment of tortuous blood vessels. We submit a new hypothesis that mechanical instability and remodeling could be mechanisms for the initiation and development of these tortuous vessels.

Medial patellar luxation (MPL) and cranial cruciate ligament disease (CCLD) frequently co-occur in dogs, with excessive tibial torsion adding surgical complexity. This study evaluates the clinical outcomes of total proximal tibial osteotomy (tPTO) combined with cranial closing wedge ostectomy (CCWO) for treating MPL and CCLD in dogs exhibiting excessive external tibial torsion. A retrospective case series was conducted at a single referral hospital, including dogs with concomitant MPL and CCLD, exhibiting external tibial torsion ≥20°, and treated with tPTO and CCWO. A total of 31 patients met the inclusion criteria. Postoperatively, tibial torsion was corrected in all cases, with 74.2% (n = 23) achieving near 0° alignment. The tibial plateau angle decreased from 23.0° ± 5.0° to 7.0° ± 3.4°. Antirotational techniques were used to prevent reluxation in 25.8% (n = 8) of cases because of stifle soft tissue laxity. The initial success rate for patellar and stifle stability was 87.1%, whereas 12.9% (n = 4) of cases exhibited patellar reluxation, necessitating surgical reintervention with antirotational techniques. Bone healing averaged 70.2 ± 21.2 days, aligning with full clinical recovery. Following the four surgical reinterventions, all patients achieved patellar and stifle dynamic stability with normal weight bearing. The combination of tPTO and CCWO proved effective for treating concomitant MPL and CCLD in dogs with excessive tibial torsion, demonstrating favorable outcomes and complication rates. This technique should be considered for managing these complex cases.

Objective This study aimed to compare the clinical characteristics and surgical and histological outcomes of premenopausal and postmenopausal patients with adnexal torsion. Methods The electronic medical records of 278 patients with adnexal torsion proven by surgery were retrospectively reviewed from January 2012 to November 2023 in our hospital. The patients were divided into two groups (premenopausal and postmenopausal). Results The study included 226 (81.3%) premenopausal patients and 52 (18.7%) postmenopausal patients. The incidence of the most common symptoms (i.e., abdominal pain, nausea and/or vomiting) was not different between the two groups. However, the postmenopausal group had a longer interval from the onset of pain to admission, a larger size of adnexal mass, a longer operation time, more blood loss, and a longer hospital stay than the premenopausal group. Regarding the procedure, the premenopausal group underwent more conservative procedures than the postmenopausal group. The most common pathological findings in the two groups were benign tumors and tubal pathology The malignancy rate was similar in the two groups. Conclusions Premenopausal and postmenopausal women with adnexal torsion had similar main symptoms, such as abdominal pain and nausea and vomiting. However, the surgical and histological outcomes varied between these groups of women.

Background Tubal mesosalpinx cysts are paratubal cysts, that account for approximately 10% of adnexal masses, and the presence of these cysts combined with adnexal torsion is a rare acute abdominal condition, with few cases reported in the literature. We reported two cases of adolescent tubal mesosalpinx cysts combined with adnexal torsion and reviewed the literature to help improve the diagnosis of the disease. Case reports The first patient was an 11-year-old girl with left lower abdominal pain for 5 days and fever with nausea and vomiting for 3 days, who was found to have a cystic pelvic mass on preoperative imaging and was diagnosed intraoperatively and postoperatively on pathology as having a left tubal mesosalpinx cyst combined with adnexal torsion. The second patient was a 13-year-old girl with right lower abdominal pain for 16 h and a palpable mass in the lower and middle abdomen on examination, which was hard and tender to palpate. Preoperative imaging revealed a large cystic mass in the right adnexal region, and intraoperative and postoperative pathology revealed a right tubal mesosalpinx cyst combined with adnexal torsion. Conclusions Tubal mesosalpinx cysts combined with adnexal torsion are rare causes of acute lower abdominal pain. Early diagnosis and timely surgery are necessary to ensure ovarian and tubal function. Accurate preoperative imaging diagnosis is challenging, and MRI is a beneficial supplement to ultrasound and CT examinations, providing more objective imaging information and reducing the incidence of adverse outcomes.

Study objectiveOvarian torsion (OT) in pediatric age is a challenging condition to diagnose and treat. To date, there is still no clear consensus about its management. Our aim was to assess some possible associated factors that can help surgeons in decision-making.DesignWe conducted a retrospective multicentric study of pediatric OT surgically treated between 2010 and 2020 in six Italian and German institutions, comparing our findings with a literature review of the last 10 years (2010–2020).ParticipantsPatients aged 0–18 years with a diagnosis of OT intraoperatively confirmed and surgically treated at the involved institutions.ResultsNinety-seven patients with a mean age at diagnosis of 8.37 years were enrolled in the study. Severe abdominal pain was present in 82 patients (84.5%). Eighty children (82.5%) presented an enlarged ovary with an US diameter > 5 cm and only 32 (40%) of them underwent conservative surgery. A laparoscopic approach was performed in 60 cases (61.9%) although in 15 (15.5%) conversion to open surgery was deemed necessary. A functional cyst was present in 49 patients (50.5%) while 11 children (11.3%) suffered from OT on a normal ovary.ConclusionsOur results showed that a post-menarchal age (p = .001), a pre-operative US ovarian size < 5 cm, (p = .001), the presence of severe abdominal pain (p = .002), a laparoscopic approach (p < .001), and the presence of a functional cyst (p = .002) were significantly associated with conservative surgery.

Purpose To compare the effectiveness of ovarian ligament plication and ovario-round ligament fixation (\"hot-dog\" technique) in preventing recurrent adnexal torsion. Methods This is a retrospective cohort study performed in the gynecology department, of a university-affiliated tertiary medical center. Women of reproductive age who underwent first fixation following adnexal torsion surgery on the ipsilateral side between 2014 and 2023. The study included a homogenous population with normal ovarian size. Primary outcome was the recurrence rate of adnexal torsion following each fixation technique. Two fixation techniques of ovarian ligament plication and ovario-round ligament fixation were compared. Results A total of 525 adnexal torsion events were reviewed, involving 413 patients. After applying strict inclusion criteria, 38 patients who underwent their first fixation on the ipsilateral side were included in the final analysis. Among them, 27 (71%) underwent ovarian ligament plication, and 11 (29%) underwent ovario-round ligament fixation. Recurrent torsion occurred in 25.9% (7 of 27) of patients in the ovarian ligament plication group, while no recurrences were observed in the ovario-round ligament fixation group. While clinically promising, the difference did not reach statistical significance ( p  = 0.08). Fixation was also safely performed during pregnancy, primarily in the first trimester, with no postoperative complications observed. Conclusions Ovario-round ligament fixation shows promise as a technique for preventing recurrent torsion with a favorable safety profile. Due to the limited sample size, further larger-scale studies are required to confirm these findings and comprehensively evaluate long-term outcomes.

PurposeExcessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational osteotomy of the femur on the tibial tubercle trochlear groove (TTTG) distance or patellar tilt angle (PTA) and to report our clinical outcomes of recurrent patellar dislocation after femoral derotation osteotomy.MethodsA retrospective analysis of 16 patients (17 knees) with recurrent patellar dislocation treated by femoral derotation osteotomy in our department from January 2016 to February 2019 was carried out. The procedure was performed with supracondylar femoral derotation. A few procedures were combined with soft tissue procedures. Knee function was evaluated by using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS) score and patient satisfaction. Additionally, CT was used to assess the influence of femoral derotational osteotomy on TTTG distance and PTA.ResultsThe average femoral antetorsion angle before surgery was 33° (SD ± 5°), and the intraoperative correction angle was 23° (SD ± 4°). A total of 17 femoral derotation osteotomies in 16 patients with patellar instability [11 females, 5 males, aged 20.8 (range 15–41) years] were included in the study. No dislocation occurred within 26.5 months after follow-up (range 12–49 months). The IKDC score, Kujala score, Lysholm score and VAS score significantly improved. The preoperative TTTG distance was 15.63 mm (SD ± 2.07 mm), and it was 14.69 mm (SD ± 1.78 mm) at the follow-up. The PTA decreased from 26.35° (SD ± 6.86°) to 11.65° (SD ± 2.85°). The powers of TTTG and PTA measurements are 0.78 and 1.00, respectively and all of these differences were statistically significant.ConclusionsDerotational osteotomy of the femur for the treatment of recurrent patellar dislocation can achieve good clinical results, including improved TTTG distance and PTA and improved knee function.

IntroductionAdnexal torsion is a gynaecological emergency in which prompt diagnosis and management are critical to preserving ovarian function. However, the clinical presentation is often non-specific, and diagnosis primarily relies on pelvic ultrasound, a modality with limited sensitivity that can lead to misdiagnosis and unnecessary surgery. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging technique that may enhance diagnostic accuracy by better characterising adnexal vascularisation.The aim of this study is to assess whether the addition of CEUS to standard diagnostic procedures can reduce the rate of unnecessary emergency surgeries. Specifically, we compare two diagnostic strategies in cases of high clinical suspicion of adnexal torsion: the current standard approach versus an experimental strategy incorporating CEUS. The primary outcome is the rate of inappropriate surgical interventions, defined as emergency surgery performed within 6 hours without intraoperative confirmation of torsion.Methods and analysisThis is a prospective, open-label, multicentre, randomised (1:1), controlled, superiority trial. A total of 256 women presenting with a high clinical suspicion of adnexal torsion will be enrolled over a period of 36 months. Participants will be randomly assigned to either the standard diagnostic strategy or an experimental strategy that includes CEUS. The primary endpoint is the proportion of emergency surgical procedures (performed within 6 hours of hospital admission) in which adnexal torsion is not confirmed.Ethics and disseminationThe study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) on 28 October 2024. The results of this study will be published in peer-reviewed journals and presented at relevant national and international conferences. The ethical approval number from the CPP is 6115.Registration numberNCT06677554; 2024-511720-13-00.