Diagnostic features, clinical picture and management of adnexal torsion in female adolescents


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Abstract

Background: The nonspecific clinical picture and the lack af early diagnosis af adnexal tarsian (AT) lead ta the persistence af high percentage af surgical remaval af argans, including in children and adalescents. Objective: Ta evaluate the diagnastic features and clinical picture af adnexal tarsian in female adalescents. Materials and methods: A retraspective case-cantral study was carried aut. The main graup included 29 girls with canfirmed adnexal tarsian aged 11-17 years. The camparisan graup cansisted af 27samatically healthy girls af the same age. A camparative analysis af clinical, anamnestic, labaratary and instrumental data af patients and healthy girls befare surgery and 3 manths after surgery was carried aut. Results: In mast cases, adnexal tarsian was abserved an the backgraund af avarian tumar (53.9%) and paraavarian cyst (46.2%). Mast aften, ATaccurred an the right side (65.5%). Accarding ta multivariate analysis, significant diagnastic criteria far adnexal tarsian in girls were acute abdaminalpain (F=11.4; p=0.001), especially in cambinatian with nausea and vamiting (F=5.8; p=0.20), that can be cansidered as an indicatian far emergency laparascapy. The reductian in blaad flaw ar absence af flaw velacity accarding ta calar flaw Dappler (F=15.6; p=0.000), the presence af additianal ultrasaund signs (spiral blaad flaw, increased avarian valume and swelling af avarian tissue, impaired visualizatian af the fallicular in the parenchyma (F=8.42; 0.005)), may indicate adnexal tarsian. Other parameters (hyperthermia (p=0.21), leukacythemia (p=0.07), CRP (p=0.44)) were nat significant criteria far the diagnasis af adnexal tarsian. In 89.7% af cases detarsian af uterine appendages was perfarmed, and in 6.9% af cases, adnexectamy was perfarmed due ta camplete necrasis; in 20.7% af patients, argan sparing surgery was supplemented with avariapexy and shartening af infundibulapelvic ligaments. Conclusion: In cases af elangated avarian ligaments and recurrent tarsian in the absence af ather abviaus causes af adnexal tarsian in female adalescents, avariapexy ar plicatian af the ligaments was justified. Na septic camplicatians were abserved after detarsian, including the cases when avaries were stained black. Organ sparing surgery was perfarmed in all cases, except far a lang-term tarsian in medical histary and tatal tissue necrasis. 3 manths after detarsian, despite the presence af black staining during surgery, the calar Dappler ultrasaund image indicated resumptian af blaad flaw in the avary.

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About the authors

Elena P. Khashchenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: khashchenko_elena@mail.ru
PhD, Researcher at the 2nd Gynecological (Children and Adolescents) Department

Elena V. Uvarova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation; I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Email: elena-uvarova@yandex.ru
Dr. Med. Sci., Professor, Corresponding Members of the RAS, Head of the 2nd Gynecological (Children and Adolescents) Department; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology of the Institute of Professional Education

Polina L. Sheshko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

obstetrician-gynecologist, oncologist at the Department of Innovative Oncology and Gynecology

Marina N. Kleymenova

M.V. Lomonosov Moscow State University

Email: mkleymenowa@yandex.ru
student of the Faculty of Fundamental Medicine

Stanislav O. Kyurdzidi

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation; I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Email: dr.kyurdzidis@gmail.com
PhD student

Irina A. Salnikova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: v_chuprynin@oparina4.ru
obstetrician-gynecologist, doctor of ultrasound diagnostics, Researcher at the 2nd Gynecological (Children and Adolescents) Department

Vladimir D. Chuprynin

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: v_chuprynin@oparina4.ru
PhD, Head of General Surgery Department

Fatima Sh. Mamedova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: mamedova_f@mail.ru
PhD, Doctor at the Department of Ultrasound Diagnostics in Neonatology and Pediatrics

Aleksandra V. Asaturova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: a_asaturova@oparina4.ru
PhD, Head of the 1th Pathology Department

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