19 10 Years of Tertiary Paediatric Centre Experience of Females Undergoing Surgery for Ovarian Torsions

Aim Review role and accuracy of imaging, and subsequent management, of patients with ovarian torsion managed at a tertiary paediatric centre. Method Retrospective review of notes for patients undergoing surgery for ovarian torsion over 10 years (2010-2019). Results 23 patients underwent surgery for ovarian torsion (one excluded due to lack of data). Median age 12 years[range 1-15]. 18/22 patients underwent imaging; 15/18 had USS, 12/15(80%) were diagnostic for ovarian torsion. 3/15 showed ovarian pathology prompting further imaging/surgery. 2/22 had initial MRI, 1 diagnostic for torsion. Time from symptom onset to surgery was assessed, data was incomplete for 4 patients. 10 patients were referred from ED/primary care; 5(50%) underwent theatre within 12 hours, 3(30%) 12-12hours and 2(20%) >24hours. 8 patients were referred from external hospitals; 2(25%) underwent theatre within 12 hours, 4(50%) 12-12hours and 2(25%) >24hours. Those having surgery>24 hours from symptom onset were awaiting imaging or had suspected other pathology. 4/22 underwent oophorectomy (open:laparoscopic=3:1) and 18/22 had detorsion +/- cyst aspiration/excision (open:laparoscopic:converted=2:15:1). Follow up imaging was performed in 13/18 patients who underwent detorsion and 2/5 who underwent oophorectomy. Of 3 patients undergoing oopherectomy who did not have follow up; 2 had benign cysts and 1 had a simple tubo-ovarian torsion. Conclusions We advocate early USS in females with presentation concerning for ovarian torsion, though a high index of suspicion is often required owing to non-specific symptoms. Imaging and transfer should be performed promptly to prevent delays in surgical management.