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A Case of Twisted Ovarian Cyst in a Young Patient and Review of the Literature

Idris S, Daud S, Ahmad Sani N, Tee Mei Li S

Am J Case Rep, 2021 Nov 17;22:e933438.

PMID: 34785630 DOI: 10.12659/AJCR.933438

BACKGROUND Adnexal torsion is a gynecologic emergency that dictates immediate surgical intervention. Twisted ovarian cysts are rare in adolescents, but they can cause significant distress to patients. Idiopathic ovarian torsion is uncommon in adolescents and the incidence is reportedly higher in women aged 20 to 40 years. Most twisted cysts in adolescents are benign. In the past, oophorectomy was commonly performed for a torsed ovary, but currently there is a trend toward ovary preservation. The diagnosis of twisted ovarian cyst is based on pathognomonic symptoms and findings from a focused clinical examination and ultrasound. Because the differential diagnosis includes acute appendicitis and gastroenteritis, referral to a gynecologist may be delayed. CASE REPORT We present the case of a huge, twisted ovarian cyst in a 16-year-old girl who presented with an acute abdomen. The initial diagnosis was acute appendicitis, which delayed her referral to a gynecologist. An emergency laparotomy and left salpingo-oophorectomy were performed. The histopathology of the ovarian cyst was reported as serous cystadenoma. CONCLUSIONS The optimal management of a twisted ovarian cyst in adolescents is the subject of much debate. Here, we review the literature on ovarian torsion in children and adolescents. The patient in the case we present had a twisted ovarian cyst that was managed with salpingo-oophorectomy.

Matched MeSH terms: Torsion Abnormality/diagnosis; Torsion Abnormality/surgery

Update on the management of ovarian torsion in children and adolescents

Nur Azurah AG, Zainol ZW, Zainuddin AA, Lim PS, Sulaiman AS, Ng BK

World J Pediatr, 2015 Feb;11(1):35-40.

PMID: 25557598 DOI: 10.1007/s12519-014-0536-3

Ovarian torsion is commonly seen in young girls. Unfortunately it is often misdiagnosed because of its non-specific symptoms and lack of diagnostic modalities. This article focuses on the diagnostic challenge and also the changes in the management of ovarian torsion.

Matched MeSH terms: Torsion Abnormality/diagnosis*; Torsion Abnormality/physiopathology; Torsion Abnormality/surgery; Torsion Abnormality/ultrasonography

Fulltext Torsion of a wandering spleen with whorled appearance of the splenic hilum in CT scan

Thambidorai CR, Imtiaz A, Nafiqudin M

Med J Malaysia, 2005 Dec;60(5):653-4.

PMID: 16515121

An eight-year-old boy admitted for acute abdominal pain was diagnosed to have torsion of the spleen (TS) based on contrast enhanced computerised tomography (CECT) of the abdomen. CECT showed whorled appearance in the splenic hilum. Whorl sign' refers to the presence of a twisted splenic pedicle intermingled with fat, resulting in alternating circular bands of radiodensity and radiolucency and is considered diagnostic of TS. This is the fourth reported case of whorl sign in children with TS and the first from Malaysia.

Matched MeSH terms: Torsion Abnormality/radiography

Re: Rare case of wandering spleen causing intra-thoracic megacolon

Hayati F, Azizan N, Ng CY, Payus AO, Syed Abdul Rahim SS

ANZ J Surg, 2021 01;91(1-2):214.

PMID: 33590622 DOI: 10.1111/ans.16380

Matched MeSH terms: Torsion Abnormality

Uterine horn torsion in a pregnant cat

Thilagar S, Yew YC, Dhaliwal GK, Toh I, Tong LL

Vet Rec, 2005 Oct 29;157(18):558-60.

PMID: 16258139

Matched MeSH terms: Torsion Abnormality/pathology; Torsion Abnormality/surgery; Torsion Abnormality/veterinary*

Fulltext Dynamic measurement of axial vertebral rotation and rotational flexibility in scoliosis by flouroscopic method

Lim HH, Ong CH

Med J Malaysia, 2001 Jun;56 Suppl C:41-5.

PMID: 11814248

The Pedriolle torsion meter is an established method of vertebral rotation assessment in scoliosis. However, the assessment of scoliosis by this method is static and indirect. The objective of this study is to compare the accuracy of a direct method of assessing scoliosis rotation by fluoroscopy compared to the Pedriolle torsion meter. Secondly, to determine that vertebral body rotation changes with supine posture compared to erect position. Eight volunteers with idiopathic scoliosis were assessed for the apical vertebral rotation with this method and the Pedriolle torsion meter. These patients were also assessed in the supine and erect position with the fluoroscopic method to determine if the apical vertebral rotation would change with posture. The mean Cobb angle of the curves was 62.8 degrees (range 45 degrees to 86 degrees). The mean apical vertebral rotation in a standing position was assessed to be 21.5 degrees by Pedriolle torsion meter and 29 degrees by the fluoroscopic method. This difference was not statistically significant by the student t-test. In most patient, the rotation of vertebrae improved by a varying degree ranging from none to 24 degrees in the supine position. In conclusion, the fluoroscopic method is an alternate mean of measuring vertebrae rotation in idiopathic scoliosis, with comparable accuracy to the Pedriolle torsion meter method. The amount of vertebral rotation changes with posture of the patient.

Matched MeSH terms: Torsion Abnormality/physiopathology; Torsion Abnormality/radiography

A Challenge in Diagnosis and Management: Uterine Torsion in Childhood

Thever Ramasamy V, Sivapatham L, Grover SR, Shanmugam SS, Ganesalingam M

J Pediatr Adolesc Gynecol, 2021 Feb;34(1):61-64.

PMID: 33010465 DOI: 10.1016/j.jpag.2020.09.003

BACKGROUND: Uterine torsion is a rare event, which mostly reported in females with a gravid uterus and is exceptionally rare in children.

CASE: A 9-year-old girl presented with 3 days of intermittent lower abdominal pain. Ultrasound revealed an ovarian mass, but laparotomy revealed an ischemic enlarged ovary and uterus rotated 180°. No reperfusion occurred after 60 minutes. A subtotal hysterectomy and right salpingoophorectomy were thus performed.

CONCLUSION: Uterine and adnexal torsion presents with symptoms similar to those of adnexal torsion. Delays in diagnosis and referral continue to be an issue, resulting in suboptimal outcomes. Uterine torsion, although exceedingly rare in childhood, appears to occur only in the setting of ovarian masses, which provide the impetus for the rotational force to the elongated cervix of the prepubertal uterus.

Matched MeSH terms: Torsion Abnormality/diagnosis; Torsion Abnormality/surgery*

Fulltext Asymptomatic torsion of a normal fallopian tube

Tai C, Neoh HS

Med J Malaysia, 1991 Dec;46(4):363-4.

PMID: 1840446

Torsion of the flliJopian tube is an uncommon condition but cases have been reported fairly often since the first case published by Bland Sutton in 1980. The following case report is presented because we have not found any report in the literature where torsion of the fallopian tube was asymptomatic and only discovered incidentally during Caesarean Section.

Matched MeSH terms: Torsion Abnormality

Torsion of ovarian tumors: a clinicopathological study

Lee CH, Raman S, Sivanesaratnam V

Int J Gynaecol Obstet, 1989 Jan;28(1):21-5.

PMID: 2565826

Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. The major presenting symptom was pain but an abdominal mass was palpable in 79.4% of cases. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Most of the tumors were benign cystic teratomas. Only 8.7% of the tumors were malignant.

Matched MeSH terms: Torsion Abnormality

Case Report: Ocular Tilt Reaction with Internuclear Ophthalmoplegia and Multiple Cranial Nerve Palsies

Teo SK, Mohd Khialdin S, Yong MH, Othman O, Ami M

Optom Vis Sci, 2020 Dec;97(12):1018-1022.

PMID: 33252541 DOI: 10.1097/OPX.0000000000001607

SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology.

PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.

CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.

CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.

Matched MeSH terms: Torsion Abnormality/diagnosis; Torsion Abnormality/etiology*; Torsion Abnormality/physiopathology

Fulltext A clinico-pathological review of benign cystic teratoma of the ovary

Ong HC, Chan WF

Singapore Med J, 1977 Jun;18(2):100-4.

PMID: 929220

Benign cystic teratoma of the ovary has a varied incidence, varying from 30 to 50 per cent of all benign ovarian tumours. This tumour tends to occur in the reproductive age group (20 to 40 years), and the majority of patients are married with children. About 40 per cent of patients are symptomless. Of those with symptoms, abdominal pain and mass are the commonest. Torsion is the most frequent complication encountered, and the presence of acute pain should make one suspect this complication. The tumour is bilateral in 10 to 20 per cent of patients. This high bilateral occurrence places a responsibility on the gynaecologist to inspect the opposite ovary in all cases of unilateral dermoid cyst of the ovary at the time of laparotomy. Germ·layer derivatives are predominantly ectodermal in origin, although both mesodermal and entodermal derivatives occur frequently.

Matched MeSH terms: Torsion Abnormality

An unusual cause of abdominal pain. Omental torsion

Khine M, Roslani AC

Ann Acad Med Singap, 2009 Feb;38(2):180.

PMID: 19271056

Matched MeSH terms: Torsion Abnormality

Primary torsion of the greater omentum

Gul YA, Jabbar MF, Moissinac K

Acta Chir. Belg., 2001 Nov-Dec;101(6):312-4.

PMID: 11868511

Primary or idiopathic greater omental torsion remains a rare cause of acute surgical abdomen in adults and children. The aetiology is as yet unknown and the treatment of choice, once diagnosis is established, is resection of the torted omentum. We report our experience with three such cases encountered over the last five years, two of which were diagnosed and subsequently managed laparoscopically. The performance of diagnostic laparoscopy for acute abdominal pain of an undetermined origin may lead to an increased detection of this condition and subsequent therapeutic intervention.

Matched MeSH terms: Torsion Abnormality

Fulltext A case of torsion of the spleen presenting as an acute abdomen

Wong SK, Renuka SN, Suppiah M

Med J Malaysia, 1994 Sep;49(3):295-6.

PMID: 7845284

A middle-aged man presented with acute abdomen was found to have torsion of the spleen on laparotomy with the spleen lying in an abnormal position. Wandering spleen is an unusual entity, with torsion being a common complication.

Matched MeSH terms: Torsion Abnormality

Case report: torsion of a gravid horn of a didelphic uterus

Achanna S, Monga D, Hassan MS

J Obstet Gynaecol Res, 1996 Apr;22(2):107-9.

PMID: 8697337

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.

Matched MeSH terms: Torsion Abnormality

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