{"paper_id":"70d1e43b-78e2-4378-be23-fe05c18f7f7a","body_text":"Difficulties in diagnosing the paraovarian cyst torsion in children: two clinical cases as an example\n- Authors: Ushakovа U.I.1, Chundokova M.A.1,2, Ushakov K.V.1,2, Dondup O.M.1, Korchagina N.S.2,3\n-\nAffiliations:\n- The Russian National Research Medical University named after N.I. Pirogov\n- Filatov N.F. Children’s City Hospital\n- Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department\n- Issue: Vol 29, No 5 (2025)\n- Pages: 353-358\n- Section: Case reports\n- Submitted: 17.04.2025\n- Accepted: 13.10.2025\n- Published: 04.11.2025\n- URL: https://jps-nmp.ru/jour/article/view/866\n- DOI: https://doi.org/10.17816/ps866\n- EDN: https://elibrary.ru/GYEJZV\n- ID: 866\nCite item\nAbstract\nAn acute surgical, fertility-related condition―torsion of the uterine appendages in children―is associated with necrosis of the follicles and requires emergency surgical intervention to preserve the ovarian reserve of a child. In half of cases, according to literature, torsion is caused by a bulky ovarian formation; most often they are functional ovarian cysts and mature teratomas.\nThe article presents two clinical cases of uterine appendage torsion in children with paraovarial cysts. The girls were initially admitted to a pediatric surgical hospital with a clinical picture of acute abdomen and suspected acute appendicitis as a leading preliminary diagnosis. Unfortunately, torsion of the uterine appendages does not have a specific clinical picture.\nInstrumental diagnostics (ultrasound and magnetic resonance imaging of the pelvic organs) revealed paraovarial cysts in both cases, but until the diagnostic laparoscopy, the diagnosis of uterine appendage torsion remained unclear and was not suspected at the diagnostic search stage in any of the girls. To keep to the organ-preserving tactics, an operating surgeon decided to completely remove membranes of the formation in order to eliminate any relapses in the future, and at the same time to spare viable uterine appendages, as far as it was possible, in each specific case. Such an approach minimizes possible complications in the postoperative period and increases chances of a valid reproduction in the future.\nOutcomes of our clinical observations allow us to conclude that timely diagnostics during monitoring and treatment of patients with clinical manifestations of acute abdomen can increase chances of girls to preserve uterine appendages, and hence their ovarian reserves. If the diagnosis of acute appendicitis in girls is excluded, it is also mandatory to exclude acute gynecological pathologies. Thus, it highlights the importance of integrated approach to the diagnosis and treatment of gynecological acute conditions in adolescents. Such children should be under the observation of not only pediatric surgeons, but also of gynecologists.\nThe discussed clinical cases will help to improve diagnostics, management, and tactics of surgical treatment of adolescent girls with diagnosed uterine appendage torsion.\nFull Text\nAbout the authors\nUlviya I. Ushakovа\nThe Russian National Research Medical University named after N.I. Pirogov\nAuthor for correspondence.\nEmail: u.yusifova.u@mail.ru\nORCID iD: 0000-0001-5032-5741\nSPIN-code: 8276-6249\nRussian Federation, Moscow\nMadina A. Chundokova\nThe Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children’s City Hospital\nEmail: cmadina@yandex.ru\nORCID iD: 0000-0002-5080-4838\nSPIN-code: 1122-0394\nMD, Dr. Sci. (Medicine), Assistant Professor\nRussian Federation, Moscow; MoscowKonstantin V. Ushakov\nThe Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children’s City Hospital\nEmail: kaskodlol@mail.ru\nORCID iD: 0000-0003-2927-8092\nSPIN-code: 8997-5308\nRussian Federation, Moscow; Moscow\nOlga M. Dondup\nThe Russian National Research Medical University named after N.I. Pirogov\nEmail: odondup@gmail.com\nORCID iD: 0000-0002-4307-6246\nSPIN-code: 9710-9737\nRussian Federation, Moscow\nNatalia S. Korchagina\nFilatov N.F. Children’s City Hospital; Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department\nEmail: Nskorchagina@gmail.com\nORCID iD: 0000-0001-5562-8397\nSPIN-code: 8748-8855\nRussian Federation, Moscow; Moscow\nReferences\n- Artymuk NV, Lamonova SS, Chernova OO. Benign ovarian masses in adolescent girls: classification, clinical features, tactics. Pediatric and adolescent reproductive health. 2021;17(4):28–38. doi: 10.33029/1816-2134-2021-17-4-28-38 EDN: YLQIEA\n- Ngo AV, Otjen JP, Parisi MT, et al. Pediatric ovarian torsion: a pictorial review. Pediatr Radiol. 2015;45(12):1845–1855; quiz 1842-4. doi: 10.1007/s00247-015-3385-x EDN: TZHOFM\n- Adnexal torsion in adolescents: ACOG Committee Opinion No. 783. Obstet Gynecol. 2019;134(2):e56–e63. doi: 10.1097/AOG.0000 000000003373\n- Adamyan LV, Sibirskaya EV, Koltunov IE, Molchanova OK. The errors of the treatment in girls and young women with ovarian neoplasms. 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