Oxidative Stress during Ovarian Torsion in Pediatric\nand Adolescent Patients: Changing The\nPerspective of The Disease

Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group\nthat must be included in the differential diagnosis of any girl with abdominal pain or\npelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility,\nalthough oophoropexy may be considered in case of severe necrosis. Nevertheless,\nmaintaining the circulation of the ovary after detorsion deteriorates the tissue injury\nand leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is\ncharacterized by oxidative stress. During the detorsion process, an excess amount of\nmolecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS)\nsuch as superoxide radical (O2-), hydrogen peroxide (H2O2), hydroxyl radical (OH•),\nas well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and\ntheir toxic products cause DNA damage and lipid peroxidation in the cellular and\nmitochondrial membranes, leading to cell death. In spite of attention on this topic,\ncurrently there is no shared and clear evidence about the use of anti-inflammatory\nand antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion.\nConsidering this element, future research should aim to develop shared protocols for\nthe clinical use (route of application, dosage and time of application) of antioxidants\nafter laparoscopic management of this condition.