Difficulties in diagnosing the paraovarian cyst torsion in children: two clinical cases as an example

An 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. The 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. Instrumental 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. Outcomes 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. The discussed clinical cases will help to improve diagnostics, management, and tactics of surgical treatment of adolescent girls with diagnosed uterine appendage torsion.