Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 220-223
Перекрут придатков матки у девочки 12 лет
https://doi.org/10.18821/1560-9510-2021-25-3-220-223Аннотация
Введение. Перекрут придатков матки (ППМ) – это ургентная патология, сопровождающаяся болевым абдоминальным синдромом и требующая неотложных диагностических и лечебных мероприятий. В детском возрасте ППМ в основном возникает вследствие органических причин и в связи с особенностями расположения внутренних органов в детском возрасте. Выполнение органосохраняющих операций при длительном ППМ, по данным литературы, является весьма спорным и неоднозначным. Отсутствуют объективные критерии оценки жизнеспособности яичника после деторсии, что влияет на тактику хирургического вмешательства – выполняется необоснованная аднексэктомия.
Описание клинического наблюдения. Девочка П., 12 лет, поступила в стационар с клиникой длительного перекрута придатков матки. Была произведена деторсия правых ПМ. Ребёнок находился под наблюдением. Через 2 года была выполнена лапароскопическая аппендэктомия по поводу хронического аппендицита. При осмотре органов малого таза правый яичник уменьшен в размерах по сравнению с левым, макроскопически не изменён, в нем визуализируются единичные фолликулы, маточная труба не изменена.
Заключение. Наличие болевого синдрома перед операцией свидетельствует о жизнеспособности придатков матки, отсутствие болей в животе – о возможном некрозе яичника и маточной трубы. Выбор тактики хирургического вмешательства основан на комплексной оценке клинических и инструментальных данных.
Список литературы
1. Jun-Kai Kao a, Chun-Chien Chiu b, Po-Yu Wang a, Meng-Kung Yu a Pediatric Ovarian Torsion in a Medical Center in Taiwan: Case Analysis. Pediatrics and Neonatology. 2012; 53: 55-9.
2. Коровин С.А., Дзядчик А.В., Галкина Я.А., Соколов Ю.Ю. Лапароскопические вмешательства у девочек с перекрутами придатков матки. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2016; 4: 73-9.
3. Volkan Sarper Erikci, M.D., Münevver Hoşgör, M.D. Isolated salpingeal torsion in children: a case series and review of the literature. Ulus Travma Acil Cerr Derg. January 2014; 20 (1): 75-78.
4. Macdougall IC. Novel erythropoiesis-stimulating agents: a new era in anemia management. Clin J Am Soc Nephrol. 2008; 3(1): 200-7.
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6. Cakmak M, Kaya M, Barlas M, Dindar H, Gokçora H, Kon kan R, et al. Histologic and ultrastructural changes in the contralateral ovary in unilateral ovarian torsion: an experi mental study in rabbits. Tokai J Exp Clin Med. 1993; 18(3-6): 167-78.
7. Akgur FM, Kilinç K, Tanyel FC, Buyukpamukçu N, Hiçson mez A. Ipsilateral and contralateral testicular biochemical acute changes after unilateral testicular torsion and detor sion. Urology. 1994; 44(3): 413-8.
8. Antonio Simone Laganà, Vincenza Sofo, Francesca Maria Salmeri. Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease. International Journal of Fertility and Sterilit. 2016; 4: 416-23.
9. Baron KT, Babagbemi KT, Arleo EK, et al. Emergent complications of assisted reproduction: expecting the unexpected. Radiographics. 2013; 33: 229–44.
10. Kun Chu, Qing Zhang, Ningxia Sun, Haixia Ding and Wen Li. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up experience. Journal of International Medical Research. 2018 46(4). 1685-1689.
11. Myoung Seok Lee, Min Hoan Moon, Hyunsik Woo1, Chang Kyu Sung1, Sohee Oh, Hye Won Jeon, Taek Sang Lee. CT findings of adnexal torsion: A matched case-control study.2018; 11: 4-14.
12. Carmine Noviello, Mercedes Romano, Alfonso Papparella, Andrea Ciavattini, Ascanio Martino, Giovanni Cobellis. The isolated tubal torsion: an insidious pediatric and adolescent pelvic urgency. La Pediatria Medica e Chirurgica. 2018; 40: 206.
13. Devi Balasubramaniam*, Kavitha Yogini Duraisamy, Malathi Ezhilmani. Laparoscopic Detorsion and Fertility Preservation in Twisted Ischemic Adnexa – A Single-Center Prospective Study. Gynecology and Minimally Invasive Therapy. 2020; 9: 24-8.
14. Чундокова М.А. Синдром «острого живота» у девочек: дифференциальная диагностика. Вопросы практической педиатрии. 2009; 4(3): 65-9.
Russian Journal of Pediatric Surgery. 2021; 25: 220-223
Torsion of the uterine appendages in a 12-year-old girl
https://doi.org/10.18821/1560-9510-2021-25-3-220-223Abstract
Introduction. The uterine appendage torsion (UAT) is an urgent pathology accompanied by a painful abdominal syndrome and requiring urgent diagnostic and therapeutic measures. In childhood, UAT develops mainly due to organic causes and due to the specific location of internal organs in children. The literature data on organ-preserving surgeries in the long-lasting UAT is very controversial and dubious. There are no objective criteria for assessing ovarian viability after detorsion what impacts the selection of surgical intervention tactics - unjustified adnexectomy may be performed.
Clinical case. Girl P., 12 years old, was admitted to the hospital with a clinical picture of long-lasting torsion of the uterus appendages. Right uterine appendages were detorsed. The child was under observation. In two years, laparoscopic appendectomy was performed for chronic appendicitis. When examining pelvic organs, the right ovary was found reduced in size compared to the left one; there were no macroscopically visible changes; single follicles were visualized in it; the fallopian tube was not changed.
Conclusion. A painful sensation before surgery indicates that the uterus appendages are viable; if there is no abdominal pain, necrosis of the ovary and fallopian tube may be suspected. A surgical tactics is chosen on making a comprehensive analysis of clinical and instrumental findings.
References
1. Jun-Kai Kao a, Chun-Chien Chiu b, Po-Yu Wang a, Meng-Kung Yu a Pediatric Ovarian Torsion in a Medical Center in Taiwan: Case Analysis. Pediatrics and Neonatology. 2012; 53: 55-9.
2. Korovin S.A., Dzyadchik A.V., Galkina Ya.A., Sokolov Yu.Yu. Laparoskopicheskie vmeshatel'stva u devochek s perekrutami pridatkov matki. Rossiiskii vestnik detskoi khirurgii, anesteziologii i reanimatologii. 2016; 4: 73-9.
3. Volkan Sarper Erikci, M.D., Münevver Hoşgör, M.D. Isolated salpingeal torsion in children: a case series and review of the literature. Ulus Travma Acil Cerr Derg. January 2014; 20 (1): 75-78.
4. Macdougall IC. Novel erythropoiesis-stimulating agents: a new era in anemia management. Clin J Am Soc Nephrol. 2008; 3(1): 200-7.
5. Coleman DA, Fleming MW, Dailey RA. Factors affecting ovarian compensation after unilateral ovariectomy in gilts. J Anim Sci. 1984; 59(1): 170-6.
6. Cakmak M, Kaya M, Barlas M, Dindar H, Gokçora H, Kon kan R, et al. Histologic and ultrastructural changes in the contralateral ovary in unilateral ovarian torsion: an experi mental study in rabbits. Tokai J Exp Clin Med. 1993; 18(3-6): 167-78.
7. Akgur FM, Kilinç K, Tanyel FC, Buyukpamukçu N, Hiçson mez A. Ipsilateral and contralateral testicular biochemical acute changes after unilateral testicular torsion and detor sion. Urology. 1994; 44(3): 413-8.
8. Antonio Simone Laganà, Vincenza Sofo, Francesca Maria Salmeri. Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease. International Journal of Fertility and Sterilit. 2016; 4: 416-23.
9. Baron KT, Babagbemi KT, Arleo EK, et al. Emergent complications of assisted reproduction: expecting the unexpected. Radiographics. 2013; 33: 229–44.
10. Kun Chu, Qing Zhang, Ningxia Sun, Haixia Ding and Wen Li. Conservative laparoscopic management of adnexal torsion based on a 17-year follow-up experience. Journal of International Medical Research. 2018 46(4). 1685-1689.
11. Myoung Seok Lee, Min Hoan Moon, Hyunsik Woo1, Chang Kyu Sung1, Sohee Oh, Hye Won Jeon, Taek Sang Lee. CT findings of adnexal torsion: A matched case-control study.2018; 11: 4-14.
12. Carmine Noviello, Mercedes Romano, Alfonso Papparella, Andrea Ciavattini, Ascanio Martino, Giovanni Cobellis. The isolated tubal torsion: an insidious pediatric and adolescent pelvic urgency. La Pediatria Medica e Chirurgica. 2018; 40: 206.
13. Devi Balasubramaniam*, Kavitha Yogini Duraisamy, Malathi Ezhilmani. Laparoscopic Detorsion and Fertility Preservation in Twisted Ischemic Adnexa – A Single-Center Prospective Study. Gynecology and Minimally Invasive Therapy. 2020; 9: 24-8.
14. Chundokova M.A. Sindrom «ostrogo zhivota» u devochek: differentsial'naya diagnostika. Voprosy prakticheskoi pediatrii. 2009; 4(3): 65-9.
