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• W2783016755 abstract "We found the article from Schuh et al. very interesting because of the wide number of adnexal torsion in the young female population. However, data from this study deserve several considerations (1Schuh A.M. Klein E.J. Allred R.J. et al.Pediatric adnexal torsion: not just a postmenarchal problem.J Emerg Med. 2017; 52: 169-175Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar). First of all, it would have been better not to include patients older than 18 years in a pediatric case series. In doing so, the title of the article would be more congruent and the concept that adnexal torsion is not simply a postmenarchal problem would be strengthened. This is also supported by our recent multicenter study in a pediatric population aged up to 14 years, in which the occurrence of ovarian torsion in the premenarchal period was 67.7% (2Bertozzi M. Esposito C. Vella C. et al.Pediatric ovarian torsion and its recurrence: a multicenter study.J Pediatr Adolesc Gynecol. 2017; 30: 413-417Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar). Secondly, the attribution of the menarche in 24 patients based on the national average age of onset appears questionable, although it was correctly reported as a study limitation. We agree that abdominal and pelvic ultrasonography (US) should be performed as a first instrumental examination when children complain of abdominal pain. In our opinion, the remarkable recourse to abdominal computed tomography (CT) instead of magnetic resonance imaging (MRI) for the definition of doubtful cases reported in this article is alarming. It must be stressed that abdominal MRI represents the best alternative to study the pelvis and its components and saves children from radiation exposure (3Bertozzi M. Riccioni S. Valoncelli C. et al.The diagnosis and management of ovarian cysts in children.J Pediatr Adolesc Gynecol. 2017; 30: 265Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar). We must be aware that radiation risk is cumulative over a lifetime and that cancer-related risk is increased by CT exposure at younger ages; therefore, closer collaboration with radiologists should be pursued in order to develop the optimal strategies to allow a decrease in CT exposure in children (4Brady Z. Cain T.M. Johnston P.N. Justifying referrals for paediatric CT.Med J Aust. 2012; 197: 95-99Crossref PubMed Scopus (15) Google Scholar, 5Frush D.P. Donnelly L.F. Rosen N.S. Computed tomography and radiation risks: what pediatric health care providers should know.Pediatrics. 2003; 112: 951-957Crossref PubMed Scopus (491) Google Scholar). Finally, it would be interesting if the authors could tell us something about the recurrence rate of adnexal torsion in patients who were managed conservatively. Based on our previous published review of the pediatric literature, this event might seldom occur in the pediatric age group, but published data are not exhaustive (6Bertozzi M. Magrini E. Bellucci C. et al.Recurrent ipsilateral ovarian torsion: case report and literature review.J Pediatr Adolesc Gynecol. 2015; 28: e197-e201Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar). Our recent multicenter study reported a recurrence rate of 12%, and the risk of recurrence seems to be increased in patients without ovarian masses at the occurrence of their first event of ovarian torsion, with no statistical significance comparing pre- and postmenarchal groups. Nevertheless, Smorgick et al. reported a higher risk of recurrence in premenarchal girls, which is different from our experience (7Smorgick N. Melcer Y. Sarig-Meth T. et al.High risk of recurrent torsion in premenarchal girls with torsion of normal adnexa.Fertil Steril. 2016; 105: 1561-1565Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar). We believe this topic deserves careful attention and the authors' opinion would be enlightening. We congratulate the authors because their rate of oophorectomy is lower than that observed in our previous retrospective 10-year study (62%), although this result may be susceptible of further improvement (2Bertozzi M. Esposito C. Vella C. et al.Pediatric ovarian torsion and its recurrence: a multicenter study.J Pediatr Adolesc Gynecol. 2017; 30: 413-417Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar). This issue was recognized by the authors when they affirm that different approaches to the ischemic-appearing ovaries may affect the rate of adnexal salvage, with teaching hospitals having the highest de-torsion rate without performing oophorectomy (8Sola R. Wormer B.A. Walters A.L. et al.National trends in the surgical treatment of ovarian torsion in children: an analysis of 2041 pediatric patients utilizing the nationwide inpatient sample.Am Surg. 2015; 81: 844-848Crossref PubMed Google Scholar). This is a very interesting topic discussed by the authors of this article. Of course, a greater awareness should support conservative therapy for ovarian torsion and reducing CT exposure in children, instead using MRI in the case of suspected ovarian torsion with an inconclusive US examination. Pediatric Adnexal Torsion: Not Just a Postmenarchal ProblemJournal of Emergency MedicineVol. 54Issue 1PreviewWe appreciate the perspective provided by Bertozzi et al. and would like to address some concerns raised in their letter to the editor. Although we are a children's hospital, we routinely see patients over the age of 18 years who have not yet transitioned to adult care. In this study, only one patient was age 18 or over (19 years old), keeping in line with other large pediatric research consortiums who define pediatric populations as children up to age 18 years (1–3). Because the main objective of our study was to compare characteristics of ovarian torsion in premenarchal and postmenarchal girls, we felt it was important to include a cohort of postmenarchal girls, which would not have been possible if the upper age limit had been held to 14 years. Full-Text PDF" @default.
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• W2783016755 title "Pediatric Adnexal Torsion" @default.
• W2783016755 doi "https://doi.org/10.1016/j.jemermed.2017.03.051" @default.
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