Author/Authors :
Laganà، Antonio Simone نويسنده Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy , , Sofo، Vincenza نويسنده Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy , , Salmeri، Francesca Maria نويسنده Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy , , Palmara، Vittorio Italo نويسنده Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy , , Triolo، Onofrio نويسنده Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy , , Terzic، Milan Milosav نويسنده University of Belgrade, School of Medicine, Belgrade, Serbia , , Patrelli، Tito Silvio نويسنده University of Parma, Parma, Italy , , Lukanovic، Adolf نويسنده Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia , , Bokal، da Vrtcnik نويسنده Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia , , Santoro، Giuseppe نويسنده Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy ,
Abstract :
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
that must be included in the differential diagnosis of any girl with abdominal pain or
pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion
should be performed in order to preserve the integrity of the ovaries and fertility,
although oophoropexy may be considered in case of severe necrosis. Nevertheless,
maintaining the circulation of the ovary after detorsion deteriorates the tissue injury
and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is
characterized by oxidative stress. During the detorsion process, an excess amount of
molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS)
such as superoxide radical (O2
-), hydrogen peroxide (H2O2), hydroxyl radical (OH•),
as well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and
their toxic products cause DNA damage and lipid peroxidation in the cellular and
mitochondrial membranes, leading to cell death. In spite of attention on this topic,
currently there is no shared and clear evidence about the use of anti-inflammatory
and antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion.
Considering this element, future research should aim to develop shared protocols for
the clinical use (route of application, dosage and time of application) of antioxidants
after laparoscopic management of this condition.
