Past Issue

Volume 9, Number 4, Jan-Mar 2016, Pages: 416-423

Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease

Antonio Simone Laganà, M.D, 1, *, Vincenza Sofo, Ph.D, 2, Francesca Maria Salmeri, M.D., Ph.D., 2, Vittorio Italo Palmara, M.D., Ph.D., 1, Onofrio Triolo, M.D., Ph.D., 1, Milan Milosav Terzić, M.D., Ph.D., 3, 4, Tito Silvio Patrelli, M.D., Ph.D., 5, 6, Adolf Lukanovic, M.D., Ph.D., 7, Eda Vrtcnik Bokal, M.D., Ph.D., 7, Giuseppe Santoro, M.D., Ph.D., 8,
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
University of Belgrade, School of Medicine, Belgrade, Serbia
Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
University of Parma, Parma, Italy
Vicenza General Hospital, Vicenza, Italy
Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy
* Corresponding Address: Unit of Gynecology and Obstetrics Department of Human Pathology in Adulthood and Childhood G. Barres University of Messina Via C. Valeria 1 98125-Messina Italy


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.