Preoperative D-Dimer has Limited Role in Predicting Ovarian Torsion Among Children: Study Suggests
Italy: Researchers have found in a new study that D-dimer levels showed no clear association with ovarian torsion in this cohort. However, their sensitivity and specificity suggest that preoperative D-dimer may aid surgeons in estimating the likelihood of adnexal torsion in children and adolescents. However, it should not replace imaging or diagnostic laparoscopy, especially in uncertain cases.
A new pilot study published in Frontiers in Medicine offers preliminary insight into whether D-dimer, a biomarker typically associated with clot formation, could support clinical decision-making in suspected adnexal torsion among pediatric and adolescent patients. The research, led by Alessandro Boscarelli from the Department of Pediatric Surgery and Urology at the Institute for Maternal and Child Health – IRCCS “Burlo Garofolo,” Trieste, Italy, explored whether preoperative D-dimer levels could help refine diagnostic accuracy for this time-sensitive surgical condition.
Adnexal torsion—twisting of the ovary or fallopian tube—remains challenging to diagnose in younger patients because of its nonspecific symptoms and the overlap with other abdominal and pelvic pathologies. While imaging plays a central role in workup, no single test provides definitive confirmation, often leaving diagnostic laparoscopy as the only reliable means of establishing the condition. Previous experimental studies, particularly in animal models, have hinted that D-dimer might be a potential marker of torsion-related ischemia, prompting interest in its clinical application.
To investigate this possibility, the research team prospectively enrolled all female patients who presented to their emergency department between January 2022 and December 2024 with symptoms raising suspicion of adnexal torsion. Preoperative D-dimer levels were measured in participants who subsequently underwent surgical exploration. In total, 15 patients between 7 and 17 years of age met criteria for inclusion in the analysis.
The study revealed the following findings:
- Among confirmed cases, adnexal torsion was right-sided in 60% of patients and left-sided in 40%.
- Most patients were treated laparoscopically, and no postoperative complications occurred.
- None of the evaluated clinical or laboratory variables showed a significant association with adnexal torsion.
- D-dimer levels were higher in patients with torsion, but the correlation was not statistically significant (odds ratio = 1).
- The D-dimer test demonstrated a sensitivity of 0.86 and a specificity of 0.75, indicating possible diagnostic usefulness, though not conclusive.
The authors caution that these findings should be interpreted in the context of several limitations. The small sample size restricts the statistical strength of the analysis, highlighting the need for larger multicenter studies to validate the preliminary observations. Additionally, factors such as symptom duration, hormonal variations, nutritional status, and concurrent infections were not accounted for and may influence D-dimer values.
Despite these constraints, the researchers emphasize the continued importance of optimizing early diagnosis in adnexal torsion, a true surgical emergency where delays can result in significant morbidity. They propose that while D-dimer cannot replace established imaging modalities or diagnostic laparoscopy, it may eventually serve as an adjunct tool to support clinical suspicion and guide timely intervention in pediatric patients.
Reference:
Boscarelli, A., Giangreco, M., Valvo, E., Codrich, D., Masiello, V., Iaquinto, M., Scarpa, M., Olenik, D., Maita, S., Campilongo, C., Guida, E., & Schleef, J. (2025). The role of preoperative D-dimer levels in diagnosing adnexal torsion in children and adolescents: A prospective monocentric pilot analysis. Frontiers in Medicine, 12, 1706633. https://doi.org/10.3389/fmed.2025.1706633
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