A Case–Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain

Budhram, Gavin; Elia, Tala; Dan, Jeff; Schroeder, Michele; Safain, Golien; Schlech, Walter F.; Friderici, Jennifer; Knee, Alexander; Anthouard, Magalie; Schoenfeld, Elizabeth M.

doi:10.1111/acem.13523

Cited by 17 publications

(34 citation statements)

References 28 publications

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“…With regards to imaging, 98 (88%) of our emergency AT cases had any imaging (ultrasound or computed tomography) pre-operatively. Of them, 80 had doppler ows reported of whom 28 (35%) had normal ows, similar to published pre-operative diagnostic rates of 36.6-55.8% [5,15,23]. Other studies have found that ultrasound (US) diagnosis of AT has low sensitivity 70% and speci city 87% [24], where abnormal dopplers only have 61% sensitivity and 98% speci city [23].…”

Section: Discussionsupporting

confidence: 75%

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Goh

2022

Arch Gynecol Obstet

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PurposeThe primary objective of this study is to identify if and which clinical factors may in uence surgical decision-making when managing premenopausal women who present emergently with adnexal torsion (AT). MethodsThis retrospective cohort study was conducted at a single tertiary hospital. Medical records for all admissions for AT between 1 January 2010 and 30 June 2020 were reviewed and data regarding patient demographics, history of torsion, and the index admission were collected. Conservative surgery was de ned as detorsion only or detorsion with cyst decompression. Interventional surgery was de ned as ovarian cystectomy, salpingectomy, oophorectomy or salpingo-oopherectomy. Results126 women were included for nal analysis. Of the 109 women diagnosed with AT at emergency surgery, 12 were postmenopausal (all had interventional surgery). In the 97 premenopausal women, 50 (52%) underwent conservative surgery. Pregnant women were more likely to undergo conservative surgery than non-pregnant women (Relative Risk [RR] 0.20, 95% con dence interval [CI] 0.5, 0.75, p=0.001). Women having laparoscopies were also more likely to undergo conservative surgery (RR 0.08, 95% CI 0.01, 0.53, p=0.001) than if they had laparotomies. Although not reaching statistical signi cance, women were more likely to undergo laparotomy if they were febrile or if a senior gynecology consultant was involved in their care. History of torsion, age, parity and ovarian size did not alter the risk of interventional surgery. ConclusionThis study identi ed that premenopausal women who presented emergently with AT were signi cantly more likely to have conservative surgery if they were pregnant or if they underwent laparoscopic surgery.

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Section: Discussionsupporting

confidence: 75%

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Goh

2022

Arch Gynecol Obstet

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“…As a predictor of ovarian torsion, there is a report that the maximum ovary diameter is 50 mm. The sensitivity when the threshold was 50 mm was 91% (83-97%) [9], and in this case, it was also suspected to be ovarian torsion based on the size of the right ovary.…”

Section: Discussionmentioning

confidence: 72%

Successful Oocyte Retrieval After Follicular Fluid Aspiration in Suspicious of Ovarian Torsion

Inoue

Asada

2020

Cureus

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During controlled ovarian stimulation, a 34-year-old woman complained of right lower abdominal pain after the decision to retrieve oocytes. Ovarian torsion was suspected and confirmed, so aspiration of follicular fluid was performed prior to oocyte retrieval for volume reduction of the affected ovary. Two days after that, oocytes were successfully collected. Four months later, the frozen embryo was transferred and got pregnant. In conclusion, it is possible to perform volume reduction before ovum pick up (OPU), and also possible to become pregnant by embryo transfer afterward. This is the rare case report of follicular aspiration prior to oocyte retrieval.

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“…Oltmann et al and Budhram et al reported that there is more likelihood of torsion when the size of the ovarian mass is 5 cm or larger [ 18 , 19 ]. In the present study, there were 17 cases (60.71%) having 5-10 cm size of adnexal mass which had undergone torsion.…”

Section: Discussionmentioning

confidence: 99%

Adnexal Torsion: A Retrospective Analysis From a Tertiary Care Teaching Hospital in Northern India

Verma¹,

Bhuria²,

Chauhan³

et al. 2021

Cureus

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BackgroundAdnexal torsion is an acute gynecological emergency presenting with acute abdomen which can be missed owing to non-specific symptoms. Among reproductive-age women, conservative surgery is preferred. The present study was a retrospective analysis of adnexal torsion cases reported to a tertiary care teaching hospital in Northern India. The purpose of the study was to describe the demography, clinical features, diagnostic and treatment modalities, and prognosis of adnexal torsion cases. MethodsSurgically proven adnexal torsion case records were retrieved and data were entered in an excel sheet from a period of two and half years from January 2018 to June 2020. ResultsThere were 28 cases with an age range of 7-85 years (median age 24 years) with lower abdominal pain and nausea/vomiting symptoms. The majority were in the reproductive age group (71.4%). A Colour Doppler was done which detected 75% (12/16) of the ovarian torsion cases. The size of the adnexal torsion was 5-10 cm in 60.7% with right-sided torsion seen in 57.14%. Detorsion and salpingo-oophorectomy was done in 14 (50%) and 11 (39.2%) cases, respectively. Histopathological examination revealed hemorrhagic/necrotic infarcts (54.2%) and dermoid cysts (33.3%). ConclusionsOwing to non-specific symptoms, adnexal torsion is diagnosed with strong clinical suspicion as routine ultrasonography diagnosed only 7.1% in the present study. Conservative surgery is preferred in the reproductive age group.

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A Case–Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain

Abstract: A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.

Cited by 17 publications

References 28 publications

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion

Successful Oocyte Retrieval After Follicular Fluid Aspiration in Suspicious of Ovarian Torsion

Adnexal Torsion: A Retrospective Analysis From a Tertiary Care Teaching Hospital in Northern India

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