Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures

Abstract

There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures. A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients’ clinical characteristics, surgical procedures, and postoperative recovery were analyzed. Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases. Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.

Changing Practices in the Surgical Management of Adnexal Torsion

“…This conclusion is based on Although the oophorectomy rate of 69.7% in this study is notably high, it is consistent with previous studies showing an oophorectomy rate of 35-80% for the treatment of ovarian torsion in adults. 3,4,6,7,12,22 These findings are also consistent with the only other large retrospective database study on torsion management in adults by Mandelbaum and colleagues. 4 In their study, the authors queried the Nationwide Inpatient Sample (NIS) database, which captures hospital discharge data from more than 36 million annual hospitalizations, and found an overall oophorectomy rate of 76.9% for the 2001-2015 study period.…”

Complicated Endometrioma of Ovarian Torsion : A Case Report at the Teaching Hospital of Angre, Abidjan, Ivory Coast

“…Endometrioma is the most common form of location, 20-55% in patients with endometriosis [3]. Torsion of an ovarian cyst is even rarer when it is of endometriotic origin [4]. Its prevalence is estimated between 2.5 and 7.4% of gynecological emergencies [5].…”

“…The torsion of an endometrioma, is the consequence of an undiagnosed pelvic endometriosis. This torsion is manifested by an acute abdominal pain syndrome sometimes accompanied by vomiting [4,10,11]. A predictive score developed by Huchon helps with the diagnosis based on 5 criteria: unilateral pain, duration >8h, vomiting, absence of leucorrhoea or metrorrhagia and the presence of a cyst of more than 5 cm at the ultrasound [12].…”

“…In fact, the torsion of the ovarian pedicle is responsible for ischemia and then edema of the ovary. Untreated, ovarian torsion progresses to ovarian necrosis, thrombophlebitis, hemorrhage, and peritonitis [4].…”

Ovarian Torsion in Pediatric and Adolescent Patients

“…The surgeon will attempt to reestablish vascularization and assess viability of the ovary. If necrosis of the tissues has occurred or the torsion was caused by tumorous growth, the entire fallopian tube and ovary may need to be removed (Zengyan et al, 2019).…”