Recurrent Ipsilateral Ovarian Torsion: Case Report and Literature Review

Bertozzi, Mirko; Magrini, Elisa; Bellucci, Cristina; Riccioni, Sara; Appignani, Antonino

doi:10.1016/j.jpag.2015.06.007

Cited by 22 publications

(19 citation statements)

References 33 publications

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“…The literature reports an 8.7 to 28.6% incidence of recurrent AT, similar to our findings (16.5%) . Most of these studies were limited to small cohorts and case reports and characterized by special populations . Although the literature has identified risk factors for AT, including pregnancy, fertility treatments and ovarian mass, it does not identify risk factors that would describe women who might be at‐risk for a recurrence, which might suggest measures for prevention.…”

Section: Discussionsupporting

confidence: 63%

Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better

Daykan

Bogin

Sharvit

et al. 2020

J of Obstet and Gynaecol

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Aim: To investigate characteristics and risk factors for recurrent adnexal torsion (AT). Methods: Retrospective cohort study in a university-affiliated medical center included 320 Women with AT verified by laparoscopy, from January 2005 through January 2017. Demographic data, clinical symptoms, surgical findings and treatment were retrospectively reviewed from patient records. Data from primary and secondary AT of patients in the recurrent torsion group was compared to those with single torsion, to evaluate risk factors for recurrent AT. Results: Two hundred and sixty seven (83.4%) patients had a single event of AT and 53 (16.5%) had recurrent AT. Patients with recurrent torsion had significantly fewer previous non-gynecologic surgeries (4.3% and 9.8% of the study groups vs 32.2% of the control group, P = 0.001 for both). Ovarian size was significantly smaller in the recurrent torsion groups (47.5 mm and 48.3 mm vs 63.9 mm, P = 0.045 and P = 0.012, respectively). Polycystic ovary was significantly more common in the recurrent AT group (P = 0.028 and P = 0.005), with risk ratio 4.4 (95% confidence interval, 1.66 to 11.63). Ovaries without any specific findings were also more common among recurrent AT cases (P = 0.001 for both groups). Logistic regression analysis demonstrated that smaller ovarian size is an independent risk factor for recurrent AT. Conclusion: Recurrent torsion correlated with fewer previous surgeries, small ovarian mass, polycystic ovaries and ovaries without specific findings, which might indicate that additional pathophysiological factors contribute to the recurrent event. Ovarian fixation might be recommended in patients with primary torsion of normal or polycystic ovaries.

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Section: Discussionsupporting

confidence: 63%

Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better

Daykan

Bogin

Sharvit

et al. 2020

J of Obstet and Gynaecol

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“…Controversy exists regarding whether oophoropexy should be performed during the same session or during a second session, when edema and hemorrhage have disappeared and after malignancy is no longer suspected [ 4 ]. Contrary to the studies that advocate fixing the remaining single ovary during the same session, even if the appearance of the ovary is normal [ 2 , 20 – 22 ], oophoropexy was reported by some studies only in recurrent cases [ 17 , 19 ]. Childress and Dietrich favored ovary protection but noted that, because the efficacy and safety of ovarian fixation were not well-established, oophoropexy could be performed if only one ovary remained due to prior oophorectomy [ 13 ].…”

Section: Discussionmentioning

confidence: 89%

“…All studies conducted on the advantages and disadvantages of the methods used have included a small number of patients. The main objections to oophoropexy are retorsion and periodic pelvic pain [ 17 , 19 ], and mechanical infertility due to disruption of the anatomy of the uterus, ovary, and fallopian tubes in cases in which the ovary is fixed [ 8 , 12 ]. The objections to the ligament plication technique are the breakdown of ovarian vascularity with the ligament adjacent to the ovarian artery, fallopian tube damage [ 14 , 19 ], and the occurrence of ovarian atrophy following fixation [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

How can the risk of ovarian retorsion be reduced?

Mehmetoğlu

2018

J Med Case Reports

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BackgroundIn the current treatment of idiopathic ovarian torsion, the use of oophorectomy has declined in favor of preserving the ovary. This approach brings with it the question of how to reduce the possibility of retorsion of the detorsioned ovary. The aim of this study was to analyze how retorsion can be prevented.MethodsFive patients (a 30-day-old Caucasian girl, a 55-day-old Caucasian girl, an 8-year-old Caucasian girl, a 10-year-old Caucasian girl, and a 16-year-old Caucasian girl) who underwent surgery due to non-neoplastic ovarian torsion were retrospectively analyzed for diagnosis and treatment in terms of reducing the possibility of retorsion.ResultsIn all patients, a precise diagnosis of idiopathic unilateral ovarian torsion was made during laparotomy, and the patients underwent different procedures. The ovary was found to be autoamputated in one patient, and two patients underwent salpingo-oophorectomies due to adnexal necrosis. The ovaries were detorsioned in the remaining two patients. During the operations, patients were evaluated regarding the prevention of retorsion of the ipsilateral and/or contralateral ovary; cyst drainage, cystectomy, ligament fixation, and/or oophoropexy were performed. The median follow-up period of the patients was 2 years (range 1.5–6 years), and they continue to be followed uneventfully.ConclusionsTo date, there is no standard approach to protect the ovary from retorsion in patients who undergo surgery due to torsion. The surgical procedure should be tailored on a case-by-case basis.

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“…Finally, it would be interesting if the authors could tell us something about the recurrence rate of adnexal torsion in patients who were managed conservatively. Based on our previous published review of the pediatric literature, this event might seldom occur in the pediatric age group, but published data are not exhaustive (6). Our recent multicenter study reported a recurrence rate of 12%, and the risk of recurrence seems to be increased in patients without ovarian masses at the occurrence of their first event of ovarian torsion, with no statistical significance comparing pre-and postmenarchal groups.…”

Section: Pediatric Adnexal Torsionmentioning

confidence: 95%