Uterine adnexal torsion: sonographic findings.

Abstract

Acute torsion of the uterine adnexal structures (ovary and fallopian tube) is a recognized surgical emergency, but rarely has the diagnosis been made preoperatively on the basis of imaging studies. This report describes 16 cases in which the diagnosis was suggested preoperatively on the basis of sonography and subsequently confirmed at surgery. In all of the patients studied, a pelvic or pelvoabdominal mass was present on sonography. These masses had a sonographic texture ranging from cystic to solid, depending on the presence and extent of internal hemorrhage and/or stromal edema. In the majority of patients (13 of 16), adnexal torsion was associated with a preexisting cystic adnexal mass. Eight of these had thin internal septae. The severity of symptoms was variable and did not correlate directly with the sonographic features of the pelvic mass. Consideration of this entity in the proper clinical setting and with the typical sonographic findings will facilitate prospective recognition of adnexal torsion, thereby improving the chances for salvage of the involved adnexal structures.

Adnexal torsion-five-year retrospective study

“…6,7 The other adnexal pathologies like endometriosis, hemorrhagic cysts, ectopic pregnancy, pelvic inflammatory disease form complex adnexal mass and make it difficult to differentiate sonographically. 4,8,9 All age groups are susceptible to develop adnexal torsion though it is commonly seen in reproductive women. 3,[10][11][12] Majority of our cases in this study also were in younger reproductive age group (Table 2).…”

Isolated tubal torsion after tubal ligation and ectopic pregnancy: A case report

“…Among the reasons why the right sided pathology predominates, the protective role of sigmoid colon has been mentioned, which situated in the left lower quadrant, via its mass effect on the left tube could keep it from turning around its pedicle, as well as the operative approach of surgeons to the patients admitted with right lower quadrant pain due to suspicion of acute appendicitis. There are also opinions proposing that the difference between the venous circulatory systems of the right and left tubes increases the incidence on the right side [5][6]. Although the mechanism of ITT remains unknown precisely, a variety of theories has been put forward.…”

Ovarian torsion in a 20-year-old patient

“…If rotation is complete and prolonged, venous and arterial thrombosis occur, ultimately causing adnexal infarction. 4,5 Adnexal torsion is rarely bilateral and is more common on the right side, 3,6 perhaps because the sigmoid colon leaves limited space for left adnexal mobility. 7 Torsion occurs more commonly in young women, with the greatest incidence in the 20-to 30-year age group.…”

“…6 In cases of incomplete ovarian torsion, ultrasonography may show massive ovarian edema due to compromise of lymphatic drainage, without ischemic necrosis. 5 Free fluid is found in the cul-desac in a small number of patients from ovarian capsule transudate secondary to lymphatic and venous obstruction. 11 In the early stages of ovarian torsion, the ovary is enlarged with prominent peripheral follicles.…”