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

Abstract

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.

A giant ovarian cyst torsion: Case report

“…The postoperative autopsy specimen in this case showed that the cyst fluid was dark brown, which may have caused intra-tumor bleeding due to rupture of small blood vessels in the cyst and rapid increase in tumor volume. [4] In practice, patients with ovarian cystic torsion have different clinical presentations due to different tumor characteristics and degrees of blood flow obstruction, which can easily lead to misdiagnosis and missed diagnosis. To improve the accuracy of ovarian cysts with tip torsion, Pierre P et al proposed a self-assessment questionnaire dedicated to gynecologic emergencies (SAQ-GE), which includes 5 independent predictors of AT diagnosis, which was used to assign a score of 3 for unilateral abdominal or low back pain, 2 for absence of abnormal leukorrhea and uterine bleeding, 2 for pain in the adnexal region, 2 for intolerable pain, and 1 for vomiting, for a total of 10 points for the diagnosis of AT.…”

“…The postoperative autopsy specimen in this case showed that the cyst fluid was dark brown, which may have caused intra-tumor bleeding due to rupture of small blood vessels in the cyst and rapid increase in tumor volume. [ 4 ]…”

Ovarian torsion: A retrospective case series at a tertiary care center emergency department

“…OT is considered a rare condition accounting for around 2.7% of gynecological surgical emergencies [ 3 ], and around 3% of ED visits presenting with abdominal discomfort [ 5 ]. Few studies have investigated the incidence of OT in the ED.…”

“…Although, the gold standard for the diagnosis of OT remains by laparoscopic surgical exploration, pelvic ultrasonography with color doppler is the diagnostic imaging of choice [ 5 , 27 ]. In fact, the sensitivity of ultrasonography to detect OT was found to range from 70%-72% and the specificity from 87%-99.6% [ 27 , 28 ].…”

“…Furthermore, OT can present to the ED in a variety of ways, making its diagnosis especially challenging as it can mimic various other gynecological and non-gynecological emergencies [ 4 ]. Differentiating ovarian torsion from other conditions with timely diagnosis and quick management are key to fertility preservation [ 5 ].…”