Analysis of ovarian torsion in a rural tertiary care centre

Abstract

Background: Ovarian torsion refers to the complete or partial rotation of the ovary. It is one of the most common gynecologic surgical emergencies affecting all ages. Early diagnosis can help prevent irreversible damage to ovary. Objective of this study was to analyze the clinical, and pathological characteristics of surgically proven cases of ovarian torsion at a tertiary care centre. Methods: This retrospective study was carried out from January 2016 to October 2019. Medical records of 20 cases of adnexal torsion were selected and analyzed retrospectively for age, parity, risk factors, clinical presentation, ultrasound and color Doppler features, management, pathological results and post-operative outcome.Results: A total of 20 patients with ovarian torsion were identified. Most commonly ovarian torsion was seen in reproductive age group (mean age of 31.4yrs) and in multiparous women (70%). More than 75% of the cases were associated with risk factors. Common presenting symptoms were sudden onset abdominal or pelvic pain (100%), vomiting (80%) and fever (40%). Ultrasonogram had various findings like mixed echogenic mass (35%), homogenously echogenic cyst (45%) anechoic cyst (20%) and free fluid (20%). Doppler studies showed absent arterial and venous flow in 25% of the cases. Cases were managed by detorsion & cystectomy (15%), unilateral salpingooophorectomy (70%), bilateral salpingooophorectomy (10%) and TAH with BSO (5%). Histopathology revealed benign serous epithelial tumors (40%), mucinous tumors (25%), mature teratoma (5%), corpus luteal cyst (10%), Para ovarian cyst (10%), gangrenous cyst (10%). Conclusions: Adnexal torsion is one of the gynecologic emergencies. Most of the findings in our study are reconfirmation of the pre-existing data based on a large number. However, we believe that area-specific information of this condition is mandatory for the medico-policy making in this institute. This data also reemphasizes the importance that the emergency physicians should have high index of concern/suspicion of ovarian tumor torsion when they encountered acute abdomen in women.