Clinical indices and histological changes over time in ovarian torsion related to ovarian tumors

Abstract

In some emergency surgeries for ovarian torsion, the ovary cannot be conserved because of necrosis. Ovarian necrosis and the time from the onset of symptoms to surgery are likely to be directly correlated. In this study, we retrospectively evaluated the clinical indices from the time of onset of acute abdomen to surgery at our hospital, in patients with tumor-related ovarian torsion. Among cases diagnosed preoperatively with benign ovarian tumors between 1995 and 2010, there were 54 patients who developed acute abdomen that was surgically diagnosed as ovarian torsion. For evaluation, these patients were divided into two groups according to the time from the onset of acute abdomen to surgical intervention as follows: <10 and ≥10 h. C-reactive protein (CRP) levels, leukocyte counts, body temperature, tumor size, and degree of torsion were compared between the two patient groups. Ovarian status based on postoperative histopathology was classified as necrotic, congestive, or normal, and was also evaluated. The mean CRP level was significantly higher in the ≥10-h patient group than in the patients undergoing surgery in <10 h. No differences were observed between the two groups for leukocyte counts, body temperature, tumor size, and mean degree of torsion. Ovarian necrosis was only observed only in patients undergoing surgery at ≥10 h. When tumorrelated ovarian torsion is suspected, surgery should be performed within 10 h after the onset of acute abdomen to conserve ovarian function.

Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion—Case Report and Review of the Literature

“…Therefore, the sparing of every ovary after detorsion combined with the expectation of recovery may be harmful for the patient and lead to further surgical procedures. In order to differentiate these cases, the preoperative level of C-reactive protein may be useful, as it correlates with the necrosis of the ovary [ 57 , 58 ]. However, its use for the perfusion evaluation after detorsion is limited as it maintains a high level even after the successful restoration of ovarian blood flow and due to its long plasma half-life of about 19 h [ 59 ].…”

Preoperative differentiation between tumor‐related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: A retrospective study

“…We think that this finding was a result of chemical peritonitis. However, in patients with tumor‐related ovarian torsion, necrosis can occur if more than 10 h have elapsed since the onset of acute abdomen, and there have been reports that CRP levels were significantly elevated in cases of necrosis 16,17 . Therefore, if the CRP level is elevated in a patient with acute abdomen, the possibility of torsion and necrosis should be considered if more than 10 h have elapsed since the onset of symptoms.…”