Detorsion and conservative therapy for twisted adnexa: Our experience

Abstract

Objective:1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa.Design:Prospective Study from September 2004 to September 2008.Setting:Private IVF and Endoscopy Centre.Patients:22 patients with twisted adnexa (15 non-pregnant and 7 pregnant).Intervention:Surgical intervention and either detorsion of adnexa or adnexectomy.Main Outcome Measures:Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently.Results:We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function.Conclusion:Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.

Torsion of Ovarian Cyst presenting as Acute Abdomen: Report of Two Cases

“…1,4 Ovaries measuring size of 6 cm or more have higher chances of undergoing torsion. 5 One in 10,000 pregnancies are complicated with adnexal torsion, mostly in first trimester.…”

“…It is most commonly seen in cases of immature teratoma (dermoid cyst) or serous cystadenomas. 1 In ovarian torsion, initially, there is venous and lymphatic blockades leading to stasis, venous congestion, hemorrhage, and necrosis, which is followed by ischemic gangrene. These patients generally present with acute abdomen.…”

“…Ovarian torsion has been as reported as the fifth leading cause of gynecologic emergencies. 1,2 Ovarian torsion increases five-fold during pregnancy. Torsion of ovarian tumors occurs predominantly in the reproductive age group.…”

“…3,4 Fallopian tube may also be involved (adnexal torsion). The predisposing factors are moderate-to-large cyst size, free mobility, and long CaSe RepoRt 1 Resident, 2 Lecturer, 3 Professor and Head …”

Detorsion of Twisted (Gangrenous) Ovarian Cyst Followed by Complete Disappearance of the Cyst-A Case Report of Innovative Outcome

“…7 However, many studies have reported the excellent recovery of ovarian function after conservative approach regardless of the necrotic appearance of the twisted ischemic ovary. [1][2][3][4][5][6][8][9][10][11][12] Adnexectomy should be avoided as recovery of normal ovarian size and function, as shown by follicular development is 88% to 100%. 8 Even gangrenous-appearing adnexa should not be removed because it is impossible to predict the chances of the ovary reviving after detorsion.…”