Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?

Bar-On, Shikma; Mashiach, Roy; Stockheim, David; Soriano, David; Goldenberg, Mordechai; Schiff, Eyal; Seidman, Daniel S.

doi:10.1016/j.fertnstert.2008.12.022

Cited by 100 publications

(84 citation statements)

References 17 publications

(26 reference statements)

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“…Mazouni et al reported that necrosis was more frequently observed in cases in which more than 10 h had passed since the onset of abdominal pain [6]. On the other hand, Bar-On et al reported that patients undergoing operations less than 10 h after admission were statistically more likely to have ovarian torsion [13]. In this study, the mean CRP level was significantly higher in the group undergoing surgery at 10 h or more than in the group undergoing surgery at less than 10 h. Histologically confirmed necrosis was only observed in the group undergoing surgery at 10 h or more.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…We have recently re-examined the accuracy of the preoperative diagnosis of OT in our department [3] and found that despite 20 years of research [4][5][6][7], the accuracy of the preoperative diagnosis of OT, 46.1%, has not improved over our previously published rates [8], as well as over the rates reported by others [9,10].…”

Section: Introductionmentioning

confidence: 94%

Sudden/nocturnal onset of acute abdominal pain, lasting less than a day and accompanied by vomiting: a tell-tale sign of ovarian torsion

et al. 2010

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The purpose of the study was to construct a clinical profile of a patient more likely to have ovarian torsion (OT). The study design was a retrospective chart review (Canadian Task Force Classification II-3). The study was done in a tertiary referral center setting. Patients were 78 women who underwent laparoscopy for suspected ovarian torsion. Intervention done was urgent laparoscopic surgery. The main outcome measure was a comparison of demographic data and the presenting signs and symptoms of the women with and without laparoscopically proven OT. Multivariable analysis was performed with a logistic regression model in order to determine the independent risk predictors for OT. The following factors were found to be predictive of OT: vomiting (OR=5.67, 95% CI 1.69-19.0, p=0.005); duration of pain less than a day (OR=3.74, 95% CI 1.24-11.3, p=0.02), and sudden/nocturnal onset of pain (OR=4.13, 95% CI 1.19-14.3, p=0.02). The model was found to be adequate, with a c value of 0.798. A patient presenting with an episode of pain lasting less than a day that started suddenly and or at night, accompanied by vomiting is more likely to have OT on urgent laparoscopy.

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“…A recent study noted that a preoperative diagnosis was confirmed in only 46.1% of patients. 6 The accuracy of the preoperative diagnosis of ovarian torsion remains low. Other authors have warned against the presence of a "normal flow on Doppler sonography."…”

Section: Torsion Of a Normalmentioning

confidence: 99%

Torsion of a Normal Ovary During the Early Postpartum Period

Tanaka

Koyama

Shiki

2015

CRSLS

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Ovarian cyst torsion is a well-known cause of acute abdominal pain in female patients. However, torsion of a normal ovary is extremely rare and predominantly occurs in premenarchal female patients. The objective of this report is to describe a rare case of acute abdomen during the early postpartum period that was ultimately diagnosed as torsion of a normal ovary by laparoscopic surgery. A 29-year-old woman vaginally delivered a healthy 3530-g baby uneventfully at 40 weeks' gestation. On postpartum day 6, she presented with acute abdominal pain in the right lower quadrant and costovertebral angle tenderness. A complete workup including laboratory examination, ultrasonography, and computed tomography was performed. Leukocytosis with a left shift and a slightly enlarged right ovary were found. Finally, diagnostic laparoscopy showed torsion of a normal ovary. The patient underwent laparoscopic detorsion of the right adnexa and was discharged on postoperative day 4 without any complications.

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Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?

Cited by 100 publications

References 17 publications

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

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

Sudden/nocturnal onset of acute abdominal pain, lasting less than a day and accompanied by vomiting: a tell-tale sign of ovarian torsion

Torsion of a Normal Ovary During the Early Postpartum Period

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