Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better

Abstract

Aim: To investigate characteristics and risk factors for recurrent adnexal torsion (AT). Methods: Retrospective cohort study in a university-affiliated medical center included 320 Women with AT verified by laparoscopy, from January 2005 through January 2017. Demographic data, clinical symptoms, surgical findings and treatment were retrospectively reviewed from patient records. Data from primary and secondary AT of patients in the recurrent torsion group was compared to those with single torsion, to evaluate risk factors for recurrent AT. Results: Two hundred and sixty seven (83.4%) patients had a single event of AT and 53 (16.5%) had recurrent AT. Patients with recurrent torsion had significantly fewer previous non-gynecologic surgeries (4.3% and 9.8% of the study groups vs 32.2% of the control group, P = 0.001 for both). Ovarian size was significantly smaller in the recurrent torsion groups (47.5 mm and 48.3 mm vs 63.9 mm, P = 0.045 and P = 0.012, respectively). Polycystic ovary was significantly more common in the recurrent AT group (P = 0.028 and P = 0.005), with risk ratio 4.4 (95% confidence interval, 1.66 to 11.63). Ovaries without any specific findings were also more common among recurrent AT cases (P = 0.001 for both groups). Logistic regression analysis demonstrated that smaller ovarian size is an independent risk factor for recurrent AT. Conclusion: Recurrent torsion correlated with fewer previous surgeries, small ovarian mass, polycystic ovaries and ovaries without specific findings, which might indicate that additional pathophysiological factors contribute to the recurrent event. Ovarian fixation might be recommended in patients with primary torsion of normal or polycystic ovaries.

Tekrarlayan over torsiyonun nadir bir komplikasyonu olarak over torsiyonu,enfarktüsü ve rüptürü olgusu

“…Most adnexal torsion cases are related to an underlying adnexal pathology; however, the ovaries are normal in 8-18% of cases (5). In the absence of an adnexal mass or cyst, ovarian torsion aetiology is not exact (3). Mobility due to a long ovarian ligament, mesosalpinx, or mesovarium is found as a reason in many studies.…”

“…The incidence of recurrent ovarian torsion has been reported in the literature as 8.7-28.6% (3). Smaller ovarian size, polycystic ovary, and ovaries without specific findings have been reported as risk factors for recurrent adnexal torsion (3).…”

“…The incidence of recurrent ovarian torsion has been reported in the literature as 8.7-28.6% (3). Smaller ovarian size, polycystic ovary, and ovaries without specific findings have been reported as risk factors for recurrent adnexal torsion (3). A delayed diagnosis of ovarian torsion leads to necrosis, loss of the affected ovary, sepsis and reduced reproductive capacity.…”

“…Torsions generally occur on one side and once only. However, recurrence in the same ovary or both ovaries is possible, and the rate of recurrent ovarian torsion has been reported to be 16.5% (3).…”

Letter to “Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better”

“…Dear Editor, We read with interest the article published in the May issue by Daykan et al 1 The most interesting finding in this article is that ovarian size was significantly smaller in the recurrent torsion groups. 1 Although we really agree that ovarian torsion is correlated with ovarian size and ultrasound plays an important role in the diagnosis of adnexal torsion, 2 certain perspectives of methodology warrant further discussion.…”