The effects of twisted ischaemic adnexa managed by detorsion on ovarian viability and histology: an ischaemia-reperfusion rodent model

Abstract

This prospective controlled follow-up study was designed to examine the effects of adnexal torsion on long-term ovarian histology and radical scavenger (FRS) activity, and subsequent viability following the detorsion of twisted ischaemic adnexa, in a primate centre of a university clinic. Adnexal torsion/occlusion was created by twisting the adnexa three times and fixing on to the side wall or by applying vascular clips in cycling female rats at 70 days of age. Following an ischaemic period of 4 to 36 h, the twisted adnexas were surgically removed and fixed. In the second group of rats, following the above ischaemic periods, the torsion/occlusion were relieved by detwisting or removing the vascular clips. Then the animals were reperfused for a week and adnexas were extirpated. After both ischaemia and reperfusion, the removed adnexas were examined histologically and tissue concentrations of glutathione peroxidase, superoxide dismutase, catalase and glutathione were determined. Regardless of the ischaemia time, all the twisted adnexas were black-bluish in appearance. Despite the gross ischaemic-haemorrhagic features, histological sections revealed negligible changes, with intact ovarian structure similar to controls in 4-24 h groups. Though decreased compared with controls, the change in tissue concentrations of FRS was not significant in 4-24 h groups. Only the 36 h group showed prominent congestion on all sections and a significant decrease in all radical scavenger concentrations studied. While no long-term reperfusion injury was observed histologically in 4-24 h groups, the 36 h group ended with adnexal necrosis. Our findings support the importance of early diagnosis and conservative surgical management (detorsion) in adnexal torsion. Lack of histological changes and unimpaired FRS metabolism are consistent with the recent data that vascular compromise is caused by venous or lymphatic stasis in early torsion and that adnexal integrity is not correlated with gross ischaemic appearance, thus providing evidence of adnexal resistance against ischaemia.

Conservative laparoscopic management of adnexal torsion

“…All rodent adnexa undergoing surgical torsion for 24 hours displayed normal histological findings despite a black-blue, ischemic appearance immediately and for one week after reversal of the torsion. The black-blue appearance was due to an initial lymphatic and venous stasis rather than significant arterial ischemia (24). In various studies in the literature, it has been reported that ovarian function is preserved in 88% to 100% of cases after detorsion of the twisted adnexa (13,(25)(26)(27)(28).…”

“…Oelsner et al demonstrated that the adnexa can retrieve its functional integrity, which was shown by the ultrasonographic observation of follicular development (91.3%), the normal macroscopic appearance of the adnexa during subsequent surgical intervention (92.4%), and successful oocyte fertilization in all reported cases (13). Taskin et al investigated adnexal recovery in rodents (24). All rodent adnexa undergoing surgical torsion for 24 hours displayed normal histological findings despite a black-blue, ischemic appearance immediately and for one week after reversal of the torsion.…”

Ovarian Torsion: A Gynecological Emergency

“…The combination of ovarian enlargement, abdominal pain, nausea, might indicate torsion of adnexa. Taskin et al 11 showed that even with complete ischemia gross appearance does not correlate with outcome and that detorsion within 24 hours did not show an increase in free radical reperfusion injury. In one of our cases inspite of hemorrhagic nature of the ovarian tissue detrosion resulted in achievement of normal functionality of the ovary.…”

Isolated Fallopian Tube Torsion in Pregnancy: An Uncommon Event

“…Therefore in pregnant women the risk of complications associated with an acute abdomen outweighs the risks associated with abdominal surgery. Additionally, early intervention can sometimes salvage torted tissue by detorsion if it is performed in time [15].…”