Management of adnexal torsion

Year 2014, , 7 - 11, 01.03.2014

Neslihan Erkal Bekir Sıtkı İsenlik Mete Çağlar Birsen Sahillioğlu Selahattin Kumru

https://doi.org/10.5799/ahinjs.01.2014.01.0350

Cited By: 1

Abstract

Objective: To evaluate clinical findings, operative reports, the pathological results of patients with diagnosis of adnexal torsion. Methods: Fourteen patients with diagnosis of adnexal torsion who presented to our clinic between January 2009 and March 2013 were included in this retrospective analysis. Data including clinical findings, operative reports, the pathological results were recorded. Results: The mean age of the patients was 28.1 ± 10.5 with a range of 16 to 52 years. All patients underwent ultrasonography, and a pelvic mass appearance was detected in all cases. The mean diameter of the mass was 8,04±2,96 cm. All of the patients had lower abdominal pain, nausea and vomiting. Six patients were operated laparoscopically, while eight patients had laparotomy. Detorsion and cystectomy was performed in 7 (50.0%) of the patients. Two of patients were pregnant in operation time that treated by cystectomy and detorsion of the ovaries successfully in the first and third trimester (one by laparoscopy). There was one patient of isolated fallopian tube torsion due to hydrosalpinks treated by laparoscopic salpingectomy. Two of the patients had paratubal cyst and tubal torsion. Detorsion and cystectomy by laparoscopy and salpingectomy by laparotomy were performed for these patients respectively. The most common histopathology was serous cystadenoma (28,6%). Conclusion: Adnexal torsion is a rare gynecologic emergency of women and occur in reproductive ages mostly. Prompt diagnosis and conservative treatment is important for the safety of ovaries and fallopian tubes and future fertility. J Clin Exp Invest 2014; 5 (1): 7-11

Keywords

Adnexal torsion, conservative management, detorsion

Adneksiyal torsiyon yönetimi

Abstract

Amaç: Adneksiyal torsiyon tanısı alan hastaların klinik, uygulanan operasyon ve patoloji bulgularının değerlendirilmesi Yöntemler: Ocak 2009 ile Mart 2013 tarihleri arasında kliniğimize başvurup adneksiyal torsiyon tanısı alan 14 hasta retrospektif olan çalışmamıza dahil edildi. Klinik bulgular, operasyon bulguları, patoloji sonuçlarını içeren bilgiler toplandı. Bulgular: 16-56 yaş arası olan hastaların ortalama yaşı 28,1± 10,5 idi. Bütün hastalara ultrasonografi yapıldı ve adneksiyal kitle bütün hastalarda saptandı. Ortalama kitle boyutu 8,04±2,96 cm idi. Bütün hastalarda alt abdominal ağrı, bulantı ve kusma şikayeti mevcuttu. 6 hastaya laparoskopi, 8 hastaya laparatomi uygulandı. 7 (50,0%) hastaya detorsiyon ve kistektomi yapıldı. Biri ilk trimesterda, diğeri üçüncü trimesterda olan 2 hamile hastaya kistektomi ve detorsiyon uygulandı( biri laparoskopi ile). Bir hastada hidrosalpinkse bağlı izole tubal torsiyon izlendi ve laparoskopik salpenjektomi uygulandı. İki hastada paratubal kist nedeniyle tubal torsiyon izlendi. Birine laparoskopik detorsiyon ve kistektomi, birine laparotomi ile salpenjektomi yapıldı. En sık görülen patoloji seröz kistadenomdu. (28,6 %). Sonuç: Adneksiyal torsiyon daha çok üreme çağında görülen nadir jinekolojik acillerdendir. Hızlı tanı ve konservatif yaklaşım ile over ve tubaları korumak gelecekteki fertiliteyi korumak için önemlidir.

Keywords

Adneksiyal torsiyon, konservatif yaklaşım, detorsiyon

References

• Kupesic S, Plavsic BM (2009) Adnexal torsion: color Doppler and three-dimensional ultrasound. Abdom Imaging 2010;35:602-606.
• Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol 2006;49:459-463.
• Rackow BW, Patrizio P. Successful pregnancy compli- cated by early and late adnexal torsion after in vitro fertilization. Fertil Steril 2007;87:697.
• Peterson WF, Prevost EC, Edmunds FT, et al. Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol 1955;70:368-382.
• Argenta PA, Yeagley TJ, Ott G, Sondheimer SJ. Tor- sion of the uterine adnexia. Pathologic correlations and current management trends. J Reprod Med 2000;45:831-836.
• Varras M, Tsikini A, Polyzos D, et al. Uterine adnexial torsion: Pathologic and gray scale ultrasonographic findings. Clin Exp Obstet Gynecol 2004;31:34-38.
• Bar-On S, Mashiach R, Stockheim D, et al. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010;93:2012-2015.
• Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynecol 2006;49:459-463.
• Haskins T, Shull B.Adnexal torsion: a mind-twisting di- agnosis. South Med J 1986;79:576-577.
• Weitzman VN, DiLuigi AJ, Maier DB, Nulsen JC. Prevention of recurrent adnexal torsion. Fertil Steril 2008;90:1-3.
• Mashiach S, Bider D, Moran O, et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after go- nadotropin therapy. Fertil Steril 1990;53:76-80.
• Gorkemli H, Camus M, Clasen K. Adnexal torsion af- ter gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet 2002;267:4-6.
• Pinto AB, Ratts VS, Williams DB, et al. Reduction of ovarian torsion 1 week after embryo transfer in a pa- tient with bilateralhyperstimulated ovaries. Fertil Steril 2001;76:403-406.
• Huchon C, Fauconnier A. Adnexaltorsion: a litera- ture review. Eur J Obstetr & Gynecol Reprod Biol 2010;150:8–12.
• Pena JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonogaraphy in the diagnosis of ovarian torsion. Fertil Steril 2000;73:1047-1050.
• Warner MA, fleisher AC, Edell SL, et al. Uterine adnexal torsion: sonographig findings. Radiology 1985;154:773-775.
• Nezhat C, Nezhat F. Operative Gynecologic laparos- copy. Principles and techniques. San Francisco, CA: McGraw-Hill; 2000. pp. 246–51.
• Oelsner G, Cohen SB, Soriano D, et al. Minimal sur- gery for the twisted ischaemic adnexa can preserve ovarian function. Hum Reprod 2003;18:2599-2602.
• Levy T, Dicker D, Shalev J, et al. Laparoscopic un- winding of hyperstimulated ischaemic ovaries dur- ing the second trimester of pregnancy. Hum Reprod. 1995;10:1478-1480.
• Shalev E, Bustan M, Yarom I, Peleg D. Recovery of ovarian function after laparoscopic detorsion. Hum Reprod. 1995;10:2965-2966.
• PanCsky M, Abargil A, Dreazen E, et al. Conservative management of adnexal torsion in premenarchal girls. J Am Assoc Gynecol Laparosc 2000;7:121-124.
• Varras M, Tsikini A, Polyzos D, et al. Uterine adnexial torsion: Pathologic and gray scale ultrasonographic findings. Clin Exp Obstet Gynecol 2004;31:34-38.
• Bagree MM, Kanwar DL, Ngar RC. Complicated ovar- ian cyst causing a diagnostic puzzle. Indian J Pediatr 1980;47:171-172.
• Ements M, Doornewaard H, Admiraal JC. Adnexial torsion in very young girls: Diagnostic pitfalls. Eur J Obstet Reprod Biol 2004;116:207-210.
• Mazouni C, Bretelle F, Menard JP, et al. Diagnosis of adnexial torsion and predictive factors of adnexal ne- crosis. Gynecol Obstet Fertil 2005;33:102-106.
• Hibbard LT. Adnexal torsion. Am J Obstet Gynecol 1985;152:456-461.
• Shukla R. Isolated torsion of the hydrosalpinx: a rare presentation. Br J Radiol 2004;77:784–786.
• Masroor I, Khan N. Torsion of fallopian tube, fimbrial cyst. J Pak Med Assoc 2008;58:571–573.
• Samiee H, Asgari Z, Mahdavi A, et al. Isolated fallopi- an tube torsion:A case report and review of literature. J Fam Repr Health 2010;4:87–89.
• Malhotra V, Dahiya K, Nanda S, Malhotra N. Isolat- ed torsion of the fallopian tube in a perimenopausal woman: A rare entity. J Gynecol Surg 2012;28:31–33.
• Bider D, Goldenberg M, Ben-Rafael Z, Oelsner G. Bi- lateral adnexal torsion after clomiphene citrate thera- py. Hum Reprod 1991;6:1443-1444.
• Ozcan C, Celik A, Ozok G, et al. Adnexal torsion in children may have a catastrophic sequel: asynchro- nous bilateral torsion. J Pediatr Surg 2002;37:1617- 1620.
• Kitporntheranunt M, Wong J, Siow A. Entangled bilat- eral adnexal torsion in a premenarchal girl: a laparo- scopic approach. Singapore Med J 2011;52:124-127.