Adnexal torsion: a single-center retrospective study of diagnosis and treatment

Abstract

Aims: This study was conducted to review the clinical, laboratory, and ultrasound findings of patients with a confirmed post-operative adnexal torsion diagnosis in a tertiary university hospital and to reflect the management of adnexal torsion.
 Methods: 44 patients (ages [15,44] with a median of 30 yr) who had an operation at Ankara University Hospital Gynecology and Obstetrics Clinics between October 2013 and February 2021 and in whom the preoperative diagnosis of adnexal torsion was confirmed intraoperatively were included in this retrospective study. Patients’ complaints, existing risk factors, physical examination, laboratory, and radiological findings were evaluated.
 Results: 26 (65%) of the patients complained about acute abdominal pain isolated on one side. Torsion was observed on the right side in 29 (66%) patients. Risk factors: History of ovarian torsion in 1 patient (2%), in vitro fertilization treatment in 5 (11%) patients, 4 (9%) of which also had ovarian hyperstimulation syndrome and 2 (5%) of them had polycystic ovary syndrome, and finally, 28 (65%) patients had increased ovarian size on ultrasound. Ovarian blood flow was not observed in 25 (81%) of 31 patients who underwent transvaginal Doppler ultrasound. Preoperative blood examination showed anemia (Hb10000/mm³) in 26 (59%), and an increase of neutrophil-lymphocyte ratio (NLR) (>3) in 36 (82%). Laparoscopy was performed in 37 (84%) patients and laparotomy in 7 (16%).
 Conclusion: There is no objective diagnostic tool that can definitively lead to the diagnosis of adnexal torsion. It may be recommended to use ultrasound, Doppler, and NLR in addition to clinical findings and anamnesis. Considering the consequences of delay in the treatment, the most appropriate approach would be to perform a laparoscopy if torsion is suspected. Additionally, the patient’s age, menopausal status, ovarian pathology, and desire for fertility are factors that should be considered in the treatment decision, and ovarian protection should be the primary goal.