Clinical and Pathologic Evaluation of Adnexal Torsion Patients in Adolescence, Reproductive and Postmenopausal Periods

Abstract

Objective: The objective of our study was to compare the adnexal torsion patients in different age groups clinically and pathologically.Methods: Sixty-eight patients who had applied with pelvic pain and adnexal torsion diagnosis had been confirmed intraoperatively were included in the study. Patients were divided into three groups based on their ages as the adolescent period (Group 1), reproductive period (Group 2) and postmenopausal period (Group 3). Ages, history of torsion, history of past operations, periods between the date of hospitalization and operation, periods of hospital stay, adnexa as the localization of torsion and number of tours of torsion were examined in groups. Mass lesions found during the operation and pathologic consequences of such masses were examined retrospectively and compared.Results: No statistically significant differences in torsion history, past operations, WBC and platelet values, neutrophil/lymphocyte ratios, preoperative fever, preoperative nausea and vomiting and preoperative Doppler US findings between the groups included in the studies (p>0,05). Although not statistically significant, WBC values were higher in the postmenopausal patient group, and it was notable that symptoms including fever, nausea and vomiting were absent in this group. The adolescent age group was the group with the least confirmation of torsion diagnosis following the operation with 13 (52%) patients. Upon evaluation of the operations carried out on patients, it was seen that mostly fertility preserving approaches were preferred for adolescent and reproductive patients with 88%, while more radical methods such as USO (72.7%) and TAH+BSO (18.2%) were preferred in postmenopausal patients. Ovarian tissue with torsion without any pathologic findings is more frequent in the adolescent period as compared to other groups (48%). In the postmenopausal period however, some pathology was found in the entire portion of the adnexa with torsion. In the postoperative evaluation of the pathology results of patients, no significant differences were observed as regards the diameters of cysts (p:0,207). There are significant differences between the histopathological types. Conclusion: Although statistically significant differences have not been observed as regards the clinic al presentation and laboratory findings based on age groups; it must be kept in mind that a mass lesion can accompany the torsion and the pathology of this mass can vary. Torsion must be remembered in pelvic pain in the adolescent age group because of the indistinct clinical findings and inadequacy of imaging methods.