Impediments to Timely Diagnosis of Adnexal Torsion

Abstract

Background Adnexal torsion (AT) is a diagnostic dilemma and a gynecologic emergency with catastrophic consequences. Rapid diagnosis avoids jeopardizing reproductive function. Delineation of factors hindering diagnosis and initiation of therapy facilitates optimal outcome. Methods To identify impediments to expedient diagnosis and operative intervention for AT, we performed a retrospective review (1991–1996) of the diagnoses of adnexal or ovarian torsion, ovarian cystectomy, or oophorectomy/salpingectomy at the Medical Center. Results The review uncovered 27 cases of surgically diagnosed and confirmed AT. The mean patient age was 9.2 years (range Conclusion Normal adnexal structures have the highest likelihood to undergo torsion in this age group, as only 7/27 patients had adnexal pamology. Recurrent patterns which delayed timely diagnosis and intervention include: A) parental/patient recognition of the significance of the non-specific abdominal symptoms (mean time lag of 7.3 days from symptom onset to presentation); B) diagnostic study performance; C) prolonged observation periods; and D) misdiagnoses. The lack of 24 hour/day imaging studies and expert interpretation can also contribute to delay. We conclude that AT is a clinical diagnosis, made by 1) history and physical exam; 2) early recognition of a classic clinical triad of pain, vomiting and a tender adnexal mass; 3) an appropriately high index of suspicion; and 4) appreciation of the limits of imaging studies. More frequent use of diagnostic laparoscopy can facilitate earlier diagnosis and surgical detorsion; thereby, offering the highest potential for salvaging reproductive function in these young patients.