Predictive Factors for Recurrence of Adnexal Torsion

Abstract

Study Objective To investigate the predisposing factors for recurrent adnexal torsion (rAT) in patients who had surgical intervention for primary adnexal torsion (pAT). Design A retrospective cohort study between 2011 and 2020. Setting A tertiary, university affiliated medical center. Patients or Participants 358 women with a primary occurrence of surgically proven adnexal torsion. Interventions Adnexal detorsion, with adjuvant cystectomy, salpingectomy or salpingoophorectomy by laparoscopy. Measurements and Main Results We collected demographic and clinical characteristics, sonographic findings and laboratory results of all pAT episodes. We compared those who had experienced rAT to those who had not. The study included 358 women. Of those, 35 (9.8%) had a rAT. Women who experienced rAT were younger (mean age 26 vs. 30, p=0.01) with higher proportion of age ≤15 [Odds Ratio (OR) 95%CI 4.4(1.80-11.1)]. A history of hysterectomy was positively associated with rAT [3(8.6%) vs. 1(0.3%), p=0.003]. Pregnancy rates during pAT were comparable between study groups. However, rAT was associated with lower gestational age at pAT (mean 9 weeks vs. 12 weeks, p=0.01) and conception by assisted reproductive technologies [OR 95%CI 6.0(1.21-29.65), p=0.02]. Clinical characteristics did not differ between groups except smaller ovarian cyst diameter in those with rAT (mean 42 vs. 59 mm. p Conclusion Recurrent adnexal torsion is more common than previously thought. Younger age and smaller ovarian cyst at pAT are independently associated with the risk for future recurrence of adnexal torsion. These factors should be considered when contemplating oophoropexy at pAT.