Reply of the authors

Abstract

We appreciate the interest of Dr. Wachsberg in our article (1Peña J Ufberg D Cooney N Denis A Usefulness of Doppler sonography in the diagnosis of ovarian torsion.Fertil Steril. 2000; 73: 1047-1050Abstract Full Text Full Text PDF PubMed Scopus (219) Google Scholar). In response to Dr. Wachsberg’s first question regarding size of the ovary, the measurement recorded is the largest ovarian diameter. The ovarian diameter ranged from 2 to 15 cm. Of the 21 surgically confirmed cases of adnexal torsion in our study, there was one ovary noted to be of normal size. In this case, the torsion involved a paraovarian/paratubal cyst. This supports Dr. Wachsberg’s suggestion that outflow obstruction of a torsed ovary would lead to ovarian enlargement and that normal ovarian dimensions probably rule out ovarian torsion. Dr. Wachsberg’s second question deals with the “dual blood supply” theory as a possible explanation for why intraovarian flow might still be detected with Doppler sonography despite torsion. Although Doppler studies show flow to the torsed ovary, clearly, in reality, inadequate perfusion is present. This finding is difficult to explain, but the most likely explanation is that there must be some flow, but not enough to maintain normal oxygenation and perfusion. There may be a technical issue in that the Doppler study may imply more blood flow to the organ than actually exists. It may not be possible to actually quantitate the amount of flow accurately. Another hypothesis is that the flow may not be adequate or evenly distributed throughout the ovary so that all the ovarian tissue is not adequately perfused to prevent ischemia. In conclusion, our main objective was to report our experience with adnexal torsion and Doppler sonography and to suggest that normal flow by Doppler sonography does not reliably rule out ovarian torsion.