Diagnosis Of Ovarian Torsion Research Articles

Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries

IntroductionThe aim of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (MRI) in the diagnosis of ovarian torsion. MethodsWe retrospectively identified 84 patients with surgically confirmed ovarian torsion. Seventeen patients with unclear ultrasound findings underwent MRI examination with two different magnetic resonance (MR) systems. ResultsIn ovarian torsion, the mean apparent diffusion coefficient (ADC) value of the torsed ovary was significantly lower than that of the nonaffected ovary in both MR systems (n=17; 0.898±0.539 vs. 1.615±0.469×10−3mm2/s; P<.001). ConclusionsADC comparisons were useful for detecting ovarian torsion.

The long pentraxin-3 is a useful marker for diagnosis of ovarian torsion: An experimental rat model

Pentraxin-3 (PTX3) plays an important role in the primary inflammatory response. We aim to evaluate PTX3 as a diagnostic marker of ovarian torsion in an experimental rat model. In this study, 16 female Sprague Dawley albino mature rats were randomly allocated to Group 1 (control, sham operated) and Group 2 (experimental ovarian torsion model). A torsion model was set up using atraumatic vascular clips just above and below the right ovary for a 3-h ischaemia. Blood samples were collected before and three hours after ovarian torsion. Three hours after ovarian torsion, right ovary was surgically removed for histopathological examination in both groups. There was no significant difference in preoperative PTX3 level in both groups (1.05 ± 0.20 ng/mL vs 1.09 ± 0.28 ng/mL, p > 0.05). Three hours after the operation, mean plasma level of PTX3 was significantly higher in ovarian torsion group than the control group (2.13 ± 0.49 ng/mL vs 1.07 ± 0.22 ng/mL, p = 0.001). Also, the mean total histopathological score was significantly increased in the torsion group. PTX3 can be used in clinical practice as a useful marker for early diagnosis of ovarian torsion.

Current trends in the surgical treatment of pediatric ovarian torsion: we can do better

IntroductionCurrent literature strongly recommends ovarian preservation for pediatric patients with ovarian torsion. The purpose of this study was to evaluate national trends in the surgical management of pediatric ovarian torsion and to compare outcomes between pediatric surgeons (PED) and gynecologists (GYN). MethodsWe queried Pediatric Health Information System (PHIS) data from 2007 to 2011 for patients <18years old with a diagnosis of ovarian torsion who underwent a surgical procedure. Patients with malignant disease were excluded. Outcomes were compared between pediatric surgeons and gynecologists. ResultsA total of 1151 patients were identified with a mean age of 10.7±4.1years with a bimodal distribution. Pediatric surgeons performed the majority of procedures (81%) and were more likely to use a laparoscopic approach (PED 27% vs. GYN 17%, p<.05). Pediatric surgeons were more likely to perform an oophorectomy (PED 38% vs. GYN 27%, p<.01), and more likely to administer antibiotics for this clean procedure (PED 61% vs. GYN 29%, p<.001). The overall reoperation rate was 5.1% and did not differ significantly by subspecialty (PED 4.4% vs. GYN 7.8%, p>.05). ConclusionsThese data demonstrate a significant opportunity for pediatric surgeons and gynecologists to improve ovarian salvage rates and to reduce unnecessary antibiotic utilization for children with ovarian torsion.

Is the Measurement of Serum Ischemia-Modified Albumin the Best Test to Diagnose Ovarian Torsion?

Aim: The aim of this study is to evaluate the diagnostic value of serum oxidative stress marker levels (ischemia-modified albumin, IMA; malondialdehyde, MDA) and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) levels that occur in ovarian torsion and to determine the threshold value of these markers in the diagnosis of ovarian torsion. Methods: In this prospective case-control study, 34 women (the study group) with acute pelvic pain (20 with and 14 without ovarian torsion) and 40 control subjects were included. The diagnosis of ovarian torsion was confirmed with laparoscopy in all cases. Preoperative serum samples were collected in the study group. Serum oxidative stress marker levels (IMA and MDA) and TOS, TAS and OSI levels were measured. Results: Serum MDA, TOS and IMA concentrations were significantly higher in women with ovarian torsion than in the healthy control group. However, serum TAS, TOS and OSI concentrations were significantly higher in women without ovarian torsion than within the healthy control group. Only IMA significantly distinguished patients with or without ovarian torsion. The best IMA value, according to the receiver operating characteristic curve, was 0.7045 absorbance units, with 90.00% sensitivity and 92.31% specificity. The patients in the ovarian torsion group had significantly lower serum TAS and OSI levels compared with patients without ovarian torsion. Conclusion: The elevated serum IMA levels with high sensitivity-specificity values observed in women with ovarian torsion seem to have a potential role as a serum marker in the preoperative diagnosis of ovarian torsion in emergency settings.

Disseminated peritoneal leiomyomatosis mimicking ovarian torsion

The presentation of disseminated peritoneal leiomyomatosis (DPL) can be misleading. Herein, we present the case of a 42-year-old nulliparous female who had previously undergone a total hysterectomy and presented with an acute abdomen. A presumptive diagnosis of ovarian torsion was made based on the clinical findings and an ultrasonographic examination. A diagnostic laparoscopy was performed immediately. DPL was subsequently diagnosed based on an intra-operative frozen section during surgical exploration and the final histopathologic examination. This case illustrates an atypical presentation of DPL mimicking ovarian torsion.

High-sensitivity C-reactive protein as a novel marker in early diagnosis of ovarian torsion: an experimental study.

To investigate the effect of ovarian torsion on plasma high-sensitivity C reactive protein (hs-CRP) levels and to determine whether hs-CRP levels were a useful adjunct that could be used in the diagnosis of ovarian torsion. Sixteen nulligravid 4-month-old female Wistar albino rats were randomly and equally allocated into two groups. Control group, sham operation (n = 8) group, and study group, ovarian torsion (n = 8) group. Ovarian torsion model was created using titanium vascular clips and vascular clips were kept for a 2-h period. Right ovaries were surgically removed at the end of the procedure in each group. Blood was sampled before and after operation to assess plasma hs-CRP levels. Ovarian histopathologic findings scores and plasma hs-CRP levels were evaluated. In study group, the mean plasma hs-CRP level was significantly higher than that in the control group. (0.91 ± 0.18 vs. 0.39 ± 0.06 mg/l, respectively, p < 0.001), following 2 h of ovarian torsion. Histologic examinations of the right ovary confirmed the torsion model. Histologic score of the specimens had higher scores for follicular cell degeneration (p = 0.002), vascular congestion (p = 0.002), inflammatory cell infiltration (p = 0.003), and hemorrhage (p < 0.001) in the study group. For the change in the plasma hs-CRP value for a cut-off value of >0.275 mg/l, sensitivity and specificity were calculated as 100 %. The measurement of hs-CRP in a rat model seems to be a valuable plasma marker in early detection and diagnosis of ovarian torsion. However, further clinical and experimental studies of a larger size are required.

The Importance of Clinical, Radiologic and Laboratory Parameters in the Diagnosis of Ovarian Torsion: Retrospective Study

The Importance of Clinical, Radiologic and Laboratory Parameters in the Diagnosis of Ovarian Torsion: Retrospective Study

Successful laparoscopic surgery for 14-month-old infant with ovarian torsion

The prevalence of ovarian torsion is 4.9 among 100,000 females between ages 1 to 20 years. The diagnosis of ovarian torsion in children, especially in infants, is very difficult. Since they cannot explain related symptoms accurately, and reproductive organs lie high in the abdomen, physical examination shows unclear findings. For these reasons, we use imaging studies, such as ultrasonography and magnetic resonance imaging, to diagnose ovarian torsion. However, it is of limited value to diagnose by using these modalities alone. Therefore, clinical suspicion is important for diagnosis. Though pediatric laparoscopic surgery was introduced 20 years ago, it has been widely performed since the mid 1990s with the development of 3-mm instruments. In addition, usually the pediatric operation is done in the pediatric surgery office, even though it is a gynecologic procedure. In addition, laparotomy is still more frequently conducted in current clinical practice, although the frequency of laparoscopic surgery has increased. However, it is thought that expert gynecologic surgeons can perform pediatric laparoscopic operations if they pay attention to some precautions. We report herein the case of a 14-month-old infant who underwent emergency laparoscopic untwisting of ovarian torsion successfully without complications by a gynecologic surgeon, with a brief review of the literature.

Ovarian Torsion in Pediatric Patients: A Review of Eleven Years' Experience.

Objectives. To examine associated clinical features and evaluate published criteria regarding volumetric diagnosis of ovarian torsion (OT). Methods. Retrospective case–control study of patients presenting to an emergency department who underwent pelvic imaging for acute abdominal or pelvic pain. Cases were found to have OT at surgery. Controls received clinical diagnosis of either acute pelvic pain or ovarian cyst. Results. The sensitivity for OT using a cutoff AV of <20 mL was 50% (95% confidence interval [CI] = 35% to 65%); specificity was 29% (95% CI = 15% to 43%). The sensitivity for OT using a cutoff AV of >75 mL was 18% (95% CI = 7% to 30%); specificity was 93% (95% CI = 85% to 100%). The ratio of affected-side to unaffected-side AV of >15 had a sensitivity of 16% (95% CI = 5% to 27%); specificity was 98% (95% CI = 93% to 100%). Conclusions. The published criteria regarding the volumetric diagnosis of OT were inadequately sensitive for detecting OT. However, an affected-side AV >75 mL and an AV ratio >15 were reasonably specific.

Ovarian Torsion in Pediatric Patients: A Review of Eleven Years’ Experience

Objectives. To examine associated clinical features and evaluate published criteria regarding volumetric diagnosis of ovarian torsion (OT). Methods. Retrospective case–control study of patients presenting to an emergency department who underwent pelvic imaging for acute abdominal or pelvic pain. Cases were found to have OT at surgery. Controls received clinical diagnosis of either acute pelvic pain or ovarian cyst. Results. The sensitivity for OT using a cutoff AV of 75 mL was 18% (95% CI = 7% to 30%); specificity was 93% (95% CI = 85% to 100%). The ratio of affected-side to unaffected-side AV of >15 had a sensitivity of 16% (95% CI = 5% to 27%); specificity was 98% (95% CI = 93% to 100%). Conclusions. The published criteria regarding the volumetric diagnosis of OT were inadequately sensitive for detecting OT. However, an affected-side AV >75 mL and an AV ratio >15 were reasonably specific.

Interleukin-6 for the diagnosis of ovarian torsion: A systematic review and meta-analysis

Ovarian torsion may have significant fertility implications. Interleukin-6 is a pro-inflammatory cytokine, which may act as a helpful diagnostic test. Our objective was to investigate the accuracy of serum interleukin-6 in the diagnosis of ovarian torsion in women with ultrasonographic evidence of an ovarian cyst. An electronic search of published data, unpublished dissertations, theses and conference proceedings was performed. The systematic review involved observational studies. The studies had to provide data to construct 2 × 2 tables. A modified QUADAS tool was used to assess the quality of studies. Sensitivity, specificity, positive and negative predictive value, likelihood ratios and diagnostic odds ratios were calculated. Three studies were identified. Two were included in the meta-analysis. The prevalence of torsion was 30% (21/70). The pooled sensitivity was 85.1% and the pooled specificity was 84.1%. Although further cohort studies would be required, there may be a role for interleukin-6 in the diagnosis of ovarian torsion.

Pediatric ovarian torsion: case series and review of the literature

Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. We sought to more completely characterize ovarian torsion with respect to pain and ancillary studies, such as urinalysis. We performed a retrospective review of hospital charts of all patients aged 0-18 years with a diagnosis of ovarian torsion at the Children's Hospital at London Health Sciences Centre, in London, Ont., from 1993 to 2008. We analyzed 13 charts of patients aged 7 months to 18 years. Most patients presented with peripheral leukocytosis, vomiting and right lower quadrant pain that did not radiate or migrate. On urinalysis, about half the patients demonstrated pyuria without bacteruria. Pelvic ultrasound revealed an ovarian cyst on the same side of the pain in 11 of 13 patients. Most were found to have a hemorrhagic cyst or ovary and underwent salpingo-oophorectomy or cystectomy within 48 hours of presentation. Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended.

Gray-Scale and Color Doppler Ultrasound Imaging Findings of an Ovarian Inguinal Hernia and Torsion of the Herniated Ovary

Inguinal hernia is extremely rare among girls. The hernia sac may sometimes involve intestinal structures, but ovaries in the sac are uncommon. Early diagnosis of a possible ovarian torsion is essential because potential amenable benefits can be achieved with surgery. A baby girl was admitted to our pediatric emergency unit with the complaints of swelling and erythema of the left groin. Then gray-scale ultrasonography and color Doppler ultrasonography was performed immediately at the emergency radiology room. In our case, ovarian torsion was diagnosed by gray-scale ultrasonography and color Doppler ultrasonography. After the diagnosis of ovarian torsion, the patient underwent surgery. It is possible to diagnose inguinal emergencies by high-resolution ultrasonography and color Doppler ultrasonography.

Sonographic Diagnosis of Ovarian Torsion: Accuracy and Predictive Factors

Sonographic Diagnosis of Ovarian Torsion: Accuracy and Predictive Factors

Surgical intervention for maternal ovarian torsion in pregnancy

Objective Maternal ovarian torsion in pregnancy is a rare complication. This study was conducted to review the clinical manifestations, and to compare the outcome between laparoscopy and laparotomy in women undergoing surgery for ovarian torsion (OT) during pregnancy. Materials and Methods Using the International Classification of Disease, Ninth Revision, and Clinical Modification, we reviewed the clinical records of patients with OT during pregnancy between 1997 and 2008 at a university hospital. Results Twenty pregnant women were identified with surgically proven OT, 10 in the first trimester, eight in the second, and two in the third. Thirteen (65%) cases were suspected before operation to be adnexal torsion. The most common symptom and sign were pelvic pain (95%) and an adnexal or pelvic mass (95%), followed by nausea and vomiting (65%), elevated white blood cell count >12 × 10 9/L (45%), and fever (10%). Most patients in the first trimester (75%) and a minority in the second and third trimesters (37.5%) received management via laparoscopy. Patients undergoing laparoscopy treatment had smaller ovarian masses and a shorter postoperative hospital stay than those receiving laparotomy. None of these patients had significant complications during or after surgery. However, the outcomes of pregnancy varied: 12 (60%) term deliveries, three (15%) preterm deliveries at over 31 gestational weeks, one missed abortion and four elective abortions in the first trimester. Conclusion The diagnosis of OT during pregnancy is often missed due to nonspecific clinical features and uncommon objective findings. Detorsion only or detorsion plus ancillary procedures via laparoscopy is recommended to treat pregnant women suffering from OT, owing to the advantages of a shorter hospital stay and favorable surgical and pregnancy outcomes.

Diagnostic accuracy of ultrasound in suspected ovarian torsion

&lt;em&gt;Objective&lt;/em&gt;. Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. &lt;em&gt;Methods&lt;/em&gt;. A retrospective observational study was conducted at the Obstetrics/Gyneacology department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n=62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. &lt;em&gt;Results&lt;/em&gt;. Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score &amp;gt;6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (P=0.039) and pain score (P=0.008). &lt;em&gt;Conclusion&lt;/em&gt;. The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.

Validity of Ultrasound in Patients with Acute Pelvic Pain Related to Suspected Ovarian Torsion

Objective: Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. Methods: A retrospective observational study was conducted at the Ob/Gyn department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n = 62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. Results: Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score >6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (p = 0.039) and pain score (p = 0.008). Conclusion: The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.

Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?

To reevaluate the rate of correct diagnosis of ovarian torsion (OT) in our department. Retrospective computerized chart review. Tertiary referral center. Seventy-eight women who underwent laparoscopy for suspected OT. Laparoscopy. Rate of true diagnosis of torsion, correlation with Doppler studies. The preoperative diagnosis of OT was confirmed in only 36 (46.1%) of the patients. Immediate operation (<10 hours) after admission (n = 48) was associated with a statistically significantly higher likelihood of operatively confirming OT (56.2% vs. 28.6%). We found that the lack of ovarian blood flow on Doppler sonography was a good predictor of OT; women with pathologic flow were statistically significantly more likely to have OT (77% vs. 29%). The sensitivity and specificity of abnormal ovarian flow for OT were 43.8% and 91.7%, respectively, with a positive and negative predictive value of 78% and 71%, respectively. Despite 20 years of research, the accuracy of the preoperative diagnosis of OT remains low. The urge to operate can be attributed to the importance of preserving ovarian function in young women as well as to the availability and the low associated complication rate of laparoscopy.

Laparoscopy versus laparotomy for surgical intervention of ovarian torsion

To review the clinical manifestations of ovarian torsion (OT) and to compare the surgical results between laparoscopy and laparotomy. From 1997 to 2006, data on 179 patients admitted to a medical center with surgically proven OT were collected. We compared patients' symptom presentations, objective findings and surgical outcomes between patients who underwent laparotomy and those who received laparoscopy, and between patients admitted via the emergency room and those via the outpatient department. The most common symptom and sign was pelvic pain (82.1%), followed by nausea and vomiting (49.7%), elevated white blood count (20.1%), lower urinary tract symptoms (14.5%) and fever (7.8%). An adnexal or pelvic mass could be detected using gynecological ultrasound in almost all of the patients (98.3%). Ovarian torsion was considered among the admission differential diagnoses in 51.4% of patients. One hundred and five patients (58.7%) seen in the emergency room were more likely to present with nausea and vomiting, sudden pain onset and peritoneal signs than those seen in the outpatient department. Patients undergoing laparoscopy had a smaller sized ovarian mass; they were less likely to require oophorectomy; they had a shorter hospital stay; and fewer of them suffered from postoperative fever compared to patients undergoing laparotomy. Discriminant analysis showed that mass size was the single determining factor for choice of operating methods. The diagnosis of OT is missed in half of the patients because clinical features are unspecific and objective findings are uncommon. The laparoscopy procedure for ovarian conservation is recommended to treat patients suffering from OT owing to its shorter hospital stay, fewer postoperative complications and ovarian preservation.

Pearls and Pitfalls in Diagnosis of Ovarian Torsion

Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. US features of ovarian torsion include a unilateral enlarged ovary, uniform peripheral cystic structures, a coexistent mass within the affected ovary, free pelvic fluid, lack of arterial or venous flow, and a twisted vascular pedicle. The presence of flow at color Doppler imaging does not allow exclusion of torsion but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of flow in the twisted vascular pedicle may indicate that the ovary is not viable. The role of computed tomography (CT) has expanded, and it is increasingly used in evaluation of abdominal pain. Common CT features of ovarian torsion include an enlarged ovary, uterine deviation to the twisted side, smooth wall thickening of the twisted adnexal cystic mass, fallopian tube thickening, peripheral cystic structures, and ascites. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary-sparing treatment.