Management Of Adnexal Torsion Research Articles

Diagnosis and management of adnexal torsion: a retrospective study of 65 cases

Diagnosis and management of adnexal torsion: a retrospective study of 65 cases

Management of Adnexal Torsion in the Pediatric and Adolescent Population at Western Australia's Single Tertiary Children's Hospital over the Last 10 Years: Retrospective Study

To review our institutional data regarding the management of adnexal torsion (AT) and assess the ovarian conservation rates. Retrospective study. Tertiary children's hospital. Pediatric and adolescent patients with surgically diagnosed AT. Participants (n = 54, mean age 9.80 ± 3.95 years) were identified between June 2010 and May 2019. Surgical management of AT. The primary outcome was to determine the ovarian conservation rates in AT cases. The secondary outcomes were to determine the incidence of AT to total emergency department (ED) presentations, decision to operation theater (OT) time in AT cases, return to OT, histopathology, and follow-up with ultrasound to determine ovarian function. Data were collected on demographic and clinical characteristics. Continuous data were compared with t tests or Kruskal-Wallis tests; categoric data were compared with chi-square tests. A total of 52 (96.29%) patients had ovarian conservation, and 53 (98.14%) had laparoscopic management. The incidence rate for AT cases to total ED presentations for the last 10 years was 9.9 per 100 000, which was based on a Poisson distribution. Presentations to an ED for AT cases have trended upward since 2010. Decision to OT time was statistically significantly shorter in cases with preoperative suspicion of AT than those with intraoperative diagnosis of AT (p = .000). A total of 7 (12.96%) patients returned to OT for suspicion of recurrent torsion. Of these, 5 (9.26%) had confirmed repeat AT. The presence of fever, pain duration, severity of pain, and severity of torsion did not correlate with the follow-up ultrasound findings of ovarian activity. The findings from our study suggest that high ovarian conservation rates are achievable in AT cases. A high index of suspicion is required to prevent a delay in surgery.

3016 Management of Adnexal Torsion in Pregnancy

Video Objective The objective of this video is to review the risk factors, perioperative planning, and surgical management of adnexal torsion in advanced pregnancy. Setting The patient is a twenty-one-year-old gravida two para one at twenty-six weeks of gestational age who presented with left adnexal torsion. Her surgical management was performed at a tertiary care center that provides obstetrical and neonatal intensive care. Interventions A minimally invasive approach to the surgical management of adnexal torsion in advanced gestation is demonstrated. The procedure will be shown in a stepwise approach consisting of: identification of the anatomy, determination of accessory port placement, detorsion of the adenexa, and finally removal of the specimen. Furthermore, general pearls to utilize and pitfalls to avoid in laparoscopic surgery during pregnancy are discussed. Conclusion A minimally invasive approach to the management of adnexal torsion in advanced gestation can be safely accomplished through proper surgical planning, a stepwise approach, and minimal manipulation of the gravid uterus.

Adnexal Torsion.

Adnexal torsion is an uncommon gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support. Delay in treatment can impact fertility adversely. The objective of this report is to provide clinical recommendations based on the latest evidence. Specifically we discuss epidemiology, clinical presentation, diagnostic approach and management of adnexal torsion in adolescents.

Torsion of Normal Adnexa in the Third Trimester of Pregnancy Mimicking Acute Appendicitis

Maternal ovarian torsion in pregnancy is very rare. Non-specific symptoms, signs, and imaging findings make the diagnosis difficult. A delay in diagnosis can lead to irreversible damage to adnexa and fetal compromise. Difficulties encountered in the diagnosis and management of adnexal torsion in the third trimester of pregnancy are highlighted in this article.

No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults.

To review the evidence and provide recommendations on the diagnosis and management of adnexal torsion in children, adolescents, and women. Elements evaluated include the risk factors, diagnostic accuracy, management options, and outcomes of adnexal torsion. Published literature was retrieved through searches of MEDLINE, Embase, CINAHL, and the Cochrane Library using appropriate controlled vocabulary and key words ("adnexal torsion," "ovarian torsion"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and new material incorporated in the guideline to December 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Canadian Paediatric and Adolescent Gynaecology and Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors. Recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. Guideline implementation should assist the practitioner in developing an optimal approach to the diagnosis and management of adnexal torsion while minimizing harm and improving patient outcomes. These guidelines have been reviewed and approved by the Gynaecology Committee of the SOGC and approved by the council of the SOGC. The Society of Obstetricians and Gynaecologists of Canada SUMMARY STATEMENTS: RECOMMENDATIONS.

An Intrauterine Pregnancy with Tubo-ovarian Torsion mimicking Ruptured Tubal Ectopic Pregnancy

ABSTRACT Aims and objectives Adnexal torsion is a rare gynecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage. Our study is about the clinical presentation and management of adnexal torsion in a pregnant woman in a tertiary care center. Materials and methods This case study was done in a pregnant woman who came with adnexal torsion in the first trimester in the labor room of Government Medical College and Patiala, Punjab, India. Results Torsion ovarian cyst is found in 5 per 10,000 women in pregnancy. The woman was suspected of having heterotopic pregnancy (an intrauterine pregnancy with ruptured tubal ectopic pregnancy). However, she was diagnosed as intrauterine pregnancy with adnexal torsion during laparotomy. Conclusion Adnexal torsion is a rare emergency, which requires a high index of clinical suspicion for diagnosis as the symptoms are nonspecific. Imaging helps in diagnosis, but most of them are diagnosed intraoperatively. Diagnosis is made clinically along with imaging modalities. Ultrasound with color Doppler is the most commonly used imaging modality. An early surgical intervention helps in salvaging the adnexa and prevents further complications. How to cite this article Kaur N, Kaur K, Saini S. An Intrauterine Pregnancy with Tubo-ovarian Torsion mimicking Ruptured Tubal Ectopic Pregnancy. J South Asian Feder Obst Gynae 2017;9(1):56-59.

Clinical Characteristics and Management of Adnexal Torsion

Clinical Characteristics and Management of Adnexal Torsion

Clinical characteristics and the risk for malignancy in postmenopausal women with adnexal torsion

ObjectiveTo compare clinical characteristics and management of adnexal torsion in postmenopausal patients as compared to premenopausal ones. MethodsA retrospective 22 year cohort of all cases of surgically verified adnexal torsion in postmenopausal and premenopausal patients, comparing presentation, imaging, surgical procedure and histology. ResultsThirty five cases of adnexal torsion among postmenopausal patients were compared to 302 cases among premenopausal ones. Complex ovarian masses and larger ovarian diameter were more common among postmenopausal patients (7.8 vs. 6.8cm, p=0.003). The admission to surgical interval differed substantially between the groups (75.5h in postmenopausal patients vs. 24.4 in the premenopausal ones, p<0.001). The main surgical indication for postmenopausal patients was pelvic mass investigation (54.3% vs 11.6%, p<0.001), and more premenopausal patients underwent surgery with a clinical suspicion of adnexal torsion (77.1% vs. 40%, p<0.001). Extensive surgery including bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients, as opposed to conservative surgery, including detorsion and cystectomy/fenestration or detorsion only, in premenopausal surgeries. Cancer was diagnosed in 3% of postmenopausal patients with adnexal torsion. ConclusionAdnexal torsion in postmenopausal women is rare, but presents similarly, results in more delayed and extensive surgery and involves malignancy in 3%.

Late Presentation of Ovarian Torsion

Ovarian Torsion (OT) is a gynecological emergency that requires quick recognition and prompt treatment to save the ovary in females of reproductive age. When the torsion occurs in the right ovary, the symptoms may be confused with the appendix. In our patient, right sided ovarian torsion was suspected as appendicitis. After 17 hours of delay, instead of removal of the ovary, de-torsion and preservation of the ovary was done despite that part of the ovary and the fallopian tube were ischemic, edematous and appeared necrotic. On follow-up, signs, symptoms and ultrasound suggested that the ovary survived. This case highlights that delayed de-torsion of adnexa has a place in the management of adnexal torsion.

A Unique Case of Adnexal Torsion

Background: A case of adnexal torsion resulting in ischemic changes without complete interruption of blood flow is described. Case: The patient had history of infertility, right unicornuate uterus, and endometriosis. She conceived with twins after in vitro fertilization and embryo transfer. At 10 weeks of gestation she presented with acute abdomen in the presence of normal transvaginal ultrasound Doppler flow study. Both ovaries were enlarged, with multiple corpora lutea cysts as a result of controlled ovarian stimulation and the effect of human chorionic gonadotropin on the ovaries during pregnancy. At laparoscopy, right adnexal torsion with two twists was documented in the absence of any change in color of the adnexa. Laparoscopic untwisting of the right adnexa was performed successfully, and the patient had an uneventful recovery and subsequently delivered at 32 weeks of gestation. Conclusions: A normal Doppler flow cannot rule out adnexal torsion. Diagnostic laparoscopy is the gold standard for the diagnosis and management of adnexal torsion. (J GYNECOL SURG 28:359)

P34.04: Successful pregnancy post laparoscopic management of adnexal torsion at 7 weeks of pregnancy and luteal corpus removed

P34.04: Successful pregnancy post laparoscopic management of adnexal torsion at 7 weeks of pregnancy and luteal corpus removed

Laparoscopic management of a patient with torsion of paratubal cyst associated with defect of the omentum

We present an unusual case of torsion of a paratubal cyst in the mesosalpinx, associated with a defect of the omentum, in which laparoscopic management proved effective. A large paratubal cyst in the left mesometrium which was twisted twice around the defect of the omentum was removed laparoscopically. The patient's postoperative course was uneventful. Early diagnosis and treatment by laparoscopy are essential in the management of adnexal torsion.

Conservative laparoscopic management of adnexal torsion in early pregnancy

We present the case of a patient with a right adnexal torsion in early pregnancy, which was treated laparoscopically.

Video. Laparoscopic management of adnexal torsion during pregnancy following ovarain hyperstimulation

Video. Laparoscopic management of adnexal torsion during pregnancy following ovarain hyperstimulation

Preservation of ovarian tissue in adnexal torsion with fluorescein

Our purpose was to assess the ability of fluorescein to intraoperatively detect viable fallopian and ovarian tissues involved in adnexal torsion. This prospective study was performed at Los Angeles County+University of Southern California Women's Hospital. Participants were female patients 18 to 45 years old with adnexal torsion confirmed at exploratory celiotomy. Five milliliters of 10% fluorescein were injected intravenously, and the involved untwisted adnexa was observed under ultraviolet light. Nonfluorescent tissue was resected and histologically evaluated. Eleven patients were entered into the study. Mean age was 25 years (range 15 to 42). Eight patients (72%) had preservation of involved ovarian tissue. No complications were associated with this procedure. Only three patients (28%) underwent oophorectomy. The use of intravenous fluorescein appears to be a valuable adjunct in the management of adnexal torsion. Application of this technique in reproductive-aged patients resulted in a three-quarter reduction in oophorectomy procedures.