Outcome Of Adnexal Torsion Research Articles

Adnexal torsion in pregnancy

This review has the purpose to evaluate and report clinical characteristics, treatment, and obstetric outcomes of adnexal torsion in pregnant women in order to raise awareness of the need for prompt diagnosis and surgical intervention. Adnexal torsion (AT) in pregnancy is a rare event but is a surgical emergency that needs prompt intervention. Misdiagnosis or delay in treatment can lead to loss of ovarian function with an effect on future fertility and loss of the pregnancy. The use of assisted reproductive technology is associated with an increased risk of AT. Diagnosis of AT is very challenging due to its nonspecific signs and symptoms such as abdominal pain, nausea, vomiting, and abdominal tenderness. Furthermore, pregnant women with AT present with specific characteristics, and these common signs and symptoms may be caused by other obstetric and non-obstetric conditions. Ultrasound examination may not be as valuable as in non-pregnant women. MRI can assist in making the diagnosis in pregnant women. Clinical suspicion of AT should not delay treatment if the imaging evaluation is not clarifying. In standard practice, the surgical treatment of AT is performed by laparoscopy which is safe for pregnant patients regardless of the trimester. The treatment is based on a conservative approach by preserving the adnexa although initially, the ovary may seem necrotic. During the intervention the adnexa is de-twisted, and cystectomy or cyst aspiration is performed, if any adnexal mass is present, to reduce the recurrence risk. Surgery during pregnancy for suspected AT does not lead to adverse obstetrical outcomes. Given the difficulties of the diagnosis of AT in pregnancy, it is of great importance that clinicians are familiar with this complication in pregnancy and are aware of the need for prompt intervention.

Diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy

Objective: To investigate the clinical characteristics, diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy. Methods: A retrospective analysis was conducted of the clinical data of 24 pregnancy patients with adnexal torsion, aged 21-38 (30.6±4.4) years old, who were admitted and delivered in Peking University Third Hospital from 2015 to 2019. According to the gestational age, all patients were divided into two groups:<28 weeks group (11cases) and ≥28 weeks group (13 cases), to compare the intergroup differences in clinical characteristics, treatment and outcome, and the differences of clinical data and outcome between two groups were compared. Results: The proportion of patients with twin pregnancy and assisted reproductive technology in the<28 weeks group was significantly higher than that in the ≥28 weeks group (5/11 vs 1/13, 8/11 vs 1/13, P<0.05). No significant differences between the two groups were recorded in terms of the size of the adnexal mass, the cycles of torsion and the duration from onset to operation. Compared with the≥28 weeks group, the adnexal removal rate of the<28 weeks group was lower (3/11 vs 6/13), but the difference was not statistically significant. The proportion of blood flow signals of ultrasound before operation, cases undergoing laparoscopic surgery and cases whose pathological findings were physiological cysts in the<28 weeks group were significantly higher than that in the ≥28 weeks group (8/11 vs 4/13, 8/11 vs 0, 8/11vs 4/13; P<0.05). Concerning the pregnancy outcomes, there was no difference in the mode of delivery, the delivery gestational age and the body weight of newborns between the two groups. Conclusions: The patients with adnexal torsion prior to 28 weeks(<28 weeks)of pregnancy were more likely to be conceived by assisted reproductive technologies, and the etiology was more likely to be ovarian physiological cysts. Both laparoscopy and laparotomy were safe and effective in the treatment of adnexal torsion with good outcome for mother and infant in the study.

Clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women: a retrospective study

BackgroundAdnexal torsion during pregnancy is a gynecological emergency. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women.MethodsA retrospective study was conducted at a tertiary center between January 2008 and January 2018. Eighty-two pregnant women with surgically confirmed adnexal torsion were included. The clinical characteristics, ultrasound data, surgical interventions and pregnancy outcomes were analyzed.ResultsThe median age of the patients was 28 (range, 18–38) years. The median gestational age was 11 (range, 6–31) weeks: 53 (64.6%) were in the first trimester, 21 (25.6%) were in the second trimester, and 8 (9.8%) were in the third trimester. The most common symptoms and signs were sudden pelvic pain (100%) and adnexal or pelvic masses (97.6%), followed by nausea and vomiting (61%). The Doppler blood flow signal disappeared in 62.5% of the patients. Sixty-three (76.8%) patients underwent laparoscopy, and 29 (24.2%) underwent laparotomy. The median gestational age in patients undergoing laparotomy was higher than that in those undergoing laparoscopy (26 weeks vs 10 weeks, p < 0.001). Fifty-three (64.6%) patients underwent conservative surgery, with 48 detorsions and cystectomies, 2 detorsions and cyst fenestrations, 1 detorsion only and 2 salpingectomies only. Twenty-nine (25.4%) patients underwent unilateral salpingo-oophorectomy. There were no cases of postoperative thrombosis, spontaneous abortion or recurrence during the same pregnancy. Seven patients underwent simultaneous artificial abortion. One patient experienced intrauterine fetal death, and 74 patients had live births.ConclusionSurgical intervention was required as soon as possible. Laparoscopic conservative surgery is safe and may be appropriate to preserve ovarian function.

Sonographic and Histologic Outcomes of Adnexal Torsion

Objective: The aim of this study was to investigate the success of ultrasound in the diagnosis of adnexal torsion before surgery and to define its histological diagnosis and results in different age periods.&#x0D; Material and Methods: This study was carried out with a retrospective examination of 130 patients clinically suspected as adnexal torsion between January 2008 and May 2012. The success of sonography in the diagnosis of adnexal torsion was investigated by diagnostic tests. 70 cases confirmed by surgery were divided into 3 groups. Children and adolescents under 18 years of age were classified as Group 1, reproductive women Group 2 and postmenopausal women Group 3. In these 3 groups, mass size, type, histological diagnosis and outcome of adnexal torsion were defined.&#x0D; Results: The sensitivity, specificity, and accuracy of ultrasound were 84.3%, 78.3%, and 81.5%, respectively. There were significant differences in the presence of ultrasonic hallmarks among the true positive, false positive, and false negative cases of adnexal torsion. Adnexal torsion was identified in 70 cases. The majority of cases were found to occur in the reproductive period (47 of 70). Teratoma was the most common histological diagnosis in children and adolescents, while normal ovary was in the reproductive period. In the postmenopausal period, the most common histological diagnosis was cystadenoma, but the malignant ovarian tumor was observed in 2 of 10 cases.&#x0D; Conclusion: We conclude that ultrasonography performed by a specialized obstetrics and gynaecology ultrasound unit plays an important role in the preoperative diagnosis of adnexal torsion. Most adnexal torsions occurred in women of reproductive age, and the right side was dominant. The spectrum of histological diagnosis varied at different ages.

Spectrums and Outcomes of Adnexal Torsion at Different Ages.

To investigate the role of ultrasound in the preoperative diagnosis of adnexal torsion and describe its histological spectrum and outcomes at different ages. This study comprised a retrospective investigation of a data set that included 195 female patients with clinically suspected adnexal torsion between January 2010 and July 2015. Each patient received a detailed pelvic ultrasound examination by an experienced ultrasound examiner, and a definitive diagnosis was achieved via surgery. The accuracy of an ultrasonic diagnosis of adnexal torsion was assessed. The patients were divided into three groups: female children and adolescents, fertile women, and postmenopausal women. The size, type, histological spectrum, and outcome of adnexal torsion in the different groups were also described. The sensitivity, specificity, and accuracy of ultrasound were 0.84, 0.77, and 0.81, respectively. There were significant differences in the presence of ultrasonic hallmarks among the true positive, false positive, and false negative cases of adnexal torsion. Ovarian torsion was identified in 94 cases, and isolated tubal torsion was identified in 15 cases. The most common histologic diagnoses of the pediatric group and the other two groups were a normal ovary and teratoma, respectively. The most common histologic diagnoses in the cases of isolated tubal torsion were mesosalpinx cyst and oviduct inflammation. Ultrasonography plays an important role in the preoperative diagnosis of adnexal torsion. Despite ovarian involvement in most of the cases, isolated oviduct torsion was not uncommon. The spectrum of histological diagnoses varied among the age groups.

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.

Differences Between Adnexal Torsion in Pregnant and Nonpregnant Women

Study ObjectiveTo compare the clinical manifestation, management, and outcome of adnexal torsion in pregnant and nonpregnant women. DesignRetrospective case-control study (Canadian Task Force classification II-3). SettingTertiary care university hospital. PatientsSixty-four pregnant women and 198 nonpregnant women with episodes of adnexal torsion. InterventionsSurgery to treat proved adnexal torsion. Measurements and Main ResultsThe mean (SD) gestational age in the pregnant group was 11.5 (7.7) weeks. Thirty six episodes of adnexal torsion in the pregnant group (56%) developed after treatment for infertility, compared with only 14 such episodes (7%) in the nonpregnant group (p < .001). A repeated episode of torsion occurred more frequently in the pregnant group (14% vs 4%; p = .03). Sonographic demonstration of multicystic ovaries was more common in pregnant women with recurrent torsion than in women with a single episode of torsion (86% vs 31%; p = .009). Tissue preservation was achieved more frequently in pregnant than in nonpregnant patients (95% vs 77%; p < .001), and the duration of surgery was 15 minutes shorter in the pregnant women (p < .001). ConclusionPregnancy after treatment for infertility is a risk factor for adnexal torsion. Recurrence of ovarian torsion occurs more frequently in pregnant patients, and in particular in enlarged multicystic ovaries.

Adnexal Torsion in Pregnancy after Assisted Reproduction - Case Study and Review of the Literature.

Purpose: Aim of the study was to investigate the incidence, progress, management and outcome of adnexal torsion after controlled ovarian hyperstimulation in embryo transfer cycles. Materials and Method: A retrospective analysis was done of 1007 patients of a private IVF centre. The literature on adnexal torsion is reviewed. Results: In the literature, the incidence of adnexal torsion after assisted reproductive technologies (ART) is given as around 0.2 %. A significant increase of up to 33 % has been reported for cases with additional ovarian hyperstimulation syndrome (OHSS) and in pregnant women. In our retrospective analysis of 1007 women (incidence 0.46 %) with 1411 fresh embryo transfer cycles, we found an incidence of 0.35 % per embryo transfer. All adnexal torsions were treated by laparoscopic derotation to preserve fertility. All 5 cases with torsion were pregnant, 2 patients had mild OHSS. We recorded 3 term deliveries, 1 induced abortion for sirenomelia, and 1 missed abortion. Conclusion: Adnexal torsion must be kept in mind after hyperstimulation and embryo transfer, especially when pregnancy or OHSS is also present. With early diagnosis, it should be possible to preserve fertility using laparoscopic derotation.

Comparison of Adnexal Torsion between Pregnant and Nonpregnant Women

An estimated 12–25% of adnexal torsion is found in pregnant women; the authors sought to characterize this rare and dangerous condition as the published data on this population currently comprise only small case series and anecdotal case reports. This case-control study compared the manifestations, treatment, and outcomes of adnexal torsion in pregnant vs. non-pregnant women. The study population included a total of 118 women with surgically confirmed adnexal torsion, 41 of whom were pregnant, in two institutions in Tel Aviv over a period of 9 years.

Management and outcomes of adnexal torsion: a 5-year experience

To discuss the surgical results of patients with diagnosis of adnexal torsion. One hundred and fifty patients with diagnosis of adnexal torsion who presented to our clinic between January 2005 and December 2009 were included in this retrospective analysis. Data regarding age, gravidity, parity, size of mass, operation time, and duration of hospitalization were recorded and compared between the patients who had laparoscopy to those who had laparotomy. The pathological results of patients were also recorded. Fifty-eight patients were treated laparoscopically while 92 patients had laparotomy. The most frequent presenting symptom was pelvic pain (96%). Laparoscopy group consisted of young patients with low parity; operation and hospital stay time was shorter in laparoscopy group. Velocity loss in Doppler ultrasonography was noted in 81.3% of the patients. Of the laparotomy group 35 postmenopausal patients had hysterectomy and bilateral salpingo-oopherectomy, and staging surgery was done for 16 of them. The pathological finding was found to be malignant in four and borderline serous tumor in four patients. Laparoscopy is preferred for young patients who want to preserve their fertility. Because of high risk of malignancy in postmenopausal ovarian masses presenting with torsion; frozen section should be used. If not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.

116: Presentation and Outcome of Adnexal Torsion in Pediatric Patients: A 15-Year Retrospective Review

To describe the presentation, evaluation, and outcome of adnexal torsion in a pediatric patient population, and to assess the relationship between the duration of time until diagnosis and the rate of salvage.