Torsion In Postmenopausal Women Research Articles

Primary papillary serous carcinoma presenting as acute ovarian torsion in postmenopausal woman: a case report

A 51-year-old postmenopausal woman, with an uneventful past gynecologic history, was admitted to the present hospital with a diagnosis of severe pelvic pain due to a suspected ovarian torsion treated with different drugs intravenously without any improvement of symptoms. As a consequence of the increasing pelvic pain, a laparoscopic surgical treatment was decided: a left necrotic ovarian mass and pelvic peritoneal carcinomatosis were visualized and the procedure was converted from laparoscopy to laparotomy that confirmed a diagnosis of primary ovarian papillary serous carcinoma and permitted an adequate treatment. This is a rare case in literature of severe pelvic pain due to an acute ovarian torsion that permitted a prompt diagnosis and treatment of malignancy.

Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and non-specific symptoms of the disease in this age group.

Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Ovarian Malignancy

Study ObjectiveTo investigate the clinical presentation, operative outcome, and incidence of malignancy in postmenopausal women who were diagnosed with adnexal torsion. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingTertiary university-affiliated hospital. PatientsPostmenopausal women diagnosed with adnexal torsion between 1995 and 2014 (study group) were reviewed and compared with 220 premenopausal patients diagnosed with adnexal torsion during the same time period. InterventionDemographic data, clinical signs and symptoms, and intra- and postoperative characteristics were compared between the 2 groups. Measurements and Main ResultsDuring the study period 44 postmenopausal women were diagnosed with adnexal torsion. Continuous dull pain was the most common presenting symptom in the postmenopausal group (57%), whereas acute-onset sharp pain was the predominant symptom in the premenopausal group (86%). The time interval from admission to surgery was significantly longer in the postmenopausal group (24 vs 6 hours, p < .001). Laparoscopic surgery was performed in 84.5% of the cases in the premenopausal group, whereas it was carried out in only 50% of cases in the postmenopausal group (p < .001). Four women in the postmenopausal group were diagnosed with malignancy, whereas only 1 case of malignancy was found in the premenopausal group (9% vs .4%, respectively; p = .003). ConclusionsAdnexal torsion in postmenopausal women is an uncommon event with a unique presentation. Because ovarian malignancy is not an uncommon finding in this group of patients, preparation for more extensive surgery should be contemplated.

English

This study aimed at determining the prevalence of ovarian torsion in postmenopausal women in Nigeria. For this purpose, a histopathology data pool was maintained for 30 years among the Igbos, a large ethnic group in Nigeria from where postmenopausal women diagnosed with ovarian torsion were extracted for classification. The data concerned 69 cases. All were presented with acute abdominal pain. None was malignant. The patients were aged between 47 and 65 years (mean 55.5 years); their parity ranged from 1 to 8 (average 5); the size of the specimens ranged from 6 to 20 cm (average 9.5 cm); and the right/left involvement was in the ratio of 3:2. It was concluded that there are well-acknowledged risk factors for ovarian torsion even in postmenopausal women presenting with acute abdominal pain. Consequently, even in a developing country, there is need for clinical awareness of this important entity. Key words: Ovary, torsion, menopause, Nigeria.

Differentiated therapy in pre- and postmenopausal adnexal torsion based on malignancy rates: A retrospective multicentre study over five years

IntroductionThe purpose of this study was to investigate the clinical presentation, intra and postoperative outcomes in pre and postmenopausal women who underwent operations for adnexal torsion, and to define our experience diagnosing and managing postmenopausal women with adnexal torsion. MethodsOne hundred and fifty-seven patients who underwent operation with a diagnosis of adnexal torsion were analyzed according to demographic characteristics, menopausal status, preoperative signs and symptoms, surgical findings and applied surgical procedures, and pathological results in four tertiary centers. ResultsThe main indication for surgery for the postmenopausal women was pelvic mass (58% vs. 40%), while for premenopausal women the main indication was suspicion of torsion (55% vs. 24%), (each p < 0.001). The duration of time between being admitted to the hospital and entering operating room as well as the duration of surgery and postoperative hospitalization were statistically longer in the postmenopausal group (each p < 0.001). While extensive surgeries were performed for 68% of the postmenopausal group, this was required for only 3% of the premenopausal group. Functional cysts were the most common pathologic finding in premenopausal women, and only 2 cases of malignancy (1.6%) were seen as opposed to the postmenopausal group, where malignancy was diagnosed in 16% of cases (p < 0.001). DiscussionAdnexal torsion in postmenopausal women is an uncommon event. Malignancy risk should be considered before operation. ConclusionThe malignancy rate was 16% in postmenopausal women with adnexal torsion. Thus, extensive surgeries are more common in postmenopausal women with adnexal torsion.

Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Malignancy

Adnexal Torsion in Postmenopausal Women: Clinical Presentation and Risk of Malignancy

Ovarian Torsion in Postmenopausal Women and risk of malignancy

Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology, with a tendency to occur in postmenopausal women. The aim of this study was to provide information concerning the clinical presentations, surgical management, pathological findings and risk of malignancy in postmenopausal women with ovarian torsion. Methods:In this cross-sectional study, the risk of malignancy was assessed in postmenopausal women with ovarian torsion, who admitted to the Tumor Clinic of Ghaem Hospital, Mashhad, Iran in 2013. Frozen section technique was applied in patients undergoing laparotomy. The recorded data included patients’ age and symptoms, tumor markers, type of surgery, radiological findings and pathological results. Results: Among 44 menopausal patients with pelvic masses, 10 women were selected. The most common symptom was acute abdominopelvic pain (100%). In ultrasonic evaluation, complex ovarian mass was the most frequent finding. Free fluid in the pelvis was reported in 30% of cases. Moreover, serous tumor was the most common pathological finding. Malignancy was reported in 20% of cases; therefore, surgical staging was carried out for these patients. Conclusion: Ovarian torsion is a differential diagnosis in postmenopausal women with acute symptoms of lower abdominal or pelvic pain. Risk of malignancy due to adnexal masses should be considered in these patients.

Ovarian fibrothecoma: a rare cause of ovarian torsion in postmenopausal woman

Ovarian torsion is a common gynecological surgical emergency. It is usually associated with a cyst or a tumor, which is typically benign. The most common cause of ovarian torsion is mature cystic teratoma. We herein present an unusual case of torsion in the ovarian fibrothecoma. We report a case of ovarian torsion in a 47-year-old postmenopausal woman who came to the emergency department with acute abdominal pain. In this case report, we highlight Doppler ultrasonography and the magnetic resonance imaging features of ovarian torsion. She underwent an urgent surgery due to a torsion indicated. Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed. The final pathologic diagnosis revealed torsion of left ovarian fibrothecoma. Ovarian fibrothecoma are usually asymptomatic. They can become symptomatic when they are torsed. Key Words: Magnetic Resonance Imaging, Ovarian Fibrothecoma, Ovarian 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%.

The risk of malignancy in post-menopausal women presenting with adnexal torsion

Objectives. Adnexal torsion is usually diagnosed in pre-menopausal women and is less common in post-menopausal patients. The risk of malignancy in cases of torsion in menopausal patients is not known. We set out to describe our experience with adnexal torsion in post-menopausal women and to discuss issues related to management in this situation. Methods. A retrospective chart review was conducted of all post-menopausal patients diagnosed with torsion of the adnexa from January 1990 through December 2005. Patient charts were reviewed for information regarding pre-operative signs and symptoms, pathology, demographics, surgical findings, procedure and outcome. As a control group, we chose a consecutive cohort of 29 pre-menopausal patients diagnosed with adnexal torsion during 2002. Results. Twenty-seven patients were found to be menopausal at the time of diagnosis of adnexal torsion. Median age at presentation was 63 years (range 43–93). A median delay of 40 h was found between the time of hospital admittance to surgery for post-menopausal patients in comparison to the pre-menopausal ones. The cause of torsion was benign in pre-menopausal patients whereas 22% of post-menopausal patients were diagnosed with malignant disease. More adnexas were found to be necrotic in menopausal patients and this resulted in under-diagnosis of malignancy on frozen section analysis. Conclusion. The diagnosis of adnexal torsion is less evident in post-menopausal patients leading to delayed treatment. The high risk of malignancy is of major importance and should be taken into account when counseling patients and when using frozen section during surgery.