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      Adnexal Torsion in Adolescents: A 24-patient Case Series with Conservative Surgical Approach

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          ABSTRACT

          Background

          Adnexal torsion is a common diagnostic challenge in an emergency setting. It has an incidence of 2–15%. Diagnosis is mainly based on clinical symptoms and imaging techniques such as ultrasound and magnetic resonance imaging (MRI), however, a normal ultrasound scan does not exclude adnexal torsion and the decision to operate should be made on clinical grounds.

          Methodology

          Data from 24 patients who were known cases of adnexal torsion was retrieved from the hospital registry to conduct a retrospective analysis of patients.

          Conclusion

          Appropriate diagnosis and timely surgical gynecological intervention are of utmost importance to preserve ovarian function.

          How to cite this article

          Sharma N, Seehra N, Kedawat A, et al. Adnexal Torsion in Adolescents: A 24-patient Case Series with Conservative Surgical Approach. J South Asian Feder Obst Gynae 2023;15(3):313–315.

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          Adnexal torsion: review of the literature.

          Kirsten J Sasaki, Charles Miller (2024)
          Adnexal torsion is one of a few gynecologic surgical emergencies. Misdiagnosis or delay in treatment can have permanent sequelae including loss of an ovary with effect on future fertility, peritonitis, and even death. A PubMed search was performed between 1985 and 2012 for reviews, comparative studies, and case reports to provide a review of the epidemiology, risk factors, clinical presentation, common laboratory and imaging findings, and treatments of adnexal torsion. Common symptoms of torsion include pain, nausea, and vomiting, with associated abdominal or pelvic tenderness, and may differ in premenarchal and pregnant patients. Laboratory and imaging findings including ultrasound with Doppler analysis, computed tomography, and magnetic resonance imaging can assist in making the diagnosis but should not trump clinical judgment; normal Doppler flow can be observed in up to 60% of adnexal torsion cases. Treatment depends on the individual patient but commonly includes detorsion, even if the adnexae initially seem necrotic, with removal of any associated cysts or salpingo-oophorectomy, because recurrence rates are higher with detorsion alone or detorsion with only cyst aspiration.
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            A review of ovary torsion

            Ci Huang, Mun-Kun Hong, Dah-Ching Ding (2017)
            Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
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              Cannot exclude torsion--a 15-year review.

              Sarah C. Oltmann, Anne E. Fischer, Robert E. Barber … (2009)
              Ovarian torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Charts of patients with ovarian operative cases were retrospectively reviewed at a free-standing children's hospital over 15 years. Torsion was based on intraoperative findings. Of 328 operative ovarian cases, 97 (29.6%) demonstrated torsion. Mean patient age was 9.2 years (2 days to 17 years, +/-0.54 SEM), with 52% occurring between 9 and 14 years. Of the patients, 97% presented in pain. Presence of a pelvic mass 5 cm or larger on imaging had 83% sensitivity for torsion: an ultrasound reading was only 51% sensitive. Elevated white blood cell count was the only preoperative characteristic associated with prompt operative intervention. Utilization of laparoscopy increased during the latter half of the study (18%-42%, P < .0434). There was a positive trend, although insignificant, in the use of laparoscopy and ovarian salvage. Pathology was overwhelmingly benign (infarction [46%], cysts [33%], and benign neoplasms [19%]). Torsion was responsible for one third of all operative ovarian cases. Sonography is not reliable in diagnosis or exclusion of ovarian torsion. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL), particularly with a pelvic mass of approximately 5 cm, may improve ovarian salvage. Because pathology is predominantly benign, the edematous detorsed ovary is safe to salvage.
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                Author and article information

                Contributors
                Journal
                Journal ID (publisher-id): JSAFOG
                Title: Journal of South Asian Federation of Obstetrics and Gynaecology
                Abbreviated Title: JSAFOG
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0974-8938
                ISSN (Electronic): 0975-1920
                Publication date (Print): May-June 2023
                Volume: 15
                Issue: 3
                Pages: 313-315
                Affiliations
                [1–3 ]Department of Obstetrics and Gynaecology, Government Medical College, Kota, Rajasthan, India
                [4 ]Department of Internal Medicine, Government Medical College, Kota, Rajasthan, India
                [5 ]Department of General Surgery, Government Medical College, Kota, Rajasthan, India
                Author notes
                Neha Seehra, Department of Obstetrics and Gynaecology, Government Medical College, Kota, Rajasthan, India, Phone: +91 7042768078, e-mail: dr.nehaseehra@ 123456gmail.com
                Article
                DOI: 10.5005/jp-journals-10006-2238
                SO-VID: 21ef65c2-82a6-45dc-be92-ef684cefa8be
                Copyright © Copyright © 2023; The Author(s).
                License:

                © The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 05 December 2022
                Date accepted : 05 January 2023
                Date: 31 July 2023
                Categories
                Subject: ORIGINAL ARTICLE
                Custom metadata
                file-pdf jsafog-15-313.pdf

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Acute abdomen,Fertility preservation,Adolescents,Adnexal torsion
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Acute abdomen, Fertility preservation, Adolescents, Adnexal torsion

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