Adnexal Torsion: Difficulty in Diagnosis and Management

Abstract

Aim:To investigate both the diagnostic value of Doppler-ultrasonography and factors influencing surgical intervention in patients with adnexal torsion (AT).Methods:We retrospectively examined medical records of 66 women with AT in a single center between January 2007 and December 2016.Results:Forty-three out of 66 patients (65.1%) with AT were correctly diagnosed preoperatively. On Doppler examination, reduced ovarian arterial blood velocity was observed in 39 patients (59.1%); and the sensitivity was 0.67. AT was diagnosed in 49 patients (74.2%) via laparotomy, and the number of patients who were subjected to radical treatment was higher than that of patients managed with conservative treatment (54.6% vs 45.4%). Although there was no difference in the surgical approaches (laparoscopy vs laparotomy) between the groups, age, gravidity, parity, body mass index, and ovarian cyst size were significantly lower in patients who were treated conservatively (p<0.05).Conclusion:The diagnostic value of Doppler examination for AT is limited and the decision for surgical management should not be delayed based on Doppler results. Early age, low gravidity, parity and body mass index, and small size of ovarian cyst on ultrasonography were indication for conservative treatment, whereas black-bluish macroscopic appearance had no influence on the preference towards the selection of treatment.

Keywords

• Adnexa uteri
• torsion abnormality
• ultrasonography
• Doppler
• color
• disease management