QuizMe 8

Adnexal Torsion

A 20 year old nulliparus patient presented to A&E with severe sudden right lower quadrant pain. She stated that she feels nauseated and vomited a couple of times. Upon examination, She was febrile and tachycadic, tenderness and guardring were noted in her right lower abdomen

  • Reproductive age
  • Acute pelvic pain
  • Nausea/vomiting
  • Tenderness/guarding
  • Appendicitis
  • Ovarian torsion
  • Ruptured ovarian cyst

Ultrasound 

Enlarged right ovary with a 5.5 cm ovarian cyst. Normal uterus and  normal left ovary.

Diagnostic Laparoscopy –urgently

  • Do nothing
  • Bilateral salpingo-oophorectomy
  • Oophoropexy
  • Ovarian cystectomy

Clinical symptoms of ovarian torsion include sudden-onset abdominal pain that is intermittent, nonradiating, and associated with nausea and vomiting.

 

Ovarian torsion is more likely in cases with concomitant large ovarian cysts (ie greater than 5 cm).

 

In recent studies, the mainstay of the treatment for ovarian torsion has been surgical evaluation by gross visual inspection to determine viability of ovarian tissue and the preservation of its function. There are many ways to perform the surgery and detorsion and ovarian conservation are almost always recommended now rather than salpingo-oophorectomy . Even if necrosis or ischemia were noted during laparoscopy, the ovary usually reperfuses and regains function; therefore,an oophorectomy is not recommended.

An ovarian cystectomy is often performed for a benign ovarian mass. If malignancy is highly suspected, a salpingo-oophorectomy is needed.

  • Abraham, M., & Keyser, E. A. (n.d.). ACOG COMMITTEE OPINION Number 783 Committee on Adolescent Health Care Adnexal Torsion in Adolescents.
  • Damigos, E., Johns, J., & Ross, J. (2012). An update on the diagnosis and management of ovarian torsion. The Obstetrician & Gynaecologist, 14(4), 229–236. https://doi.org/10.1111/j.1744-4667.2012.00131.x
  • Eskander, R., Berman, M., & Keder, L. (2016). Evaluation and management of adnexal masses. Obstetrics and Gynecology, 128(5), e210–e226. https://doi.org/10.1097/AOG.0000000000001768
  • Huang, C., Hong, M. K., & Ding, D. C. (2017). A review of ovary torsion. In Tzu Chi Medical Journal (Vol. 29, Issue 3, pp. 143–147). Medknow Publications. https://doi.org/10.4103/tcmj.tcmj_55_17 
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