Clinical Characteristics and Management of Adnexal Torsion

Adnexal torsion is a gynaecologic surgical emergency. Misdiagnosis or delay may lead to loss of the adnexa and may compromise fertility.

Aim: To determine the most relevant findings for the diagnosis of adnexal torsion and the results of laparoscopic surgery.

Methodology: A retrospective cohort study of 266 patients who underwent surgical treatment for adnexal torsion in our department from January 1994 to January 2014. Clinical, biological, ultasonographic, therapeutic and histological findings were analysed as well as risk factors and prognosis.

Results: The mean age of patients was 33.1 years. Adnexal torsion occurred during pregnancy in 21 patients (7.8%). Abdominal pain was present in 91.7%, vomiting in 63.9% and fever in 19.1% of the cases. Ultrasonographic findings were: ovarian cysts (54.1%), complex mixed echogenicity masses (40.2%) and ovarian enlargement (5.6%). The pain-to-surgery interval varied from 4 hours to 26 hours. At surgery, the mean number of spiral turns was 2. Treatment was carried out by laparotomy in 87 patients (32.7%). The mean size of the adnexa treated by laparotomy was 10.7 cm. Laparoscopic surgery was performed in 137 patients (51.5%). The mean size of the adnexa treated by laparoscopy was 6.9 cm. Laparoscopic treatment was conservative in 77.3% of the cases.

Conclusion: Adnexal torsion is a common gynaecologic emergency. Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and sonographic investigation. The prognosis of adnexal torsion was potentially increased by the interval period before surgery. Laparoscopic treatment is the gold standard if possible.