Adnexal torsion should be considered in women of all ages with acute abdominopelvic pain
Adnexal torsion, described as the rotation of the ovary and/or fallopian tube on its vascular pedicle, accounts for 2.7% of surgical emergencies in women.1 The main risk factor in adults is the presence of an adnexal cyst, without which torsion is unlikely.2
Signs and symptoms are often nonspecific
Patients typically report sudden-onset pelvic pain that may be intermittent and accompanied by nausea and low-grade fever.2 However, symptoms can be poorly localized, with absence of peritoneal signs or a palpable mass leading to common diagnostic delays.2
Transvaginal ultrasonography is the imaging modality of choice to assess the adnexae
Ultrasonography findings suspicious for torsion include a unilaterally enlarged ovary, intraperitoneal fluid and absent blood flow on Doppler testing, particularly with an ovarian mass.3 However, absence of these features does not exclude torsion.3 Abdominal ultrasonography is an alternative when a transvaginal approach is not possible.3 There is no role for computed tomography or magnetic resonance imaging.2
Adnexal torsion is a surgical emergency
Adnexal torsion results in ischemia, and loss of ovarian function and fertility potential.2 Urgent gynecologic consultation is indicated; patients who undergo surgery within 24 hours of symptom onset experience better outcomes.4 Laparoscopic management is the gold standard; however, surgery should not be delayed by lack of access to laparoscopy.2
At surgery, the affected ovary should be preserved
Recent studies show that necrotic-appearing ovaries often regain function following surgical detorsion; therefore, conservative surgery with ovarian preservation is recommended.2 The theoretical risk of venous thromboembolism with detorsion has been disproved and does not justify oophorectomy.2 The rate of malignancy in young women and girls is low, thus oophorectomy is reserved for postmenopausal women with adnexal torsion, who, according to a recent retrospective study, have a 9% risk of cancer and may require further staging.5
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.