Torsion In Women
Adnexal torsion is a rare gynecologic emergency
. Early diagnosis is detrimental, because misdiagnosis or late diagnosis may lead to irreversible damage to the ovary.Laparoscopy is considered as the gold standard method of diagnosis and treatment.
Previous studies have demonstrated that neither the symptoms, nor the signs of adnexal torsion are specific. Furthermore, there is no agreement regarding the risk factors.
Nonetheless, high clinical suspicion and early diagnosis may prevent irreversible damage.
Many studies are aimed to examine the clinical manifestations involving adnexal torsion, time to diagnosis and treatment methods.
The current data in medical literature about possible risk factors for adnexal torsion is limited. Ovarian cysts and fertility treatment are known risk factors. A higher prevalence of adnexal torsion among pregnant women has been found, although this data is based on reviews of 40-50 cases each, therefore still limited.
Further study should be held, in order to add to the data in current literature about the clinical manifestations of women with adnexal torsion, specifically about the correlation between pregnancy or fertility treatment and torsion.
After reviewing the scientific background, is it possible to estimate, that there is indeed a correlation between fertility treatment and higher prevalence of adnexal torsion, and between pregnancy and higher prevalence of torsion (higher prevalence during pregnancy). It is also possible to estimate, that there is a higher rate of recurrence in women that haven't undergone adnexal fixation as opposed to women who have. Another estimation made, is that a longer period of time to diagnosis is correlated with a higher risk for irreversible damage to the ovary, thus possibly making the conservative treatment less effective, causing increased use of radical methods of treatment such as adnexectomy (removal of the ovary and uterine tube).
When suspecting adnexal torsion, demographic data, past medical history, gynecological and obstetrical history (including fertility treatments, pregnancy and week of pregnancy), signs and symptoms of the patient and other signs of abdominal discomfort should be asked about. Elaborated physical examination should be performed to rule out any peritoneal signs or ruptured ovary. Patients usually present with lower right or left abdominal pain, usually on the same side of the affected adnexa. Imaging techniques such as Doppler ultrasound or CT-scan can be performed. When suspected, the diagnosis is confirmed in the operating room, usually by laparoscopic surgery. Occasionally laparotomy must be performed.
If not treated on time, permanent damage to the adnexa can be caused. This can lead to future fertility problems and great discomfort.
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