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Jajoo S, Jajoo S, Naval R. Isolated Unilateral Hydrosalpinx Torsion in a Post-Tubal Ligation Patient: A Case Report and Review of Literature. Cureus 2024; 16:e56351. [PMID: 38633976 PMCID: PMC11021850 DOI: 10.7759/cureus.56351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Isolated tubal torsion of the hydrosalpinx is a rare occurrence with a varied clinical presentation, presenting a diagnostic challenge. We present a case involving the isolated torsion of the right hydrosalpinx in a 33-year patient with a history of bilateral tubal ligation who presented with an acute abdomen. Based on ultrasound and clinical findings, an initial diagnosis of ovarian torsion was considered. However, escalating pain severity led to diagnostic laparotomy, revealing torsion in the right hydrosalpinx. Subsequent right salpingectomy was done, and as the patient had undergone tubal ligation, preventive left salpingectomy was also performed. Both ovaries were preserved. The patient experienced an uneventful recovery. A literature review uncovered fewer than 50 reported cases of unilateral or bilateral isolated fallopian tube torsion post-tubal ligation. This case underscores the diagnostic challenges associated with isolated tubal torsion and emphasizes the crucial role of early surgical intervention in preventing morbidity and preserving ovaries.
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Affiliation(s)
- Shubhada Jajoo
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhas Jajoo
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rucha Naval
- Laparoscopic Surgery, Naval Multispeciality Hospital, Jalgaon, IND
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2
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Atia O, Hazan E, Rotem R, Armon S, Yagel S, Grisaru-Granovsky S, Sela HY, Rottenstreich M. A Scoring System Developed by a Machine Learning Algorithm to Better Predict Adnexal Torsion. J Minim Invasive Gynecol 2023; 30:486-493. [PMID: 36775053 DOI: 10.1016/j.jmig.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
STUDY OBJECTIVE To establish a clinically relevant prediction score for the diagnosis of adnexal torsion (AT) in women who were operated on for suspected AT. DESIGN A retrospective cohort study conducted between 2014 and 2021. SETTING A large tertiary teaching medical center. PATIENTS Women who underwent urgent laparoscopy for suspected AT. INTERVENTIONS Analyses included univariate and multivariate models combined with the machine learning (ML) Random Forest model, which included all information available about the women and reported the accuracy of the model and the importance of each variable. Based on this model, we created a predictive score and evaluated its accuracy by receiver operating characteristic (ROC) curve. MEASUREMENTS AND MAIN RESULTS A total of 503 women were included in our study, 244 (49%) of whom were diagnosed with AT during the surgery, and 44 (8.8%) cases of necrotic ovary were found. Based on the Random Forrest and multivariate models, the most important preoperative clinical predictive variables for AT were vomiting, left-side complaints, and concurrent pregnancy; cervical tenderness and urinary symptoms decreased the likelihood of surgically confirmed AT. The most important sonographic findings that predicted increased risk of surgically confirmed AT were ovarian edema and decreased vascular flow; in contrast, hemorrhagic corpus luteum decreased the likelihood of surgically confirmed AT. The accuracy of the Random Forest model was 71% for the training set and 68% for the testing set, and the area under the curve for the multivariate model was 0.75 (95% confidence interval [CI] 0.69-0.80). Based on these models, we created a predictive score with a total score that ranges from 4 to 12. The area under the curve for this score was 0.72 (95% CI 0.67-0.76), and the best cutoff for the final score was >5, with a sensitivity, specificity, positive predictive value, and negative predictive value of 64%, 73%, 70%, and 67%, respectively. CONCLUSION Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of women with suspected AT. ML in this setting has no diagnostic/predictive advantage over the performance of logistic regression methods. Additional prospective studies are needed to confirm the accuracy of this model.
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Affiliation(s)
- Ohad Atia
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Dr. Atia), Jerusalem, Israel
| | - Ella Hazan
- Faculty of Medicine, Hadassah-Hebrew University Medical Center (Hazan), Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel.
| | - Shunit Armon
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Simcha Yagel
- Department of Nursing, Jerusalem College of Technology (Dr. Yagel), Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center (Dr. Rottenstreich), Jerusalem, Israel
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3
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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4
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Soh PQ, Cheng C, Reddington C, Dior UP, Healey M. Oophorectomy for ovarian torsion - should this be abandoned? Aust N Z J Obstet Gynaecol 2022; 62:548-552. [PMID: 35246837 DOI: 10.1111/ajo.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Management of ovarian torsion ranges from de-torsion to oophorectomy and is dependent on various factors. Oophorectomy can have significant implications for fertility and general health, thus requiring careful consideration. AIMS We evaluate the management of ovarian torsion at a tertiary hospital over a ten-year period and identify the predictors of oophorectomy in ovarian torsion cases. MATERIALS AND METHODS Inpatient notes of patients who underwent surgical management for acute ovarian torsion at a tertiary hospital in Victoria, Australia, were reviewed, from January 2008 to June 2018. We reported the incidence and predictors of oophorectomy and ovarian ischaemia and current practices in oophoropexy. RESULTS Our analysis included 159 patients. The incidence of oophorectomy was 47%. After confounders were adjusted, increasing age was the only significant predictor for oophorectomy. The adjusted odds ratio of having an oophorectomy based on age alone was 1.10 for each year increase in age between the ages of 15 and 68 (P = 0.001, 95% confidence interval 1.04-1.16). Of those with oophorectomy, 57% had ischaemia confirmed histologically. There were no significant predictors for ischaemia. CONCLUSION The incidence of oophorectomy in this audit is comparable to reported incidences in current literature. However, with increasing evidence to support ongoing ovarian function even in cases where ischaemia is histologically confirmed, this incidence could be lowered. Age was the only variable that was found to have a significant effect on the incidence of oophorectomy.
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Affiliation(s)
- Pei Qian Soh
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Claudia Cheng
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Charlotte Reddington
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Uri P Dior
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Martin Healey
- Gynecology 2 Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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Deneysel İskemi/Reperfüzyon Modelinde İlioprostun Karaciğer Dokusu Üzerindeki Koruyucu Etkisi. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2021. [DOI: 10.21673/anadoluklin.1030797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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6
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Qian L, Wang X, Li D, Li S, Ding J. Isolated fallopian tube torsion with paraovarian cysts: a case report and literature review. BMC WOMENS HEALTH 2021; 21:345. [PMID: 34583677 PMCID: PMC8479896 DOI: 10.1186/s12905-021-01483-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 09/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions. CASE PRESENTATION A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma. CONCLUSION Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy.
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Affiliation(s)
- Liang Qian
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China
| | - Xue Wang
- Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Dingheng Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China.
| | - Songyi Li
- Department of Gynecology, Hangzhou Women's Hospital, Hangzhou, 310008, Zhejiang, China
| | - Jiashan Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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7
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DOKUZEYLÜL GÜNGÖR N, YURCİ A, GÜÇLÜ M. Retrospective analysis of ovarian torsion incidence in 5186 women undergoing controlled ovarian hyperstimulation. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.946002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Martínez Fernández GS, Zomeño Bravo G, Cañete San Pastor P, Ortiz Murillo E, Balanza Chancosa R. Adnexal Torsion: Clinical Presentation and Management of a Retrospective Series of 21 Years. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Gema Zomeño Bravo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
| | | | - Ester Ortiz Murillo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
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9
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Michelis LD, Politch JA, Kuohung W. Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Laura Daniela Michelis
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph A. Politch
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
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10
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Contralateral recurrence of fallopian tube torsion: A case report. Case Rep Womens Health 2021; 30:e00307. [PMID: 33777710 PMCID: PMC7985475 DOI: 10.1016/j.crwh.2021.e00307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
Unilateral lower quadrant pain is a common presenting complaint in the emergency room with a wide differential. It is important to consider fallopian tube torsion in the differential, especially in premenopausal women, as fertility-sparing detorsion, especially in a woman with a previous salpingectomy or other fertility-affecting surgery, is essential. This case report is of a 25-year-old woman with worsening left lower quadrant abdominal pain over 24 h found to have an extraovarian cystic mass. When taking into consideration the patient with a history of contralateral fallopian tube torsion secondary to a paraovarian cyst, now presenting with left lower quadrant abdominal pain and a cystic extraovarian mass, immediate laparoscopic evaluation was warranted. Immediate intervention revealed an isolated fallopian tube torsion and resulted in surgical preservation of fertility. Recurrent paratubal cyst resulting in isolated fallopian tube torsion Immediate fallopian tube detorsion as fertility sparing procedure Gross necrotic appearance of adnexa does not require salpingectomy/oopherectomy.
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11
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Novoa M, Friedman J, Mayrink M. Ovarian torsion: can we save the ovary? Arch Gynecol Obstet 2021; 304:191-195. [PMID: 33638663 DOI: 10.1007/s00404-021-06008-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the correlation between visually appearing ovarian necrosis and necrosis in histopathology in patients with ovarian torsion; and to identify predictive factors of ovarian necrosis. METHODS This is a retrospective study. All women admitted to the hospital with a diagnosis of suspected ovarian torsion from January 2014 to December 2018 were recruited. Forty-two patients with a confirmed diagnosis of ovarian torsion were finally included. Correlation analysis was done between visual judgement of ovarian necrosis and necrosis in histopathology. Chi-square was performed to analyze dependence between time from pain onset to surgery, ovarian size in ultrasound, Doppler flow, and histopathological analysis. RESULTS Thirty-one ovaries were visually judged as necrotic. Only five of them (16%) had histopathologically confirmed necrosis, 20 (64.5%) had hemorrhage or congestion, and 6 (19%) had normal ovarian tissue, p = 0.349. Development of ovarian necrosis showed to be dependent on time from onset of pain to surgery. All patients with necrotic ovaries in histopathology underwent surgery after 24 h of pain onset, while there was no necrosis in those who had surgery before 24 h. (p = < 0.05). There was no relationship between ovarian size measured by ultrasound and necrosis (p = 0.265), as well as color flow in ultrasound and necrosis (p = 0.388). CONCLUSION Visual assessment of ovarian necrosis intraoperatively is not a good predictor of real necrosis in histopathology. To preserve the ovary, surgical management should not be delayed.
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Affiliation(s)
- Maria Novoa
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 2701 Biscayne Boulevard, Number 2101, Miami Beach, FL, 33137, USA.
| | - Jonathan Friedman
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Maximiliano Mayrink
- Department of Obstetrics and Gynecology, Mount Sinai Medical Center, 2701 Biscayne Boulevard, Number 2101, Miami Beach, FL, 33137, USA
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12
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Karaçor T, Dogan Z, Elibol E, Bulbul M, Nacar MC. Effects of iloprost on experimental ischemia and reperfusion injury in rat ovary. Biotech Histochem 2020; 95:373-380. [PMID: 31937143 DOI: 10.1080/10520295.2019.1703219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We investigated the protective effect of iloprost against ischemia/reperfusion (I/R) injury in rat ovary. We used 32 female Sprague-Dawley rats randomly allocated to four experimental groups: sham, ischemia, I/R and I/R + iloprost. Ovarian torsion was established in all rats except the sham group. The torsion group was exposed to ischemia for 3 h. The detorsion group was exposed to 3 h ischemia applied + 3 h reperfusion. The detorsion + iloprost group was exposed to ischemia for 3 h + reperfusion for 3 h + intravenous (IV) iloprost infusion for 60 min starting at the beginning of reperfusion. Ovaries were removed and prepared for histopathological evaluation. Reduced glutathione (GSH) and malondialdehyde (MDA) were measured in the blood. The total histopathological injury score and MDA level of the ischemia group were significantly higher than for the sham group. Ovarian injury score and MDA level following I/R increased compared to the ischemia group. Iloprost administration reduced the total injury score and MDA level. The GSH level was higher in the I/R + iloprost group than in the I/R group. We concluded that IV iloprost administration reduces I/R injury in rat ovarian tissue.
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Affiliation(s)
- T Karaçor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Z Dogan
- Department of Anatomy, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - E Elibol
- Faculty of Medicine Department of Histology and Embryology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - M Bulbul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - M C Nacar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Güney C, Coskun A. A Fifteen-Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series. Diagnostics (Basel) 2019; 9:diagnostics9030110. [PMID: 31487839 PMCID: PMC6787606 DOI: 10.3390/diagnostics9030110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023] Open
Abstract
Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12-17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility.
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Affiliation(s)
- Cengiz Güney
- Cumhuriyet University Medical Faculty, Department of Pediatric Surgery, 58140 Sivas, Turkey.
| | - Abuzer Coskun
- Sivas Numune Hospital, Department of Emergency, 58030 Sivas, Turkey.
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Kives S, Gascon S, Dubuc É, Van Eyk N. No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:82-90. [PMID: 28241927 DOI: 10.1016/j.jogc.2016.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the evidence and provide recommendations on the diagnosis and management of adnexal torsion in children, adolescents, and women. OUTCOMES Elements evaluated include the risk factors, diagnostic accuracy, management options, and outcomes of adnexal torsion. EVIDENCE Published literature was retrieved through searches of MEDLINE, Embase, CINAHL, and the Cochrane Library using appropriate controlled vocabulary and key words ("adnexal torsion," "ovarian torsion"). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and new material incorporated in the guideline to December 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The evidence obtained was reviewed and evaluated by the Canadian Paediatric and Adolescent Gynaecology and Obstetrics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors. Recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. BENEFITS, HARMS AND COSTS Guideline implementation should assist the practitioner in developing an optimal approach to the diagnosis and management of adnexal torsion while minimizing harm and improving patient outcomes. VALIDATION These guidelines have been reviewed and approved by the Gynaecology Committee of the SOGC and approved by the council of the SOGC. SPONSOR The Society of Obstetricians and Gynaecologists of Canada SUMMARY STATEMENTS: RECOMMENDATIONS.
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Warwar RE, Schmidt GE. Bilateral ovarian torsion with ovarian fusion in the setting of polycystic ovarian syndrome: A case report. Case Rep Womens Health 2019; 23:e00129. [PMID: 31431889 PMCID: PMC6580322 DOI: 10.1016/j.crwh.2019.e00129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/24/2022] Open
Abstract
Background Case Conclusion Polycystic ovarian syndrome is a risk factor for ovarian torsion because the ovaries are enlarged and heavy. De-torsion with adnexal conservation is favored over removal of the adnexa because of its high rate of functional preservation. Oophoropexy should be considered for the prevention of recurrence of torsion when there is no removable ovarian pathology.
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16
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Sze A, Fogel J, Grotell L, Tetrokalashvili M. Predictors of Ovarian Torsion: Clinical and Sonographic Characteristics. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angelica Sze
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY
| | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY
| | - Lauren Grotell
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY
| | - Maggie Tetrokalashvili
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, NY
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17
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[Ovarian or tubal ?]. Presse Med 2019; 48:336-339. [PMID: 30853290 DOI: 10.1016/j.lpm.2019.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/28/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022] Open
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Günay T, Yardımcı OD, Hocaoğlu M, Demirçivi Bör E, Erdem G. Over Torsiyonu ve Cerrahi Tedavisi: Tersiyer bir merkezin 5 yıllık deneyimi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2018. [DOI: 10.17517/ksutfd.423102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Uzun Ö, Kaban I, Midi A, Uysal H, Boran AB, Bacanakgil BH, Tarbaghia M. Diagnostic value of signal peptide-CUB-EGF domain-containing protein 1 as an early and late biochemical marker in the ovarian torsion rat model. J Obstet Gynaecol Res 2018; 44:1092-1099. [PMID: 29607598 DOI: 10.1111/jog.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Abstract
AIMS Signal peptide-CUB-EGF (epidermal growth factor-like protein) domain-containing protein 1 (SCUBE1) is an experimental marker of ischemia that has been previously studied both in rat models and humans. In this study, we aim to investigate the importance of SCUBE1 levels in ovarian torsion using an ovarian torsion model in rats. METHODS A total of 18 Sprague-Dawley rats were equally divided into three groups. Group 1 (n = 6) was the Sham group and was only given a laparotomy procedure. Group 2 (n = 6) underwent bilateral ovarian torsion and ovarian ischemia lasting 8 h. Group 3 (n = 6) was subjected to bilateral ovarian torsion and ischemia lasting 24 h. Blood samples were collected from all three groups after the operations, and SCUBE1 levels were studied. Ovarian samples were collected, and microscopic evaluation was performed. The correlation of SCUBE1 levels and histopathological findings were investigated. RESULTS The mean SCUBE1 level of group 3 was statistically higher than other groups (P < 0.01). Follicular degeneration and infiltration of inflammatory cells were, respectively, statistically significant in groups 2 and 3 (P = 0.002 and P = 0.045, respectively). CONCLUSION SCUBE1 can be useful in diagnosing ovarian torsion during the first 24 h, but more randomized controlled studies are necessary in order to implement it in clinical settings.
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Affiliation(s)
- Özgür Uzun
- Gynecology and Obstetrics Clinic, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Işık Kaban
- Gynecology and Obstetrics Clinic, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ahmet Midi
- Department of Pathology, Bahçeşehir University Medical Faculty, Istanbul, Turkey
| | - Hande Uysal
- Department of Medical Student, Bahçeşehir University Medical Faculty, Istanbul, Turkey
| | - Ahmet B Boran
- Gynecology and Obstetrics Clinic, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Besim H Bacanakgil
- Gynecology and Obstetrics Clinic, Istanbul Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Marwa Tarbaghia
- Department of Medical Student, Bahçeşehir University Medical Faculty, Istanbul, Turkey
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Wade TMM, Diagne M, Ba PA, Diao ML, Konaté I. Ovarian Torsion: Report of 27 Cases at Surgical Department of Aristide Le Dantec Teaching Hospital of Dakar, Senegal. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas Marcel Mbar Wade
- General Surgery Department, Aristide Le Dantec Teaching Hospital of Dakar, Dakar, Senegal
- Faculty of Health Sciences, University of Thies, Thies, Senegal
| | - Mohamadou Diagne
- General Surgery Department, Aristide Le Dantec Teaching Hospital of Dakar, Dakar, Senegal
| | | | - Mohamed Lamine Diao
- Department of General Surgery, Gaston Berger University of St. Louis, St. Louis, Senegal
| | - Ibrahima Konaté
- Department of General Surgery, Gaston Berger University of St. Louis, St. Louis, Senegal
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Clinical Predictors of Isolated Tubal Torsion: A Case Series. J Pediatr Adolesc Gynecol 2017; 30:578-581. [PMID: 28571941 DOI: 10.1016/j.jpag.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/02/2017] [Accepted: 05/07/2017] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE A rare cause of adolescent abdominal pain includes isolated tubal torsion (ITT). Presentation is nonspecific and few studies have investigated ITT in adolescents. Our study objective was to describe the presentation and management of ITT in a large case series. DESIGN Retrospective observational case series. SETTING Tertiary care children's hospital. PARTICIPANTS Participants were female and aged 3-21 years, presenting to Children's Hospital Colorado and diagnosed with ITT between January 2004 and August 2015. INTERVENTIONS AND MAIN OUTCOME MEASURES Clinical presentation, physical exam, laboratory findings, surgical diagnosis, and treatment provided. RESULTS A total of 19 cases were included. Average age was 13.3 (range, 11-18) years. In patients with unilateral abdominal pain (n = 16), there was 100% correlation with side of adnexal pathology. Ultrasound examination in 14 of 18 cases (78%) noted abnormal findings ipsilateral to the ITT. Most cases were managed with laparoscopy (84%; n = 16 of 19) and detorsion with or without cystectomy (74%; n = 14 of 19). Salpingectomy was more common with prolonged pain greater than 24 hours (relative risk 5.6, 95% confidence interval, 0.7-39.0). The most common intraoperative finding was a paratubal cyst (74%; n = 14 of 19). When Doppler flow was performed, it was present in 88% (n = 16 of 18) of the affected adnexa. ITT was more common on the left side (68%; n = 13 of 19). CONCLUSION The high occurrence of paratubal cysts might suggest pathologic predisposition for ITT. Providers should maintain a high index of suspicion for ITT, particularly if associated with a paratubal cyst. Classic examination findings of surgical abdomen, leukocytosis, fever, and absence of Doppler flow are infrequently present. Laparoscopy and detorsion are appropriate treatments for managing ITT.
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Kives S, Gascon S, Dubuc É, Van Eyk N. N° 341-Diagnostic et prise en charge de la torsion annexielle chez les filles, les adolescentes et les femmes adultes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:91-100. [DOI: 10.1016/j.jogc.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yildirim A, Yildirim S, Topaloglu N, Tekin M, Kucuk A, Erdem H, Erbas M, Cakir DU. Correlation of ischemia-modified albumin levels and histopathologic findings in experimental ovarian torsion. Turk J Emerg Med 2016; 16:8-11. [PMID: 27239631 PMCID: PMC4882193 DOI: 10.1016/j.tjem.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/11/2015] [Accepted: 07/23/2015] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Ischemia modified albumin (IMA) levels significantly increased and may be used as a diagnostic marker in ovarian torsion. The aim of this study is to investigate whether there was any correlation between IMA levels and histopathologic changes in experimental ovarian torsion. MATERIAL AND METHODS Fourteen Sprague-Dawley rats, each weighing 220-250 g were divided randomly into 2 groups; in Group 1, the control group (n = 7), only laparotomy was performed and in Group 2, the experimental group (n = 7), ovarian torsion was performed. Ischemia was performed for 3 h; following the ischemia period, the torsion was relieved by detwisting the adnexa and then the ovarian I/R protocol was applied for 3 h. Blood samples were taken from all of the rats to measure the IMA levels and the ovaries were surgically removed for histologic examination. A blinded pathologist examined and scored the samples. RESULTS The median (minimum-maximum) IMA values were 921.00 (870.00-966.00) ABSUs in the ovarian torsion group and 853.00 (782.00-869.00) ABSUs in the control group. The difference was statistically significant. In the correlation analysis, a significant and strong correlation was found between IMA levels and histopathologic changes (Spearman's rho = +0.987, p < 0.001). CONCLUSION Positive correlation was found between the IMA levels and the histopathologic severity of the disease. This finding is important for both diagnosis of the disease and patient follow-up. As a new marker in ovarian torsion, IMA may also indicate the severity of the ovarian histopathology.
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Affiliation(s)
- Ahmet Yildirim
- Department of Emergency Medicine, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Sule Yildirim
- Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Naci Topaloglu
- Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Mustafa Tekin
- Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Adem Kucuk
- Department of Pediatric Surgery, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Havva Erdem
- Department of Pathology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mesut Erbas
- Department of Anaesthesiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Dilek Ulker Cakir
- Department of Biochemistry, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Ashwal E, Krissi H, Hiersch L, Less S, Eitan R, Peled Y. Presentation, Diagnosis, and Treatment of Ovarian Torsion in Premenarchal Girls. J Pediatr Adolesc Gynecol 2015; 28:526-9. [PMID: 26168769 DOI: 10.1016/j.jpag.2015.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To describe the clinical characteristics and treatment of ovarian torsion in premenarchal girls with surgically verified ovarian torsion. DESIGN AND PARTICIPANTS A retrospective cohort study design was used. The medical charts of all premenarchal girls with surgically verified ovarian torsion treated in a university-affiliated tertiary medical center from 1997 to 2012 were reviewed for clinical, treatment, and outcome data. RESULTS Thirty-two premenarchal girls were identified. Their median age was 9 years. There were 7 recurrences during the study period (17.9%), for a total of 39 cases. The main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). Physical examination revealed abdominal tenderness in 25 cases (64.1%). Abdominal ultrasound, performed in 31 patients (38 cases), yielded pathologic findings in 28 (73.7%), mainly an enlarged ovary (11 cases, 28.9%). Doppler flow studies were abnormal in 15 cases. In 26 cases (68.4%), the tentative preoperative working diagnosis was ovarian torsion. Laparoscopy was performed in 26 cases, laparotomy in 10, and laparoscopy converted to laparotomy in 3 cases. Conservative management, mainly with additional cyst drainage or cystectomy, was used in 37 cases (95.2%) with oophoropexy in 5 cases. Two patients required oophorectomy because of a suspected neoplasm and severe ovarian necrosis. Pathologic examination demonstrated 5 simple cysts, 1 necrotic ovary, and 1 mature cystic teratoma. CONCLUSIONS Ovarian torsion in premenarchal girls is associated with nonspecific signs and symptoms. Abdominal ultrasound and Doppler imaging may assist in the diagnosis. Laparoscopy with conservative management is preferred. Owing to the high recurrence rate, oophoropexy may be considered.
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Affiliation(s)
- Eran Ashwal
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Hiersch
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saharon Less
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Eitan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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25
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Köleli I. Mean Platelet Volume in Early Diagnosis of Adnexal Torsion. Balkan Med J 2015; 32:410-3. [PMID: 26740902 DOI: 10.5152/balkanmedj.2015.151092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/11/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adnexal torsion (AT) is among the gynecological emergencies; more common in reproductive age, if diagnosed late, this can cause ovarian failure and infertility, but rarely thrombophlebitis and peritonitis. Despite these severe complications, preoperative diagnostic tests are not enough for early diagnosis. There are certain pieces of literature on the subject that reveal changes in mean platelet volume (MPV) values occur in inflammatory and ischemic diseases and that these changes have diagnostic and prognostic significance. However, there are no studies investigating this relationship with adnexal torsion. AIMS The aim of the study is to investigate the diagnostic and prognostic significance of the mean platelet volume value in the early diagnosis of patients with adnexal torsion. STUDY DESIGN Case-control study. METHODS Pre-operative demographic data, MPV, leukocyte count and neutrophils to lymphocytes (N/L) ratio in the blood samples of 51 patients, who were operated on preliminary adnexal torsion and diagnosed as adnexal torsion with a benign ovarian cyst (AT group) were retrospectively compared with those of 50 patients who were operated upon because of benign ovarian cysts and without torsion (control group) at this hospital between 2006 and 2014. RESULTS The mean MPV level was found to be 8.1 (7.1-10.7) fL in the AT group and 7.9 (6.6-10.2) fL in the control group; no statistically significant difference was found between the groups (p>0.05). Leukocyte count and N/L ratio in the AT group were, on average, 12×10(3)/mm(3) and 82% respectively and in control group; they were, on average, 7.2×10(3)/mm(3) and 59%, respectively. A statistically significant increase was found in the leukocyte count and N/L ratio of the AT group compared to the control group (p<0.001). The platelet count in the AT group was, on average, 253×10(3)/mm(3) and in the control group it was, on average, 280×10(3)/mm(3); no statistically significant difference was detected between these two groups (p>0.05). No correlation was detected between the MPV, platelet and leukocyte counts. The sensitivity of the leukocytosis to the AT cases was found to be 66.7%, and selectivity was 94%. CONCLUSION The AT diagnostic and prognostic importance of MPV value has not been determined in this study.
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Affiliation(s)
- Işıl Köleli
- Department of Gynecology and Obstetrics, İnönü University Faculty of Medicine, Malatya, Turkey
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Lacher M, Kuebler JF, Dingemann J, Ure BM. Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 2014; 23:249-56. [PMID: 25459008 DOI: 10.1053/j.sempedsurg.2014.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The evolution of minimally invasive surgery (MIS) in the newborn has been delayed due to the limited working space and the unique physiology. With the development of smaller instruments and advanced surgical skills, many of the initial obstacles have been overcome. MIS is currently used in specialized centers around the world with excellent feasibility. Obvious advantages include better cosmesis, less trauma, and better postoperative musculoskeletal function, in particular after thoracic procedures. However, the aim of academic studies has shifted from proving feasibility to a critical evaluation of outcome. Prospective randomized trials and high-level evidence for the benefit of endoscopic surgery are still scarce. Questions to be answered in the upcoming years will therefore include both advantages and potential disadvantages of MIS, especially in neonates. This review summarizes recent developments of MIS in neonates and the evidence for its use.
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Affiliation(s)
- Martin Lacher
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany.
| | - Joachim F Kuebler
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Benno M Ure
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
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Deffieux X, Thubert T, Huchon C, Demoulin G, Rivain AL, Faivre E, Trichot C. [Complications of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:816-32. [PMID: 24210240 DOI: 10.1016/j.jgyn.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
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Özler A, Turgut A, Soydinç HE, Sak ME, Evsen MS, Alabalik U, Basarali MK, Deveci E. The Biochemical and Histologic Effects of Adnexal Torsion and Early Surgical Intervention to Unwind Detorsion on Ovarian Reserve. Reprod Sci 2013; 20:1349-55. [DOI: 10.1177/1933719113485300] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ali Özler
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Abdulkadir Turgut
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hatice Ender Soydinç
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Muhammet Erdal Sak
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mehmet Sıddık Evsen
- Department of Obstetrics and Gynecology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Ulas Alabalik
- Department of Pathology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Mustafa Kemal Basarali
- Department of Medical Biochemistry, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Engin Deveci
- Department of Histology and Embryology, School of Medicine, Dicle University, Diyarbakır, Turkey
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Huchon C, Panel P, Kayem G, Schmitz T, Nguyen T, Fauconnier A. Does this woman have adnexal torsion? Hum Reprod 2012; 27:2359-64. [DOI: 10.1093/humrep/des186] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1205-1210. [PMID: 21876091 DOI: 10.7863/jum.2011.30.9.1205] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of typical sonographic signs. METHODS The study included 63 women attending an ultrasound unit of a tertiary obstetrics and gynecology department in 2002 through 2008 who had suspected ovarian torsion on sonography and subsequently underwent laparoscopy. RESULTS Sonography had diagnostic accuracy of 74.6% for ovarian torsion. Abnormal ovarian blood flow and the presence of free fluid were the most diagnostically accurate isolated sonographic signs (positive predictive values, 80.0% and 89.2%, respectively; negative predictive values, 46.2% and 46.2%). Using combinations of sonographic signs yielded higher specificity and positive predictive values and lower sensitivity and negative predictive values for ovarian torsion. The diagnostic accuracy was largely affected by the ultrasound operator (mean ± SD, 78.8% ± 16.0%; range, 60.0%-100%). CONCLUSIONS In the setting of a specialized ultrasound unit, sonographic diagnosis of ovarian torsion had high (74.6%) accuracy compared with previous reports. The absence of typical sonographic signs does not rule out ovarian torsion, especially when the clinical presentation is suggestive. Basing assessments on multiple sonographic signs, including Doppler evaluation, increases the diagnostic specificity.
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Affiliation(s)
- Reuven Mashiach
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100 Petach Tikva, Israel.
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Tobiume T, Shiota M, Umemoto M, Kotani Y, Hoshiai H. Predictive Factors for Ovarian Necrosis in Torsion of Ovarian Tumor. TOHOKU J EXP MED 2011; 225:211-4. [DOI: 10.1620/tjem.225.211] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takako Tobiume
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine
| | - Mitsuru Shiota
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine
| | - Masahiko Umemoto
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine
| | - Yasushi Kotani
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine
| | - Hiroshi Hoshiai
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine
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Karayalçın R, Ozcan S, Ozyer S, Var T, Yeşilyurt H, Dumanlı H, Soysal S, Mollamahmutoğlu L, Batıoğlu S. Conservative laparoscopic management of adnexal torsion. J Turk Ger Gynecol Assoc 2011; 12:4-8. [PMID: 24591949 DOI: 10.5152/jtgga.2011.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 12/17/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate our experience with adnexal torsion (AT) in 36 patients and the outcomes of the patients who were managed conservatively via laparoscopy. MATERIAL AND METHODS A prospective study was conducted on 36 patients who underwent operations for AT via laparoscopy between January 2008 and December 2009. Data including age, previous history, time of onset of symptoms, time of admission to hospital, gray-scale and color Doppler US findings, time interval between hospital admission and surgery, type of intervention, operative findings and postoperative gray-scale and Doppler US findings were recorded. RESULTS In 29 (80.5%) patients, a preoperative diagnosis of AT was confirmed clinically. The mean age of the patients was 26.5, with a range of 11 to 44. Ovarian blood flow was assessed by color Doppler US ultrasonography in 30 patients preoperatively. In 11 (36.6%) patients, this was found to be normal. In 19 (63.3%) patients, ovarian blood flow was found to be pathological or absent. Laparoscopic conservative treatment was performed in 34 patients. In two patients, salpingo-oophorectomy was performed. No thromboembolic complications were seen. Postoperative ultrasonographic examinations confirmed normal ovarian morphology and Doppler blood flow in all patients with no recurrence. CONCLUSION Early diagnosis and treatment are key factors in managing AT. According to the results of the present study, given its demonstrated safety and benefits, in women of reproductive age, a conservative approach of untwisting the adnexa and salvaging the ovary via laparoscopy should be considered in AT cases in which the time from the onset of symptoms to surgery does not exceed 44 hours, regardless of the color and number of twists.
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Affiliation(s)
- Rana Karayalçın
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sarp Ozcan
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sebnem Ozyer
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Turgut Var
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hüseyin Yeşilyurt
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hüseyin Dumanlı
- Department of Radiology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sunullah Soysal
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Leyla Mollamahmutoğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Sertaç Batıoğlu
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Serum ischemia-modified albumin as a novel marker of ovarian torsion: An experimental study. Eur J Obstet Gynecol Reprod Biol 2010; 150:72-5. [DOI: 10.1016/j.ejogrb.2010.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 12/29/2009] [Accepted: 01/25/2010] [Indexed: 11/23/2022]
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Huchon C, Fauconnier A. Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 2010; 150:8-12. [DOI: 10.1016/j.ejogrb.2010.02.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/16/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
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Sqalli-Houssaini A, Dafiri R. Imagerie de la torsion de l’ovaire : à propos de 22 cas. IMAGERIE DE LA FEMME 2010. [DOI: 10.1016/j.femme.2009.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best Pract Res Clin Obstet Gynaecol 2009; 23:711-24. [DOI: 10.1016/j.bpobgyn.2009.02.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 11/25/2022]
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Coskun A, Coban YK, Ciralik H. Critical ischemic time for the rat ovary: experimental study evaluating early histopathologic changes. J Obstet Gynaecol Res 2009; 35:330-4. [PMID: 19708179 DOI: 10.1111/j.1447-0756.2008.00874.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to determine a critical ischemic time for ovary in an experimental study in rats. An experimental model using slip-knot tying of all ovarian arteries and veins in cycling female rats was developed. Rat ovaries were tied using the technique through an explorative laparotomy. Complete ischemia times of 1, 2 and 3 h were used for the study. At the end of the ischemic times, the ovaries were harvested following 1 h of reperfusion. Histology indicated a gradually increased congestion correlating with the respective increased ischemic times. According to the present findings 2 h complete ischemia yields a significant injury. The model used in the present study may be used for complete ischemia-reperfusion injury of the rat ovary.
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Affiliation(s)
- Ayhan Coskun
- Department of Obstetrics and Gynecology, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey.
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Dane B, Dane C, Kiray M, Cetin A. Sonographic findings in adnexal torsion: a report of 34 cases. Arch Gynecol Obstet 2008; 279:841-4. [DOI: 10.1007/s00404-008-0835-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
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Singh Y, Shankar A, Dutta S, Chari V. Adnexal Torsion in Second Trimester of Pregnancy. Med J Armed Forces India 2008; 64:193-4. [PMID: 27408137 DOI: 10.1016/s0377-1237(08)80084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 08/25/2007] [Indexed: 11/30/2022] Open
Affiliation(s)
- Y Singh
- Reader (Gynaecology and Obstetrics) & Maternal Foetal Medicine: AFMC, Pune-40
| | - A Shankar
- Graded Specialist (Anaesthesiology), 158 Base Hospital
| | - S Dutta
- Graded Specialist (General Surgery), 158 Base Hospital
| | - Vrr Chari
- Ex Senior Advisor (Anaesthesiology), 158 Base Hospital
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Abstract
This review provides timely information concerning clinical, surgical, and pathologic findings of adnexal torsion (AT). AT mostly occurs in the child-bearing age group, but is not uncommon in premenarchal girls or postmenopausal women. When AT is suspected, urgent surgical intervention is indicated, and is usually performed by laparoscopy. Incidence of AT is 3.5% of all benign cystic teratomas. Despite the "necrotic" appearance of the twisted ischemic ovary, detorsion is the only procedure which should be performed at surgery. Adnexectomy should be avoided as ovarian function is preserved in 88% to 100% of cases. Awareness and suspicion of the diagnosis of AT is needed in patients who present with lower abdominal pain.
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