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Marwaha PD, Kaundal A, Bhavna, Malik N, Kaushal S. Ovarian Torsion in a Postmenopausal Woman: A Case Report and Review of Literature. J Menopausal Med 2023; 29:134-138. [PMID: 38230597 PMCID: PMC10796202 DOI: 10.6118/jmm.23022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Poojan Dogra Marwaha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
| | - Asmita Kaundal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India.
| | - Bhavna
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
| | - Nisha Malik
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
| | - Sushruti Kaushal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
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Homewood LN, Dave ED, Ali R, Mallawaarachchi IV, Ratcliffe SJ, Balasubramani G, Lee TT. Risk Factors Associated with Adnexal Torsion after Hysterectomy. J Minim Invasive Gynecol 2022; 29:250-256. [PMID: 34400354 PMCID: PMC8837652 DOI: 10.1016/j.jmig.2021.08.006] [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: 02/18/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery. DESIGN Retrospective nested case-control study. SETTING Large urban medical system. PATIENTS Eighty-nine female patients ages 17 to 51. INTERVENTIONS Patients underwent ovarian-sparing hysterectomy. MEASUREMENTS AND MAIN RESULTS The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic or laparoscopic-assisted approach to hysterectomy vs any other approach (odds ratio [OR], 3.36; 95% confidence interval [CI], 0.86-13.23); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR, 3.45; 95% CI, 1.33-8.97); and a gynecologic history significant for endometriosis (OR, 4.07; 95% CI, 1.04-15.88). CONCLUSION There is an association between laparoscopic approach to hysterectomy, younger age at time of hysterectomy, and a history of endometriosis with subsequent risk of adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.
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Affiliation(s)
- Laura N. Homewood
- Department of Obstetrics and Gynecology, University of Virginia Health, Charlottesville, VA
| | - Eesha D. Dave
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Riyas Ali
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Indika V. Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA
| | - Sarah J. Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA
| | - Goundappa.K Balasubramani
- Department of Epidemiology, and Clinical and Translational Science Institute, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Ted T.M. Lee
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA
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Vicente AP, Gomes AS, Jokubkiene L, Sladkevicius P. Ovarian borderline tumor presenting as ovarian torsion in a 17-year-old patient: a case report. J Med Case Rep 2021; 15:7. [PMID: 33436080 PMCID: PMC7802186 DOI: 10.1186/s13256-020-02597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ovarian torsion is a gynecological surgical emergency whose diagnosis remains a challenge. Torsion occurs most frequently in women of reproductive age. It is usually associated with the presence of benign masses in the ovary, as malignant tumors are less frequent and less prone to undergo torsion. Case presentation We report the case of a 17-year-old Caucasian patient who presented to the emergency department with lower abdominal pain. Ultrasonography evaluation revealed a unilateral ovarian lesion, 11.2 cm, with features suspicious for malignancy and torsion. The patient was referred for surgical torsion treatment and underwent unilateral salpingo-oophorectomy. The pathology report confirmed a serous borderline ovarian tumor with torsion. Conclusions Malignant ovarian torsion in pediatric age groups is rare. Ultrasound examination should be recognized as a powerful tool for diagnosis and management, especially when performed by an experienced ultrasonographer.
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Affiliation(s)
- Ana Patrícia Vicente
- Department of Obstetrics and Gynecology, Hospital de Cascais - Dr. José de Almeida, Lisbon, Portugal
| | - Andrea Sousa Gomes
- Department of Obstetrics and Gynecology, Hospital de Cascais - Dr. José de Almeida, Lisbon, Portugal
| | - Ligita Jokubkiene
- Mälmo Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Mälmo, Sweden
| | - Povilas Sladkevicius
- Mälmo Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Mälmo, Sweden.
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The effect of folate on ischemia/reperfusion injury in a rat adnexal torsion model. Arch Gynecol Obstet 2021; 303:1495-1500. [PMID: 33399929 DOI: 10.1007/s00404-020-05934-3] [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: 06/28/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The ischemia/reperfusion (I/R) injury of ovaries in adnexal torsion may have inadvertent consequences. Many agents have been studied in terms of their ability to prevent reperfusion damage to ovaries in suspected cases. In this study, folic acid, known to have antioxidative properties, was investigated to determine whether it played a role in the prevention of I/R damage in a rat ovarian torsion model. METHODS In this experimental study, 40 female adult Wistar-Albino rats were randomly divided into five groups as control, ischemia, I/R, Fol2 (2 mg/kg folic acid), and Fol4 (4 mg/kg folic acid). In the Fol2 and Fol4 groups, folic acid was intraperitonelly administered 30 min before reperfusion. Blood samples were obtained from the tails of each rat at the second hour of reperfusion. RESULTS The total oxidant status (TOS), total antioxidant status, cystatin C and folic acid levels of the five groups were investigated. Folic acid in 2 mg/kg dose could moderately increase the serum folic acid concentration (15.75-19.95 ng/ml, p < 0.05), reduce the level of cystatin C (0.18-0.12 μg/L, p < 0.05), and had a tendency to improve the oxidative stress injury (OSI: 76.05-33.06, p > 0.05), although there was no statistical difference in TOS levels (p = 0.07). Folic acid in 4 mg/kg dose, could significantly increase the serum folic acid concentration (15.75-37.65 ng/ml). However, it did not significantly reduce the level of cystatin C (0.18-0.19 μg/L, p > 0.05), and did not improve oxidative stress injury (76.05-130.58, p > 0.05). CONCLUSION Folic acid in 2 mg/kg dose might improve the ovarian I/R injury though this was not statistically significant. Further studies are required to reach a definitive conclusion about the protective effect of folic acid in I/R injury.
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Seo SK, Lee JB, Lee I, Yun J, Yun BH, Jung YS, Chon SJ. Clinical and pathological comparisons of adnexal torsion between pregnant and non‐pregnant women. J Obstet Gynaecol Res 2019; 45:1899-1905. [DOI: 10.1111/jog.14057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Seok K. Seo
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Jun B. Lee
- Department of Emergency MedicineYongin Severance Hospital, Yonsei University College of Medicine Yongin Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Bo H. Yun
- Department of Obstetrics and Gynecology, Severance HospitalYonsei University College of Medicine Seoul Republic of Korea
- Institute of Women's Life Medical Science Seoul Korea
| | - Yeon S. Jung
- Department of Obstetrics and Gynecology, Wonju Severance Christian HospitalYonsei University College of Medicine Wonju Korea
| | - Seung J. Chon
- Department of Obstetrics and Gynecology, Gil HospitalGachon University College of Medicine Incheon Korea
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Grunau GL, Harris A, Buckley J, Todd NJ. Diagnosis of Ovarian Torsion: Is It Time to Forget About Doppler? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:871-875. [DOI: 10.1016/j.jogc.2017.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 10/17/2022]
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Abstract
ABSTRACTOvarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females.
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Affiliation(s)
- Chris Martin
- Faculty of Medicine, University of Western Ontario, London, Ont
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Bharathan R, Ramsawak L, Kelly A. Ovarian torsion: Opportunities to improve clinical management. J OBSTET GYNAECOL 2012; 32:683-6. [DOI: 10.3109/01443615.2012.698331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F. Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol 2012; 162:203-5. [DOI: 10.1016/j.ejogrb.2012.02.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/29/2011] [Accepted: 02/29/2012] [Indexed: 11/29/2022]
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Alouini S, Mesnard L, Coly S, Dolique M, Lemaire B. [Gynecological emergencies: etiology and degree of gravity]. ACTA ACUST UNITED AC 2011; 41:48-54. [PMID: 21944576 DOI: 10.1016/j.jgyn.2011.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/20/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the type and the emergency degree of the pathologies met in gynecological emergencies. METHODS prospective study including 205 patients presented to the Emergency department of a maternity level 3 between the 2011 January 4 and February 15. RESULTS One hundred and ninety-four patients (95%) came from their own initiative. One hundred and eighty-one patients (88%) consulted for abdominal/pelvic or lumbar pain and or metrorragia. The mean age of the patients was of 31 ± 11 years and the average waiting time before being examined was of 84 ± 101 minutes. For 94 patients (46%), the diagnosis was an asymptomatic intra-uterine pregnancy in 41 cases or associated with minor symptoms. 21 patients (8.9%) consulted for menstruation with or without dysmenorrhea, 17 (8,3%) had a miscarriage, 14 (7%) a genital infection, 11 (5%) an ovarian pathology and eight (4%) an ectopic pregnancy or its follow-up. Seven patients had an axillary lymphocele or a breast tumor and four symptomatic myomas. Six patients presented with non-gynecological pathologies. In 23 cases (11%) no organic cause was found. Only 24 patients (12%) were hospitalized and nine (4.5%) operated. CONCLUSION Most of the patients consulted for minor obstetrical or gynecological pathologies without relation with the function of Emergency department. Ectopic pregnancy remains a rare event. Better information of the users on the significance of the urgency is desirable. Consultation of a referent physician before emergency services should be privileged.
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Affiliation(s)
- S Alouini
- Département de chirurgie gynécologique et obstétrique, CHR Orléans, 1, Porte-Madeleine, 45000 Orléans, France.
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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: 86] [Impact Index Per Article: 6.6] [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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Cicchiello LA, Hamper UM, Scoutt LM. Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am 2011; 38:85-114, viii. [PMID: 21419329 DOI: 10.1016/j.ogc.2011.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Ultrasound should be considered the first-line imaging modality of choice in women presenting with acute or chronic pelvic pain of suspected gynecologic or obstetric origin because many, if not most, gynecologic/obstetric causes of pelvic pain are easily diagnosed on ultrasound examination. Since the clinical presentation of gynecologic causes of pelvic pain overlaps with gastrointestinal and genitourinary pathology, referral to CT or MRI, especially in pregnant patients, should be considered if the US examination is nondiagnostic.
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Affiliation(s)
- Lawrence A Cicchiello
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA.
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Abstract
Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. Ovarian torsion and degenerating fibroids occur less frequently. Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.
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Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010; 93:2012-5. [DOI: 10.1016/j.fertnstert.2008.12.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/04/2008] [Accepted: 12/11/2008] [Indexed: 11/19/2022]
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Tandulwadkar S, Shah A, Agarwal B. Detorsion and conservative therapy for twisted adnexa: our experience. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2009; 1:21-6. [PMID: 22442506 PMCID: PMC3304263 DOI: 10.4103/0974-1216.51905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: 1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa. Design: Prospective Study from September 2004 to September 2008. Setting: Private IVF and Endoscopy Centre. Patients: 22 patients with twisted adnexa (15 non-pregnant and 7 pregnant). Intervention: Surgical intervention and either detorsion of adnexa or adnexectomy. Main Outcome Measures: Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently. Results: We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function. Conclusion: Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.
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Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:7-13. [PMID: 18096725 DOI: 10.7863/jum.2008.27.1.7] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the most closely associated sonographic and clinical characteristics of ovarian torsion. METHODS The medical records and sonographic studies of 39 patients with pathologically proven ovarian torsion diagnosed at our institution from July 1, 2000, through December 31, 2005, were retrospectively reviewed. The volumes of the affected ovaries and ovary/mass complexes were compared with an age-appropriate standard. Statistical significance of the data was assessed by a likelihood ratio chi(2) analysis. RESULTS All patients (100%) had a chief symptom of abdominal pain. Thirty-three (85%) reported vomiting; 22 (56%) had leukocytosis; and 7 (18%) had a documented elevated temperature. All affected ovaries and ovary/mass complexes were enlarged. Twenty-one (54%) had arterial flow on Doppler interrogation, and 18 (46%) had no arterial flow. Thirteen (33%) had venous flow, and 26 (67%) had no venous flow. Differences in the arterial and venous flow patterns between the premenarchal and reproductive age groups were not statistically significant. CONCLUSIONS Abdominal pain, vomiting, ovarian enlargement, and absence of ovarian venous Doppler flow are the most frequently shown clinical and sonographic indicators of ovarian torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement regardless of the presence or absence of an ovarian Doppler signal.
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Affiliation(s)
- Libby L Shadinger
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA
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Abstract
PURPOSE OF REVIEW This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function. RECENT FINDINGS This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion. The role of oophoropexy in the pediatric and adolescent population is also reviewed. SUMMARY The discussion reinforces the role of detorsion in lieu of oophorectomy or adnextomy in an effort to preserve reproductive capacity in a young population. Long-term follow-up, including reproductive outcomes, is needed to determine the role of oophoropexy.
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Affiliation(s)
- Lesley L Breech
- Department of Pediatrics, Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Abstract
A 2-month-old infant girl died suddenly as a result of torsion of the uterine adnexa. The infant was found unresponsive in bed and was pronounced dead shortly after her arrival at a hospital. There were no antecedent signs of illness. At autopsy, the right ovary and right fallopian tube were twisted and were dark purple, swollen, and necrotic. The right ovary was enlarged by a follicle cyst 4 cm in diameter, which likely precipitated the torsion. The mechanism of death was unclear but may have resulted from the release of cytokines produced in response to necrotic adnexal tissue. Fatal uterine adnexal torsion has been reported rarely in infants; in all those cases there were antecedent symptoms. Torsion of the uterine adnexa should be included in the differential diagnosis of sudden death in infancy.
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Affiliation(s)
- Dean M Havlik
- Office of Medical Investigator, University of New Mexico Health Science Center, Alburquerque, New Mexico 87131, USA.
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Abstract
STUDY OBJECTIVE Our purpose was to describe the history, physical, and laboratory findings in women with ovarian torsion (OT). METHODS A retrospective chart review was conducted at 2 urban teaching hospitals. All women admitted from 1984 to 1999 with surgically proven OT were included in the study. RESULTS The 87 women ranged in age from 14 to 82 years (mean 32 years). Twelve were pregnant, 15 were postmenopausal, and 7 were posthysterectomy. Thirty-five (40%) had prior pelvic surgery; 18 of these (21% of the total) had undergone tubal ligation. Twenty-two (25%) women had a history of an ovarian cyst. Sixty-five (75%) patients were seen in the emergency department. Pain characteristics were variable: the onset was sudden in 51 (59%); "sharp" or stabbing in 61 (70%); and radiated to the flank, back, or groin in 44 (51%) patients. Only 3 had peritoneal signs at presentation. The majority of patients (70%) had nausea or vomiting. Fever was rare (2 patients). OT was considered in the admitting differential diagnosis in 41 (47%) patients. An enlarged ovary (>5 cm) was found in 77 (89%) patients at surgery. Only 26 patients had surgery within 24 hours. In 8 (9%) patients, detorsion was possible; of these, 3 had surgery within 24 hours. CONCLUSION The diagnosis of OT is often missed and ovarian salvage is rare. Pain characteristics are variable and objective findings are uncommon in OT.
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Affiliation(s)
- D Houry
- Emergency Medicine Residency, Denver Health Medical Center, 601 Broadway, Denver, CO 80204, USA
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Meschengieser SS, Alberto MF, Salviú J, Bermejo E, Lazzari MA. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit. Blood Coagul Fibrinolysis 2001; 12:207-9. [PMID: 11414635 DOI: 10.1097/00001721-200104000-00007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.
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Affiliation(s)
- S S Meschengieser
- Departamento de Hemostasia y Trombosis, Instituto de Investigaciones Hematológicas Mariano R. Castex, Academia Nacional de Medicina, Buenos Aires, Argentina.
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Tarraza HM, Moore RD. Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy. Surg Clin North Am 1997; 77:1371-94. [PMID: 9431345 DOI: 10.1016/s0039-6109(05)70623-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Evaluation of a female patient who presents with an acute abdomen must always consider surgical and gynecologic disorders. Laparoscopy and pelviscopy have had a major impact on the surgical approach in gynecology. Most acute abdomens can now be approached laparoscopically. Certain conditions that are discussed require the traditional laparotomy. Preservation of reproductive capability has a major impact on the wellness of a woman.
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Affiliation(s)
- H M Tarraza
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, USA
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O'Brien PM, DiMichele DM, Walterhouse DO. Management of an acute hemorrhagic ovarian cyst in a female patient with hemophilia A. J Pediatr Hematol Oncol 1996; 18:233-6. [PMID: 8846148 DOI: 10.1097/00043426-199605000-00031] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This case report represents a description of a hemorrhagic ovarian cyst in a patient with hemophilia A. PATIENT An 18-year-old female patient with severe factor VIII deficiency presented with the acute onset of a hemorrhagic ovarian cyst, meeting the standard indications for surgical intervention. Instead, because of the underlying coagulopathy, factor VIII therapy was instituted. RESULT Within 1 day of starting the factor VIII therapy, the hemorrhage had clinically resolved and surgical intervention was avoided. CONCLUSIONS Hemorrhagic ovarian cysts in the setting of hemophilia may respond to factor VIII replacement therapy without the need for surgical intervention. Because the incidence of functional ovarian cysts is high in the general population, female patients with hemophilia should be counseled regarding its possibility of occurrence. Moreover, if a female patient with hemophilia displays a propensity toward the development of ovarian cysts, the administration of prophylactic oral contraceptive pills should strongly be considered.
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Affiliation(s)
- P M O'Brien
- Division of Pediatric Hematology/Oncology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614, USA
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