Adnexal torsion: a review of diagnosis and management strategies

Nomogram prediction model based on non-enhanced computed tomography for adnexal torsion: A retrospective multicenter study

OBJECTIVE

To develop and validate an individualized nomogram for predicting adnexal torsion in women with abdominal pain and an adnexal mass based on preoperative non-contrast computed tomography (CT) findings.

METHODS

This retrospective study included 200 women with surgically resected ovarian lesions who underwent preoperative non-contrast CT for abdominal pain from January 2017 to September 2023 in seven hospitals. The 200 patients were randomly divided into a development group (140 cases) and a validation group (60 cases). The independent risk factors for adnexal torsion from non-contrast CT signs were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The areas under the receiver operating characteristic curves (AUC) and the calibration plots were used to estimate the discrimination and calibration of the prediction model, respectively.

RESULTS

The most common lesion causing adnexal torsion was ovarian cyst (30.1%), followed by mature cystic teratoma (25.7%), whereas malignant tumors and tubo-ovarian abscesses were more common in non-torsioned patients. Multivariable regression analysis showed that navel sign (odds ratio [OR] 14.78; P = 0.005), whirl sign (OR 38.05; P = 0.002), and peri-adnexal fat haziness (OR 0.20; P = 0.012) were independent significant parameters predicting adnexal torsion. The AUC of the development group and validation group were 0.903 and 0.861, respectively, and the calibration curve suggested good agreement between the predictive probability and the actual probability.

CONCLUSION

Navel sign, whirl sign, and peri-adnexal fat haziness, and an integrated nomogram derived from these non-contrast CT findings, can be useful for predicting adnexal torsion, especially when ultrasound and contrast-enhanced CT cannot be used.

Comparison of characteristics and outcomes of premenopausal and postmenopausal women with adnexal torsion

OBJECTIVE

This study aimed to compare the clinical characteristics and surgical and histological outcomes of premenopausal and postmenopausal patients with adnexal torsion.

METHODS

The electronic medical records of 278 patients with adnexal torsion proven by surgery were retrospectively reviewed from January 2012 to November 2023 in our hospital. The patients were divided into two groups (premenopausal and postmenopausal).

RESULTS

The study included 226 (81.3%) premenopausal patients and 52 (18.7%) postmenopausal patients. The incidence of the most common symptoms (i.e., abdominal pain, nausea and/or vomiting) was not different between the two groups. However, the postmenopausal group had a longer interval from the onset of pain to admission, a larger size of adnexal mass, a longer operation time, more blood loss, and a longer hospital stay than the premenopausal group. Regarding the procedure, the premenopausal group underwent more conservative procedures than the postmenopausal group. The most common pathological findings in the two groups were benign tumors and tubal pathology The malignancy rate was similar in the two groups.

CONCLUSIONS

Premenopausal and postmenopausal women with adnexal torsion had similar main symptoms, such as abdominal pain and nausea and vomiting. However, the surgical and histological outcomes varied between these groups of women.

Influence of ovarian torsion on reproductive outcomes and mode of delivery

Purpose

To investigate differences in reproductive outcomes among patients before and following ovarian torsion.

Study design

In this retrospective cohort study, we investigated the reproductive outcomes of patients who underwent surgery for ovarian torsion between 1988 and 2015 in a tertiary medical center. Data on deliveries before and after ovarian torsion were compared.

Results

During the study period, 199 women underwent surgery due to ovarian torsion. The majority (91.4%; n = 182) underwent detorsion, and 8.6% (n = 17) underwent unilateral adnexectomy. At the time of the torsion, 27.6% (n = 55) of patients were pregnant. Among women who suffered from ovarian torsion, about half (52%) of the deliveries occurred before the torsion and 48% following the torsion. No significant difference in the live birth rate was noted (p = 0.19). The fertility treatment rate in our cohort was 7.5% before and 5% after the torsion (p = 0.01). In addition, live birth, cesarean delivery, and fertility treatment rates were similar in women who underwent detorsion vs. those who had adnexectomy.

Conclusion

Surgically treated ovarian torsion does not appear to negatively influence fertility and live birth potential.

Ovarian Torsion in Polycystic Ovary Syndrome: A Potential Threat?

Polycystic ovary syndrome (PCOS) constitutes the most prevalent endocrine disorder in women of reproductive age worldwide. Given the increased risk of ovarian torsion in the presence of large ovarian cysts, polycystic ovarian syndrome could be regarded as one of the most significant risk factors for ovarian and/or adnexal torsion in cases of significantly enlarged ovaries. The aim of the present review is to investigate, for the first time, the association between polycystic ovarian syndrome and ovarian torsion. We performed a review of the literature using the MEDLINE and LIVIVO databases in order to find relevant studies. By using the search terms "polycystic ovarian syndrome" and "ovarian torsion", we were able to identify 14 studies published between 1995 and 2019. The present work constitutes the most up-to-date, comprehensive literature review focusing on the risk of ovarian/adnexal torsion in patients with polycystic ovaries. Ovarian/adnexal torsion seems to be a feared complication in patients with polycystic ovary syndrome. Acute lower abdominal pain in patients with known polycystic ovaries represents the most common symptom, while diagnostic assessment almost always incorporates transvaginal ultrasound and computer tomography or magnetic resonance tomography scans. In case of suspected torsion, emergency laparoscopy with ovarian or adnexal detorsion seems to be the standard therapeutic approach with a view to restitute the interrupted blood supply. In cases of repeated ovarian/adnexal torsions, ovariopexy or ovariectomy/adnexectomy had to be discussed with the patient in the context of risk recurrence minimization.