FIGS 1, 2, 3 1
the twisted side, smooth wall thickening of the twisted adnexal cystic mass, peripheral cystic mass, and ascites.
DIFFERENTIAL DIAGNOSIS
2
Ovarian torsion should be considered in any girl or woman with lower abdominal pain and an adnexal mass, especially if there is nausea and/or vomiting present. Other diagnostic possibilities include ectopic pregnancy, ruptured or hemorrhagic cysts, appendicitis, pelvic inflammatory disease, degenerating leiomyoma, and endometriosis.
SURGICAL MANAGEMENT Expedient operative evaluation is important when ovarian torsion is suspected. Subsequent management depends upon intraoperative findings and patient age. Surgical treatment by laparoscopy or laparatomy should take place as an emergency. Cohen et al. made a retrospective
3
comparison of laparoscopy and laparatomy for the treatment of 102 torsions: 67 patients underwent laparoscopy and 35 underwent laparatomy. None of the patients suffered from any post-operative thromboembolic complications. There was no significant difference between the two groups in ovarian function or in the macroscopic appearance of the ovaries when secondary surgery took place. The only difference between the two groups was that the hospital stay was shorter in the case of laparoscopy (2.1 days vs. 7.4 days; p < 0.001). So there would not appear to be any advantage to be carrying out laparotomy when laparoscopy is not contra-indicated. Conservative treatment consists of untwisting the adnexa, potentially followed by a procedure with no adverse effect on fertility: puncture of a cyst or intra- peritoneal cystectomy.
The main hesitation concerning
in a prospective study of 199 women with pelvic pain. In general, neither the presence nor absence of Doppler flow found not to be diagnostically useful in children. However, Doppler can only diagnose interruptions of the arterial flow and cannot diagnose venous flow interruptions, which often precede arterial interruptions. So a normal Doppler result cannot exclude the diagnosis of adnexal torsion.
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MRI and CT MRI and CT may have limited value when Doppler ultrasound findings are equivocal, but the cost and time required for these imaging studies likely does not justify their routine use. Furthermore, the diagnostic criteria for torsion using these modalities have not been well defined or validated in large studies. CT features suggestive of adnexal torsion include enlarged ovary, uterine deviation toward
conservative treatment consists of the theoretical fear of thromboembolic complications secondary to untwisting of ischaemic adnexa. However, the incidence of pulmonary embolism in the case of adnexal torsion is 0.2%. This incidence is no greater after untwisting. No increase in the number of thromboembolic complications after untwisting is evident from the literature. The rate of adnexectomy in literature
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