Adnexal torsion

Adnexal torsion

An adnexal torsion is commonly the result of an ovary , and occasionally a fallopian tube, twisting along its pedicle and interrupting its arterial supply , leading to ischaemia. Rapid identification and intervention are necessary to preserve ovarian function. Table 87.3 lists the presenting character - istics, recommended investigations and management options of an ovarian torsion. /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - /uni25CF e best /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 87.3 Presenting characteristics, recommended investigations and management options of an ovarian torsion. Characteristics Symptoms and Abdominal pain (sudden onset) signs Nausea/vomiting Diarrhoea Abdominal/pelvic tenderness Palpable adnexal mass Signs of peritonism Non-speci /f_i c and, therefore, a high clinical suspicion is necessary Risk factors Enlarged ovary, e.g. cyst Para-ovarian cyst Hydrosalpinx Previous torsion Investigations Ultrasound Unilateral ovarian enlargement and ovarian tissue oedema, with less de /f_i ned borders. Comparison with the contralateral ovary will show a distinct difference Peripheral displacement of follicles; follicular ring sign Central placement of the ovarian/adnexal mass in the suprapubic region The affected ovary may appear as a solid mass with hypo- and hyperechoic areas, in keeping with haemorrhage and necrosis The pedicle that is twisted may be seen as a ‘whirlpool’ that is visible both in grey

scale and on colour Doppler Abnormal Doppler signals, e.g. coiling of the ovarian vessels (early/subacute), complete absence of perfusion (late) Free /f_l uid in the pelvis Bloods Raised in /f_l ammatory markers (can also be normal) Management Laparoscopy Detorsion ( Figure 87.10 ) Ovarian cystectomy to be performed at the same time or at a later date once the ovary is reperfused and the degree of oedema has diminished to reduce the likelihood of an oophorectomy

Figure 87.10 Laparoscopic image of ovarian torsion.