Mesut POLAT, Taylan ŞENOL, ADNAN İNCEBIYIK, Enis ÖZKAYA, İlhan ŞANVERDİ, Evrim BOSTANCI, Egemen AYDIN, Ateş KARATEKE

Gebelik sırasında adneksiyal torsiyon nedeniyle tedavi edilen 14 olgunun retrospektif analizi

Amaç: Gebelik sırasında adneksiyal torsiyon saptanarak tedavi edilen hastaların klinik karakteristiklerini değerlendirmek. Yöntemler: 1 Ocak 2011 ile 30 Ekim 2015 tarihleri arasında hastanemizde cerrahi ile tedavi edilen 14 adneksiyal torsiyonlu gebenin medikal kayıtları tarandı. Hastaların medikal kayıtlarından elde edilen demografik verilerin yanı sıra, hastaların hastaneye geliş şikâyetleri, muayene bulguları, ultrasonografik bulguları, cerrahi tedavi şekilleri (detorsiyon, kistektomi), histopatolojik sonuçları, doğum şekli ve doğum komplikasyonları not edildi. Bulgular: Çalışmaya dâhil edilen gebelerin yaş ortalaması 27,8 ± 3,9 yıl, gravida ortalaması 2,8 ± 1,8, gebelik haftası 14.4 olarak saptandı. En sık saptanan şikâyet pelvik ağrı iken, ardından bulantı ve kusma olarak tespit edildi. Tüm gebelere abdominal ultrasonografi yapıldığı ve tespit edilen adneksiyal kitle volümünün ortalama 48,4 ± 12,1 cm2 olduğu görüldü. Tüm gebelere doppler ultrasonografinin yapıldığı ve en sık rastlanılan bulgunun ovaryan kan akımında azalma olduğu gözlendi. 14 hastanın üçü- ne laparoskopik, geriye kalan 11 hastaya ise laparatomi yapıldığı tespit edildi. Tedavi olarak 10 hastaya detorsiyon-kistektomi, üç hastaya detorsiyon, bir hastaya ise detorsiyon sonrası ovaryan kan akımının düzelmemesi ve belirgin nekroz görünümü nedeniyle salpingo-ooferektomi uygulandı. Histopatolojik sonuç olarak en sık tespit edilen bulgu matur kistik teratom idi. Hiçbir hastamızda operatif girişime bağlı komplikasyon gözlenmedi. Sonuç: Gebelik sırasında akut batın kliniği ile başvuran hastalarda ayırıcı tanıda adneksiyal torsiyon mutlaka akılda tutulmalıdır. Erken tanı ve tedavi organ koruyucu cerrahi yapılması açısından hayati öneme sahiptir.

Retrospective analysis of 14 patients who managed for adnexal torsion during pregnancy

Objective: To assess some clinical characteristics of patients who were treated for adnexal torsion during pregnancy. Methods: Medical records of 14 pregnant women with adnexal torsion who were surgically treated at our hospital between 1st January 2011 to 30th October 2015 were screened. In addition to the demographic features obtained from medical records, presenting complaints, physical examination and ultrasonographic findings, type of surgery, histopathologic findings, route of deliveries and complications were all recorded. Results: Mean age of patients included in the study was 27.8 ± 3.9 years, mean gravidity was 2.8 ± 1.8 and mean gestational age was 14.4 weeks. Most commonly seen complaint was pelvic pain followed by emesis and vomiting. All participants underwent abdominal surgery showing an adnexal mass with a mean volume of 48.4 ± 12.1 cm2. Also all participants underwent Doppler ultrasound assessment showing decreased ovarian blood flow. Among 14 patients, 3 of them were managed by laparoscopy while remaining was treated by laparotomy. Detorsion and cystectomy were performed in 10 patients while detorsion was performed in 3 patients, in 1 patient after detorsion no blood flow was observed therefore salpingooophorectomy was performed due to overt necrotic appearance. Most commonly seen histopathologic type was mature cystic teratoma. No operative complication was observed. Conclusion: Adnexal torsion should be kept in mind in pregnant presenting with acute abdominal pain. Early diagnosis and treatment are important for organ preserving surgery.

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Incebiyik A, Camuzcuoglu A, Hilali NG, et al. Plasma Ddimer level in the diagnosis of adnexal torsion. J Matern Fetal Neonatal Med 2015;28:1073-1076.
Hasiakos D, Papakonstantinou K, Kontoravdis A, et al. Adnexal torsion during pregnancy: Report of four cases and review of the literature. J Obstet Gynaecol Res 2008;4:683 687.
Kolluru V, Gurumurthy R, Vellanki V, Gururaj D. Torsion of ovarian cyst during pregnancy: a case report. Cases J 2009;2:9405-9407.
Ashwal E, Krissi H, Hiersch L, et al. Presentation, diagnosis, and treatment of ovarian torsion in premenarchal girls. J Ped Adoles Gynecol 2015;28:526-529.
Vijayalakshmi K, Reddy GM, Subbiah VN, et al. Clinicopathological profile of adnexal torsion cases: a retrospective analysis from a tertiary care teaching hospital. J Clin Diagn Res 2014;8:OC04-7.
Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010;202:536-539.
Born C, Wirth S, Stäbler A, Reiser M. Diagnosis of adnexal torsion in the third trimester of pregnancy: a case report. Abd Imag 2004;29:123-127.
Zainuddin ZRB, Sulaiha S, Azmi M. Acute appendicitis in pregnancy: a diagnostic and management challenge. Int Med J Mal 2014;13:1-3.
Mathevet P, Nessah K, Darget D, Mellier G. Laparoscopic management of adnexal masses in pregnancy. Eur J Obstet Gynecol Reprod Biol 2003;108:217222.
Bider D, Mashiach S, Dulitzky M, et al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and non-pregnant women. Surg Gynecol Obstet 1991;173:363- 366.
Smorgick N, Pansky M, Feingold M, et al. The clinical characteristics and sonographic findings of maternal ovarian torsion in pregnancy. Fertil Steril 2009;92:1983-1987
Prefumo F, Ciravolo G. Adnexal torsion in late pregnancy. Arch Gynecol Obstet 2009;280:473474.
Chang SD, Yen CH, Lo LM, et al. Surgical intervention for maternal ovarian torsion in pregnancy. Taiwan J Obstet Gynecol 2011;50:458-462.
Pena JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 2000;73:1047-1040.
Ekin M, Kaya C, Cengiz H, et al. A rare case: ruptured ectopic pregnancy with contralateral adnexal torsion. Bakırköy Tıp Der 2015;11:29-32.
Rabinerson D, Tohar M, Pomerantz M, Haimovich L. Persistence of a normal pregnancy after an early luteectomy. A report of two cases. J Reprod Med 1992;37:749-752.
Vural F, Vural B, Çakıroğlu Y. A Case of adnexial torsion during pregnancy: shortcomings in Doppler ultrasonography. CausaPedia 2015;4:978-982.
Ventolini G, Hunter L, Drollinger D, Hurd W. Ovarian torsion during pregnancy. Res Staff Phys 2005;51:26-30.
McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv 1999;54:601-608.
Ekin M, Yaşar L, Özdemir İA, İdil S. The management of adnexal torsion: ovaries can be saved by early diagnostic laparoscopy and detorsion. Bakırköy Tıp Der 2011;7:125- 129.
Eckler K, Laufer MR, Perlman SE. Conservative management of bilateral asynchronous adnexal torsion with necrosis in a prepubescent girl. J Pediatr Surg 2000;35:1248- 1251.
Shalev E, Bustan M, Yarom I, Peleg D. Recovery of ovarian function after laparoscopic detorsion. Hum Reprod 1995;10:2965-2966.
Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19-24.
Jackson H, Granger S, Price R, et al. Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surg Endos 2008;22:1917-1927.