Mesut Polat, Taylan Şenol, Adnan İncebıyık, Enis Özkaya, İlhan Şanverdi, Evrim Bostancı, Egemen Aydın, Ateş Karateke

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 salpingo-oophorectomy 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.Key words: Pregnancy, adnexal torsion, ultrasonography

Anahtar Kelimeler:

Gebelik, adneksiyal torsiyon, ultrasonografi

The comparison of Brucella gel agglutination test with other Brucella tests

Objective: In this study, it was aimed to compare the sensitivity of diagnostic tests in patients with a preliminary diagnosis of brucellosis.Methods: We have compared the serological methods, standard tube agglutination test (STA), Coombs Test (CT), Rose Bengal (RBT), and the gel centrifugation test. In patients with a preliminary diagnosis of brucellosis, subjects with a positive test result of RBT has been included in the research and other diagnostic tests STA, CT and Coombs Gel centrifugation tests were performed within the range of same titration.Results: Total 132 patient’s serums were studied. In RBT positive 92 patients’ serums, negative test results were found in 11 with STA, in 9 with CT and in 6 with gel test. While 35 patients were identified to be positive by using Brucella gel test at 1/5120 titer, no positive test results were seen with STA and CT at the same titer. Generally, CT results were one titration below the gel centrifugation test results.Conclusion: In conclusion, RBT and STA were not always adequate to determine the diagnosis of brucellosis. Low titer STA results should be supported by tests such as CT or gel centrifugation and the seroconversion must be monitored. Due to giving fast results, gel centrifugation test can be preferred in diagnosis of Brucellosis.Key words: Brucellosis, gel centrifugation, Coombs test

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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 regnancy: 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;108:217–222.
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;280:473–474.
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 repubescent 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.