Bora ÇOŞKUN, Burcu TİMUR, Buğra ÇOŞKUN, Ferdi KINCI, Coşkun ŞİMŞİR

1911

Clinical and Pathologic Evaluation of Adnexal Torsion Patients in Adolescence, Reproductive and Postmenopausal Periods

Objective: The objective of our study was to compare the adnexal torsion patients in different age groups clinically and pathologically.Methods: Sixty-eight patients who had applied with pelvic pain and adnexal torsion diagnosis had been confirmed intraoperatively were included in the study. Patients were divided into three groups based on their ages as the adolescent period (Group 1), reproductive period (Group 2) and postmenopausal period (Group 3). Ages, history of torsion, history of past operations, periods between the date of hospitalization and operation, periods of hospital stay, adnexa as the localization of torsion and number of tours of torsion were examined in groups. Mass lesions found during the operation and pathologic consequences of such masses were examined retrospectively and compared.Results: No statistically significant differences in torsion history, past operations, WBC and platelet values, neutrophil/lymphocyte ratios, preoperative fever, preoperative nausea and vomiting and preoperative Doppler US findings between the groups included in the studies (p>0,05). Although not statistically significant, WBC values were higher in the postmenopausal patient group, and it was notable that symptoms including fever, nausea and vomiting were absent in this group. The adolescent age group was the group with the least confirmation of torsion diagnosis following the operation with 13 (52%) patients. Upon evaluation of the operations carried out on patients, it was seen that mostly fertility preserving approaches were preferred for adolescent and reproductive patients with 88%, while more radical methods such as USO (72.7%) and TAH+BSO (18.2%) were preferred in postmenopausal patients. Ovarian tissue with torsion without any pathologic findings is more frequent in the adolescent period as compared to other groups (48%). In the postmenopausal period however, some pathology was found in the entire portion of the adnexa with torsion. In the postoperative evaluation of the pathology results of patients, no significant differences were observed as regards the diameters of cysts (p:0,207). There are significant differences between the histopathological types. Conclusion: Although statistically significant differences have not been observed as regards the clinic al presentation and laboratory findings based on age groups; it must be kept in mind that a mass lesion can accompany the torsion and the pathology of this mass can vary. Torsion must be remembered in pelvic pain in the adolescent age group because of the indistinct clinical findings and inadequacy of imaging methods.
Keywords:

Adnexal Torsion, Pelvic Pain, Gyneacologic Emergency,

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  • Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. Journal of Ultrasound in Medicine. 2001;20(10):1083-9.
  • Anders JF, Powell EC. Urgency of evaluation and outcome of acute ovarian torsion in pediatric patients. Archives of pediatrics & adolescent medicine. 2005;159(6):532-5.
  • Bayer AI, Wiskind AK. Adnexal torsion: can the adnexa be saved? American journal of obstetrics and gynecology. 1994;171(6):1506-11.
  • Bellati F, Ruscito I, Gasparri ML, Antonilli M, Pernice M, Vallone C, et al. Effects of unilateral ovariectomy on female fertility outcome. Archives of gynecology and obstetrics. 2014;290(2):349-53.
  • Bodur S, Alanbay I, Karasahin KE, Kinci MF, Fidan U, Keskin U. Chronic Ovarian Torsion Mimicking Subserosal Postmenopausal Fibroid. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2016;206:e137.
  • Bronstein ME, Pandya S, Snyder CW, Shi Q, Muensterer OJ. A meta-analysis of B-mode ultrasound, Doppler ultrasound, and computed tomography to diagnose pediatric ovarian torsion. European Journal of Pediatric Surgery. 2015;25(01):82-6.
  • Chang S-D, Yen C-F, Lo L-M, Lee C-L, Liang C-C. Surgical intervention for maternal ovarian torsion in pregnancy. Taiwanese Journal of Obstetrics and Gynecology. 2011;50(4):458-62.
  • Chiou S-Y, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. Journal of Ultrasound in Medicine. 2007;26(10):1289-301.
  • Eitan R, Galoyan N, Zuckerman B, Shaya M, Shen O, Beller U. The risk of malignancy in post-menopausal women presenting with adnexal torsion. Gynecologic oncology. 2007;106(1):211-4.
  • Ekmekci E, Aydogmus H, Ergun Y, Eren R. Analyzing adnexiel torsion cases recognized in our clinic retrospectively. Turkiye Klinikleri Journal of Gnynecology and Obstetrics. 2010;20(5):287.
  • Gunay T, Yardimci Od, Hocaoğlu M, Bör Ed, Erdem G. Ovarian Torsion and Surgical Treatment: 5 years experience of a tertiary center. Journal of Kahramanmaras Sutcu Imam University Faculty of Medicine.2018;13(2):33-42.
  • Hibbard LT. Adnexal torsion. American journal of obstetrics and gynecology. 1985;152(4):456-61.
  • Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Annals of emergency medicine. 2001;38(2):156-9.
  • Huchon C, Fauconnier A. Adnexal torsion: a literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2010;150(1):8-12.
  • Lomano jm, Trelford jd, Ullery jc. Torsion of the uterine adnexa causing an acute abdomen. Obstetrics & Gynecology. 1970;35(2):221-5.
  • Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. Journal of Ultrasound in Medicine. 2011;30(9):1205-10.
  • Mazouni C, Bretelle F, Menard J, Blanc B, Gamerre M. Diagnosis of adnexal torsion and predictive factors of adnexal necrosis. Gynecologie, obstetrique & fertilite. 2005;33(3):102-6.
  • McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstetrical & gynecological survey. 1999;54(9):601-8.
  • Moribata Y, Kido A, Yamaoka T, Mikami Y, Himoto Y, Kataoka M, et al. MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction. Journal of Obstetrics and Gynaecology Research. 2015;41(9):1433-9.
  • Noviello C, Romano M, Papparella A, Ciavattini A, Martino A, Cobellis G. The isolated tubal torsion: an insidious pediatric and adolescent pelvic urgency. La Pediatria Medica e Chirurgica. 2018;40(2):48-51
  • Naiditch JA, Barsness KA. The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. Journal of pediatric surgery. 2013;48(6):1283-7.
  • Oelsner G, Cohen SB, Soriano D, Admon D, Mashiach S, Carp H. Minimal surgery for the twisted ischaemic adnexa can preserve ovarian function. Human Reproduction. 2003;18(12):2599-602.
  • Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance. Journal of pediatric surgery. 2010;45(1):135-9.
  • Parelkar SV, Mundada D, Sanghvi BV, Joshi PB, Oak SN, Kapadnis SP, et al. Should the ovary always be conserved in torsion? A tertiary care institute experience. Journal of pediatric surgery. 2014;49(3):465-8.
  • Rody A, Jackisch C, Klockenbusch W, Heinig J, Coenen-Worch V, Schneider H. The conservative management of adnexal torsion—a case-report and review of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2002;101(1):83-6.
  • Rossi BV, Ference EH, Zurakowski D, Scholz S, Feins NR, Chow JS, et al. The clinical presentation and surgical management of adnexal torsion in the pediatric and adolescent population. Journal of pediatric and adolescent gynecology. 2012;25(2):109-13.
  • Santra D, Dasgupta A, Ray N, Talukder A, Dasgupta S. Adnexal Torsion: Clinical Presentations and Challenges. Journal of Clinical & Diagnostic Research. 2018;12(6).
  • Savic D, Stankovic ZB, Djukic M, Mikovic Z, Djuricic S. Torsion of malignant ovarian tumors in childhood and adolescence. Journal of Pediatric Endocrinology and Metabolism. 2008;21(11):1073-8.
  • Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. Journal of Ultrasound in Medicine. 2008;27(1):7-13.
  • White M, Stella J. Ovarian torsion: 10‐year perspective. Emergency Medicine Australasia. 2005;17(3):231-7.
  • Wilkinson C, Sanderson A. Adnexal torsion—a multimodality imaging review. Clinical radiology. 2012;67(5):476-83.
Middle Black Sea Journal of Health Science-Cover
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2015
  • Yayıncı: Ordu Üniversitesi
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