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Hongju H. A giant ovarian cyst torsion: Case report. Medicine (Baltimore) 2024; 103:e33283. [PMID: 38608053 PMCID: PMC11018219 DOI: 10.1097/md.0000000000033283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Adnexal torsion (AT) is one of a gynecological condition characterized by an acute abdomen. Clinically, a giant ovarian cyst torsion with a diameter of 30 cm is rare. Therefore, an accurate and timely diagnosis and treatment are important. PATIENT CONCERNS A 25-year-old unmarried female, presented to the emergency department with intermittent abdominal cramps after a sudden change in position. Considering her symptoms and examination, ultrasound, and magnetic resonance imaging (MRI) results, ovarian cyst torsion was suspected. DIAGNOSIS Giant ovarian cyst torsion. INTERVENTIONS Surgical intervention with exploratory laparotomy was performed immediately. OUTCOMES Intraoperatively, we found a 30-cm left ovarian cyst with a clear root. The left fallopian tube, infundibulopelvic ligament, and ovarian ligament were twisted 900 degrees. Finally, the pathological report revealed mucinous cystadenoma. CONCLUSION Giant ovarian cyst torsion with a diameter of 30 cm is rare. Considering her symptoms and examination, ultrasound, and MRI results, ovarian cyst torsion was suspected. The patient was successfully treated using emergency surgery.
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Affiliation(s)
- He Hongju
- Department of Obstetrics & Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Güvenç M, Yüksel M, Kutlu T, Etyemez M, Gökçek İ, Cellat M. Protective effects of esculetin against ovary ischemia-reperfusion injury model in rats. J Biochem Mol Toxicol 2024; 38:e23528. [PMID: 37661762 DOI: 10.1002/jbt.23528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/15/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
AIMS Ovarian ischemia-reperfusion (I/R) injury is a phenomenon that necessitates urgent intervention, which occurs as a result of ovarian torsion, and it is frequently seen in young women. A large amount of free radical and oxidative damage as a result of I/R plays a role in the cause of the incident. Antioxidant agents are thought to be beneficial in preventing this damage, and the potential protective effects of esculetin, which had not been tested previously, were investigated in this study. STUDY DESIGN The rats in the study were divided into five groups at random: control, sham, esculetin, I/R, and treatment. Oxidative stress parameters, proinflammatory cytokines, nuclear factor erythroid 2-related factor 2 (Nrf-2)/nuclear factor-kβ (NF-κβ) pathway, and histopathological analyses were evaluated at the end of the study. KEY FINDINGS After I/R, malondialdehyde levels, proinflammatory cytokines, tumor necrosis factor-α and interleukin-1β levels and NF-κβ expressions were increased, Nrf-2 expression and glutathione level decreased and the histopathologic picture deteriorated. However, as a result of the esculetin treatment, ameliorative effects in the aforementioned parameters were determined, and it was ensured that they returned to normal levels. CONCLUSION According to these findings, esculetin has protective effects on I/R damage by lowering lipid peroxidation and having antioxidant and anti-inflammatory properties. SIGNIFICANCE Our results proved the protective effect of esculetin against ovarian IR injury in rats and this may be attributed to Nrf-2/NF-κβ axis which showed antioxidant and anti-inflammatory effects. Therefore, esculetin can be used in the future for preventive effects to ovarian IR injury.
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Affiliation(s)
- Mehmet Güvenç
- Department of Physiology, Faculty of Veterinary Medicine, University of Hatay Mustafa Kemal, Antakya, Hatay, Turkey
| | - Murat Yüksel
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, University of Hatay Mustafa Kemal, Antakya, Hatay, Turkey
| | - Tuncer Kutlu
- Department of Pathology, Faculty of Veterinary Medicine, University of Hatay Mustafa Kemal, Antakya, Hatay, Turkey
| | - Muhammed Etyemez
- Department of Physiology, Faculty of Veterinary Medicine, University of Kastamonu, Kastamonu, Turkey
| | - İshak Gökçek
- Department of Physiology, Faculty of Veterinary Medicine, University of Hatay Mustafa Kemal, Antakya, Hatay, Turkey
| | - Mustafa Cellat
- Department of Physiology, Faculty of Veterinary Medicine, University of Hatay Mustafa Kemal, Antakya, Hatay, Turkey
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Meyer R, Meller N, Mohr-Sasson A, Toussia-Cohen S, Machtinger R, Bart Y, Mashiach R, Levin G. Clinical features of isolated Fallopian tube torsion: evidence from a large series. HUM FERTIL 2023; 26:971-977. [PMID: 35114880 DOI: 10.1080/14647273.2022.2034056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98-33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70-0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96); (v) vomiting (aOR 95% CI 0.38, 0.19-0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Toussia-Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Yagur Y, Brisker K, Kveler K, Cohen G, Weitzner O, Schreiber H, Schonman R, Klein Z, Biron-Shental T. Can Natural Language Processing Improve Adnexal Torsion Predictions? J Minim Invasive Gynecol 2023; 30:672-677. [PMID: 37119990 DOI: 10.1016/j.jmig.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
STUDY OBJECTIVE To create a decision support tool based on machine learning algorithms and natural language processing (NLP) technology, to augment clinicians' ability to predict cases of suspected adnexal torsion. DESIGN Retrospective cohort study SETTING: Gynecology department, university-affiliated teaching medical center, 2014-2022. PATIENTS This study assessed risk-factors for adnexal torsion among women managed surgically for suspected adnexal torsion based on clinical and sonographic data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The dataset included demographic, clinical, sonographic, and surgical information obtained from electronic medical records. NLP was used to extract insights from unstructured free text and unlock them for automated reasoning. The machine learning model was a CatBoost classifier that utilizes gradient boosting on decision trees. The study cohort included 433 women who met inclusion criteria and underwent laparoscopy. Among them, 320 (74%) had adnexal torsion diagnosed during laparoscopy, and 113 (26%) did not. The model developed improved prediction of adnexal torsion to 84%, with a recall of 95%. The model ranked several parameters as important for prediction. Age, difference in size between ovaries, and the size of each ovary were the most significant. The precision for the "no torsion" class was 77%, with a recall of 45%. CONCLUSIONS Using machine learning algorithms and NLP technology as a decision-support tool for the diagnosis of adnexal torsion is feasible. It improved true prediction of adnexal torsion to 84% and decreased cases of unnecessary laparoscopy.
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Affiliation(s)
- Yael Yagur
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel.
| | - Karin Brisker
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Ksenya Kveler
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
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5
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Atia O, Hazan E, Rotem R, Armon S, Yagel S, Grisaru-Granovsky S, Sela HY, Rottenstreich M. A Scoring System Developed by a Machine Learning Algorithm to Better Predict Adnexal Torsion. J Minim Invasive Gynecol 2023; 30:486-493. [PMID: 36775053 DOI: 10.1016/j.jmig.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
STUDY OBJECTIVE To establish a clinically relevant prediction score for the diagnosis of adnexal torsion (AT) in women who were operated on for suspected AT. DESIGN A retrospective cohort study conducted between 2014 and 2021. SETTING A large tertiary teaching medical center. PATIENTS Women who underwent urgent laparoscopy for suspected AT. INTERVENTIONS Analyses included univariate and multivariate models combined with the machine learning (ML) Random Forest model, which included all information available about the women and reported the accuracy of the model and the importance of each variable. Based on this model, we created a predictive score and evaluated its accuracy by receiver operating characteristic (ROC) curve. MEASUREMENTS AND MAIN RESULTS A total of 503 women were included in our study, 244 (49%) of whom were diagnosed with AT during the surgery, and 44 (8.8%) cases of necrotic ovary were found. Based on the Random Forrest and multivariate models, the most important preoperative clinical predictive variables for AT were vomiting, left-side complaints, and concurrent pregnancy; cervical tenderness and urinary symptoms decreased the likelihood of surgically confirmed AT. The most important sonographic findings that predicted increased risk of surgically confirmed AT were ovarian edema and decreased vascular flow; in contrast, hemorrhagic corpus luteum decreased the likelihood of surgically confirmed AT. The accuracy of the Random Forest model was 71% for the training set and 68% for the testing set, and the area under the curve for the multivariate model was 0.75 (95% confidence interval [CI] 0.69-0.80). Based on these models, we created a predictive score with a total score that ranges from 4 to 12. The area under the curve for this score was 0.72 (95% CI 0.67-0.76), and the best cutoff for the final score was >5, with a sensitivity, specificity, positive predictive value, and negative predictive value of 64%, 73%, 70%, and 67%, respectively. CONCLUSION Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of women with suspected AT. ML in this setting has no diagnostic/predictive advantage over the performance of logistic regression methods. Additional prospective studies are needed to confirm the accuracy of this model.
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Affiliation(s)
- Ohad Atia
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Dr. Atia), Jerusalem, Israel
| | - Ella Hazan
- Faculty of Medicine, Hadassah-Hebrew University Medical Center (Hazan), Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel.
| | - Shunit Armon
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Simcha Yagel
- Department of Nursing, Jerusalem College of Technology (Dr. Yagel), Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine (Drs. Rotem, Armon, Grisaru-Granovsky, Sela, Rottenstreich), Jerusalem, Israel; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center (Dr. Rottenstreich), Jerusalem, Israel
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6
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Shwyiat R, Taso OA, Al-Edwan F, Khreisat B, Al-Dubees A. Retrospective analysis of patients with surgically proven ovarian torsion, our experience. J Family Med Prim Care 2023; 12:637-643. [PMID: 37312776 PMCID: PMC10259567 DOI: 10.4103/jfmpc.jfmpc_1450_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 06/15/2023] Open
Abstract
Aim To study the patients who were admitted to our hospital with surgically proven ovarian torsion and were operated for the same and to study for whom detorsion was done. Materials and Methods A retrospective analysis of the medical records and surgical notes of 150 patients with surgically proven ovarian torsion over a 10-year period between January 2011 and January 2021 was carried out. Surgical notes included details like mode of the surgery (laparotomy or laparoscopy), type of surgery (oophorectomy, detorsion, detorsion with cystectomy), whether fixation was done or not, size of mass/ovary, laterality, appearance of the torted ovary, color of the ovary, and number of twists. Histopathologic reports of the patients who underwent oophorectomy or detorsion with cystectomy were also recorded. Results During the 10-year study period, 88 (58.7%) patients had undergone laparotomy and 62 (41.2%) patients had undergone laparoscopy. Detorsion with cystectomy was done in 96 (64%) cases, detorsion alone in 14 (9.3%) cases, and oophorectomy was done in 40 (26.6%) cases. There was no significant difference in terms of increase in postoperative complications. Conclusion Laparoscopic detorsion with cystectomy is the most common surgical procedure used for ovarian torsion at King Hussein Medical Center.
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Affiliation(s)
- Rami Shwyiat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Omar A. Taso
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Fatima Al-Edwan
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Basel Khreisat
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
| | - Ammal Al-Dubees
- Department of Obstetrics and Gynecology, Royal Medical Services, King Hussain Medical Center, Amman, Jordan
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Preoperative Neutrophil Lymphocyte Ratio in Prediction of Adnexal Mass Torsion. Obstet Gynecol Int 2023; 2023:3585189. [PMID: 36880062 PMCID: PMC9985499 DOI: 10.1155/2023/3585189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Abstract
Aims Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23-66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts. Methods This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated. Results A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon's skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst. Conclusion Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.
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Meyer R, Meller N, Amitai Komem D, Abu-Bandora E, Cohen A, Cohen SB, Mashiach R, Levin G. Pregnancy-Associated Ovarian Torsion - a Single-Center Case-Control Study. Reprod Sci 2022; 30:1998-2002. [PMID: 36576712 DOI: 10.1007/s43032-022-01138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/29/2022]
Abstract
The etiology of OT is largely unknown. Any predisposition to rotation of the infundibulopelvic ligament and utero-ovarian ligament should be considered a possible etiology. Information with respect to ovarian torsion (OT) among pregnant is underreported and based on small studies. We aim to compare characteristics of confirmed OT to laparoscopies performed for the indication of suspected OT, in which no OT was found among pregnant women. This is a retrospective case-control study. We included pregnant women who underwent laparoscopy for a suspected OT between March 2011 and August 2020. Pregnant women with confirmed OT (torsion group) were compared to those without (no torsion group). There were 169 women with suspected OT. OT was confirmed in 140 (82.8%) women. There was higher proportion of assisted reproductive technology (ART) gestation in the torsion group [76 (54.3%) vs. 5 (17.2%), p < 0.001]. The rate of pregnant approaching evaluation within 8 h of symptoms onset was higher in the torsion group [57 (40.7%) vs. 2 (6.9%), p < 0.001]. The mean visual analogue score (VAS) was higher in the torsion group (8.5 vs. 7.1, p = 0.002). The mean pulse was lower in the torsion group (79 vs. 88 bpm, p < 0.001). From sonographic characteristics examined, the following was higher in the torsion group; mean maximal size of the ovary (70 mm in the torsion group vs. 54 mm in the no torsion group, p = 0.011). In a multivariable logistic regression analysis, number of hours of symptoms was negatively associated with AT [aOR, 95% CI 0.95 (0.91-0.98)] and pulse was negatively associated with OT [aOR, 95% CI 0.78 (0.63-0.95)]. Among the 29 cases in which no OT was found during laparoscopy, the following findings were noted: 16 (55.2%) no abnormality at all, 5 (17.2%) functional ovarian cyst, 2 (6.9%) mature teratoma and 6 cases of peritoneal adhesions (20.7%). The time from pain onset to approaching evaluation and women's pulse should be considered and acknowledged in the evaluation of OT during pregnancy.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Adiel Cohen
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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10
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Clinical factors and surgical decision-making when managing premenopausal women with adnexal torsion. Arch Gynecol Obstet 2022; 306:1077-1084. [DOI: 10.1007/s00404-022-06580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
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Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Ovarian torsion. Am J Emerg Med 2022; 56:145-150. [PMID: 35397355 DOI: 10.1016/j.ajem.2022.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ovarian torsion is a rare, frequently misdiagnosed condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of ovarian torsion, including presentation, evaluation, and management in the emergency department (ED) based on current evidence. DISCUSSION Ovarian torsion is one of the most common gynecological surgical emergencies and occurs with complete or partial rotation of the ovary along the supporting ligaments, obstructing vascular flow. Several risk factors include the presence of an ovarian mass or cyst. The most common population affected includes reproductive aged women, though cases also occur in premenarchal females, pregnant women, and postmenopausal women. Abdominal or pelvic pain is common but is not always sudden in onset or severe. Nausea and vomiting occur in 70%. Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Computed tomography with intravenous contrast can assist with diagnosis. Treatment includes emergent gynecologic consultation for surgical detorsion, along with symptomatic therapy in the ED. CONCLUSIONS An understanding of ovarian torsion can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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12
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Meller N, Meyer R, Cohen A, Abu-Bandora E, Amitai Komem D, Toussia-Cohen S, Mashiach R, Levin G, Orvieto R, Cohen SB. A validated predictive model for adnexal torsion pre-operative diagnosis. Arch Gynecol Obstet 2022; 305:1069-1077. [PMID: 35001184 DOI: 10.1007/s00404-021-06388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a simple predictive model for pre-operative diagnosis of adnexal torsion (AT). METHODS A retrospective cohort study with a retrospective validation, including 669 separate episodes of women who underwent laparoscopy due to a suspected AT between January 2011 and June 2020. We compared the pre-operative characteristics between women with surgically confirmed AT and those without. RESULTS The derivation cohort included 615 episodes of suspected AT. AT was surgically confirmed in 445 episodes (72%). The retrospectively collected validation cohort included 54 episodes, with 31 (57.4%) surgically confirmed AT. In a multivariate regression analysis, vomiting, neutrophils to lymphocytes ratio > 3.5 and sonographic finding of enlarged ovary were independently associated with AT [OR 95% CI 2.78 (1.21-6.36), 3.15 (1.42-6.97) and 2.80 (1.33-5.88), respectively]. In the derivation cohort, the PPV for AT diagnosis was 69.7%, 84.5% and 93.1% if 1, 2 and 3 risk factors were present, respectively. Retrospective validation analysis underlined a PPV of 67.6%, 82.6 and 66.6% for 1, 2 and 3 risk factors, respectively. CONCLUSION We have developed and validated a simple predictive model for pre-operative diagnosis of AT, based on three parameters. Our model may assist clinicians while evaluating patients with suspected AT and improve pre-operative diagnosis.
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Affiliation(s)
- Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel. .,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | | | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomi Toussia-Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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13
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Meller N, Levin G, Cohen A, Abu-Bandora E, Amitai Komem D, Mashiach R, Meyer R. Surgically confirmed adnexal torsion during pregnancy: Does the trimester make a difference? J Obstet Gynaecol Res 2021; 47:4216-4223. [PMID: 34605118 DOI: 10.1111/jog.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. METHODS This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. RESULTS The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p = 0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p = 0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p = 0.023). CONCLUSIONS Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.
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Affiliation(s)
- Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adiel Cohen
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Martínez Fernández GS, Zomeño Bravo G, Cañete San Pastor P, Ortiz Murillo E, Balanza Chancosa R. Adnexal Torsion: Clinical Presentation and Management of a Retrospective Series of 21 Years. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Gema Zomeño Bravo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
| | | | - Ester Ortiz Murillo
- Service of Obstetrics and Gynecology, University Hospital Dr. Peset, Valencia, Spain
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15
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Michelis LD, Politch JA, Kuohung W. Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Laura Daniela Michelis
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph A. Politch
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
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16
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Duan N, Chen X, Rao M, Zhou C, Wang Z. CT predictive model for torsion angle as a marker for risk of necrosis in patients with adnexal torsion. Clin Radiol 2021; 76:540-546. [PMID: 33863549 DOI: 10.1016/j.crad.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the feasibility of preoperative computed tomography (CT) prediction of torsion angle for stratifying the risk of necrosis in patients with adnexal torsion. MATERIALS AND METHODS In this multicentre, retrospective study, 72 patients underwent preoperative CT and surgically verified adnexal torsion. Surgeons identified the torsion angle and adnexal necrosis requiring adnexectomy. The twisted angles were compared between conservative surgery group and salpingo-oophorectomy group. Variables included demographic, pathological and CT details. Logistic analysis was used to identify the indicators of twisted angle associated with high-risk necrosis. RESULTS The necrosis associated with adnexal torsion treated with adnexectomy was performed more often in patients with a torsion angle of ≥720° (odds ratio [OR]=7, 95% confidence interval [CI]: 1.314-37.295, p=0.023). The enlarged twisted pedicle (OR=14.592, 95% CI: 2.048-103.953, p=0.007) and pedicle haemorrhage (OR=5.612, 95% CI: 1.088-28.941, p=0.039) can predict a torsion angle of ≥720°, and area under the receiver operating characteristic (ROC) curve (AUC=0.758±0.058) was generated with the combined variables. CONCLUSION The risk of adnexal necrosis is high in patients with torsion angle of ≥720°. CT findings of enlarged twisted pedicle and pedicle haemorrhage can be used to predict torsion angle of ≥720° and can imply adnexal necrosis indirectly.
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Affiliation(s)
- N Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - X Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - M Rao
- Department of Radiology, Ruijin Hospital North of the Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Zhou
- Department of Radiology, The first Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Z Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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17
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Meyer R, Meller N, Mohr-Sasson A, Abu-Bandora E, Cohen A, Tamir M, Mashiach R, Levin G. Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion. Int J Gynaecol Obstet 2021; 155:411-416. [PMID: 33629355 DOI: 10.1002/ijgo.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a risk score for preoperative prediction of recurrent adnexal torsion (rAT) among women with a history of previous adnexal torsion (AT). METHODS A retrospective cohort study. We included women with a history of AT, presenting with suspected rAT who underwent diagnostic laparoscopy between March 2011 and March 2020. We compared women with rAT to those without. We constructed a prediction score and validated it in a prospectively collected cohort between April 2020 and June 2020. RESULTS One hundred and fifteen women composed the study cohort. Recurrent AT was confirmed laparoscopically in 86 (74.8%) cases. A risk score for rAT was developed, based on three associated factors: enlarged ovary, no previous oophoropexy and current IVF treatment. In the construction cohort, the rate of torsion was 44.4%, 67.9%, 82.9% and 100% if none, one, two, or three risk factors were present, respectively. In the prospective validation of the risk score, the prediction of one and two risk factors was 60.0% and 100% respectively. CONCLUSION Enlarged ovary is independently associated with preoperative rAT diagnosis. Coupled with information regarding the previous surgical approach in previous AT and current IVF use, these factors could be used to efficiently predict rAT among women with a previous AT.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Mordechai Tamir
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of medicine, Hebrew University, Jerusalem, Israel
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18
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Dawood MT, Naik M, Bharwani N, Sudderuddin SA, Rockall AG, Stewart VR. Adnexal Torsion: Review of Radiologic Appearances. Radiographics 2021; 41:609-624. [PMID: 33577417 DOI: 10.1148/rg.2021200118] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- M Taufiq Dawood
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Mitesh Naik
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Nishat Bharwani
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Siham A Sudderuddin
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Andrea G Rockall
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
| | - Victoria R Stewart
- From the Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, England (M.T.D., M.N., N.B., S.A.S., A.G.R., V.R.S.); and Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, England (N.B., A.G.R.)
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19
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Just the Facts: Ovarian torsion in the emergency department setting. CAN J EMERG MED 2020; 22:756-759. [DOI: 10.1017/cem.2020.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 23-year-old female presents with right lower quadrant pain that has been intermittent for the past several days. The pain suddenly worsened 1 hour ago. She denies vaginal bleeding or discharge, dysuria, fever, and back pain, but she has had several episodes of nausea with nonbloody, nonbilious vomiting. On examination, she is tender in the right lower quadrant, but her abdomen is not rigid.
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20
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Colak S, Gurlek B, Topcu A, Tumkaya L, Mercantepe T, Yilmaz A. Protective effects of nebivolol on ovarian ischemia-reperfusion injury in rat. J Obstet Gynaecol Res 2020; 46:2407-2416. [PMID: 32961615 DOI: 10.1111/jog.14503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/14/2020] [Accepted: 08/29/2020] [Indexed: 12/12/2022]
Abstract
AIM Ovarian torsion is a common gynecological emergency of reproductive ages, occurring at rates of 2.7-7.4%. This study aimed to evaluate the antioxidant effects of Nebivolol (NEB) and histopathological changes in experimental ischemic (I) and ischemic-reperfusion (I/R) injury in rat ovaries. METHODS Forty-eight adult female rats were randomly separated into six groups as group 1 (control) receiving an oral saline solution for 3 days; group 2 (I) that underwent ischemia for 3 h with the application of atraumatic vascular clips; group 3 (I/R); group 4 (I + NEB) receiving 10 mg/kg NEB by oral gavage 30 min prior to the ischemia induction; group 5 (I/R + NEB) receiving 10 mg/kg NEB, and group 6 (control + NEB) receiving oral 10 mg/kg NEB for 3 days before ischemia induction followed by consequent reperfusion. Ovarian tissue damage was scored by histopathological analysis. Ovarian tissue malondialdehyde (MDA) and glutathione (GSH) levels were measured biochemically. RESULTS The levels of MDA and tumor necrosis factor-alpha (TNF-α), and TUNEL assay positivity scores increased in the I and I/R groups. GSH levels decreased in all case groups (P < 0.05). The oral administration of NEB (10 mg/kg) to the I- and I/R-groups reduced the levels of MDA and TNF-α and TUNEL assay immunopositivity scores (P < 0.05). GSH levels increased in the treatment groups. CONCLUSION The current experimental ovarian torsion study suggests a protective role for NEB against I and I/R injury in rat ovaries. NEB may be a novel agent for decreasing ovarian I/R injury.
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Affiliation(s)
- Sabri Colak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Beril Gurlek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Atilla Topcu
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adnan Yilmaz
- Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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21
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Moura APC, Novis MI, Demarchi GTS, Fernandes LM, D'Ippolito G, Torres US, Chamié LP. Pelvic hemorrhagic lesions in women: MRI findings and differential diagnosis. Clin Imaging 2019; 60:16-25. [PMID: 31864195 DOI: 10.1016/j.clinimag.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
A large spectrum of pathologic pelvic conditions can present with hemorrhage in structures or organs. These may present acutely, subacutely, chronically or as incidental findings. Clinical history and MRI characteristics can often narrow the differential diagnosis and guide management. The purpose of this article is to showcase a wide array of pelvic lesions, in which the presence of blood is a key imaging feature, and their differential diagnosis.
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Affiliation(s)
- Ana Paula Carvalhal Moura
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP 01221-020, Brazil.
| | - Maria Inês Novis
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil.
| | | | - Lizieux Matos Fernandes
- Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP 01221-020, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil; Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil.
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22
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Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging. Eur Radiol 2019; 30:1054-1061. [DOI: 10.1007/s00330-019-06434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/23/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023]
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Abstract
The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.
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Affiliation(s)
- Sarah Mahonski
- Heritage Valley Health System, 1000 Dutch Ridge Road, Beaver, PA 15009, USA
| | - Kami M Hu
- Emergency/Internal/Critical Care Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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24
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Foster G, Keene J. Isolated fallopian tubal torsion: A challenging ultrasound diagnosis. SONOGRAPHY 2019. [DOI: 10.1002/sono.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Grant Foster
- Medical Imaging; The Women's Hospital; Melbourne Australia
- BMI; Barwon Health; Geelong Australia
| | - Jacqueline Keene
- Medical Imaging; The Women's Hospital; Melbourne Australia
- Specialist Imaging for Women; Melbourne Australia
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25
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Melcer Y, Maymon R, Pekar-Zlotin M, Vaknin Z, Pansky M, Smorgick N. Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women. Arch Gynecol Obstet 2017; 297:685-690. [DOI: 10.1007/s00404-017-4628-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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26
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Hosny TA. Oophoropexy for ovarian torsion: a new easier technique. ACTA ACUST UNITED AC 2017; 14:7. [PMID: 28603475 PMCID: PMC5440535 DOI: 10.1186/s10397-017-1001-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022]
Abstract
Background Oophoropexy for ovarian torsion is easy to be done by many tools either suturing to the lateral pelvic wall, plication of the ovarian ligament or even fixation to the back of the uterus, but it is little bit difficult to do it for pregnant women with less manipulation. Objective We propose that using trocar site closure needle can be easier and faster technique to do this. To assess the feasibility of using the trocar site closure needle to do oophoropexy in ovarian torsion and its possible applicability. Patients Seven patients presented with ovarian torsion; four of them were pregnant at 7, 15, 19 and 20 weeks of gestation, two patients with ovarian hyperstimulation in IVF cycles and one adolescent patient with hemorrhagic cyst. They were diagnosed by clinical presentation and ultrasound with Doppler analysis, and confirmed by laparoscopy where they underwent detorsion and fixation of the ovary using the trocar site closure needle. Results Follow up of all the cases after one week showed improvement of the symptoms and normal Doppler flow of the target ovary then after three weeks by ultrasonography which revealed normal Doppler flow in the previously torsioned ovary. Two pregnant women underwent cesarean delivery where the operated ovary was observed during the delivery and was normal in shape and freely mobile with no adhesions. Conclusion We propose that this technique is easier, faster and more comfortable especially in ovarian torsion in pregnant women and torsion in hyperstimulated ovaries. Electronic supplementary material The online version of this article (doi:10.1186/s10397-017-1001-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tamer A Hosny
- Department of Obstetrics and Gynecology, Alexandria University Hospital, 16A Mohamed Said Pasha street, San Stefano, Alexandria, 21411 Egypt
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27
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Abstract
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%-15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Mimoun C, Fauconnier A, Varas C, Huchon C. Is a Self-Assessed Questionnaire Useful for the Diagnosis of Ectopic Pregnancy in Hospitalized Patients? PLoS One 2016; 11:e0155054. [PMID: 27832075 PMCID: PMC5104447 DOI: 10.1371/journal.pone.0155054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 04/24/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Delayed diagnosis of ectopic pregnancy (EP) is responsible for maternal morbidity and mortality. Our objective was to develop and validate decision rules for the diagnosis of EP, in patients in their first trimester of pregnancy with symptoms, based solely on a self-assessment questionnaire. METHODS From September 2006 to March 2008, 574 patients, who have consulted for acute pelvic pain at the gynecologic emergency department (ED) of five hospitals, completed a Self-Assessment Questionnaire for Gynecological Emergencies (SAQ-GE). We included for our study only women in their first trimester of pregnancy experiencing acute pelvic pain and/or vaginal bleeding who were hospitalized (262 patients). Two-thirds of patients were selected to derive the SAQ-GE EP score which was built on multiple logistic regression. One third of patients were used for internal validation. RESULTS Five variables were independently and significantly (p<0.05) associated with EP: no frequent need to change sanitary towels (aDOR = 6.1; 95% CI [2.1-17.8]), duration of bleeding > 24 hours (aDOR = 4,3; 95% CI [1,7-11,0]), pain during coughing (aDOR = 3.1; CI 95% [1,4-6,7]), brown discharge (aDOR = 3.0; 95% CI [1.3-7.1]) and unilateral pelvic pain (aDOR = 2.7; 95% CI [1.3-5.9]). The SAQ-GE ectopic pregnancy score was based on these five criteria with values ranging from 0 to 100. The low-risk group of EP (score<25) had a sensitivity of 95.9% 95% CI [89.8-98,9] and an LR- of 0.2 95% CI [0.1-0.5]. The high-risk group (score>70) had a specificity of 97.4 95% CI [90.9-99.7] and a LR+ of 12.3 95% CI [3.0-49.8]. The percentages of EP observed in the validation sample were: 0% in the low-risk group and 88.9% in the high-risk group. DISCUSSION These prediction rules that classify patients in a low-risk or high-risk group may prove useful for triaging pregnant women in their first trimester with symptoms before complementary exams.
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Affiliation(s)
- Camille Mimoun
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy / Saint-Germain, University of Versailles-Saint-Quentin (UVSQ), Poissy, France
- Research unit EA 7285 “Risk and safety in clinical medicine for women and perinatal health”, University of Versailles Saint-Quentin (UVSQ), Poissy, France
- * E-mail:
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy / Saint-Germain, University of Versailles-Saint-Quentin (UVSQ), Poissy, France
- Research unit EA 7285 “Risk and safety in clinical medicine for women and perinatal health”, University of Versailles Saint-Quentin (UVSQ), Poissy, France
| | - Catalina Varas
- Research unit EA 7285 “Risk and safety in clinical medicine for women and perinatal health”, University of Versailles Saint-Quentin (UVSQ), Poissy, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy / Saint-Germain, University of Versailles-Saint-Quentin (UVSQ), Poissy, France
- Research unit EA 7285 “Risk and safety in clinical medicine for women and perinatal health”, University of Versailles Saint-Quentin (UVSQ), Poissy, France
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Varas C, Ravit M, Mimoun C, Panel P, Huchon C, Fauconnier A. Optimal Combination of Non-Invasive Tools for the Early Detection of Potentially Life-Threatening Emergencies in Gynecology. PLoS One 2016; 11:e0162301. [PMID: 27583697 PMCID: PMC5008751 DOI: 10.1371/journal.pone.0162301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/20/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives Potentially life-threatening gynecological emergencies (G-PLEs) are acute pelvic conditions that may spontaneously evolve into a life-threatening situation, or those for which there is a risk of sequelae or death in the absence of prompt diagnosis and treatment. The objective of this study was to identify the best combination of non-invasive diagnostic tools to ensure an accurate diagnosis and timely response when faced with G-PLEs for patients arriving with acute pelvic pain at the Gynecological Emergency Department (ED). Methods The data on non-invasive diagnostic tools were sourced from the records of patients presenting at the ED of two hospitals in the Parisian suburbs (France) with acute pelvic pain between September 2006 and April 2008. The medical history of the patients was obtained through a standardized questionnaire completed for a prospective observational study, and missing information was completed with data sourced from the medical forms. Diagnostic tool categories were predefined as a collection of signs or symptoms. We analyzed the association of each sign/symptom with G-PLEs using Pearson’s Chi-Square or Fischer’s exact tests. Symptoms and signs associated with G-PLEs (p-value < 0.20) were subjected to logistic regression to evaluate the diagnostic value of each of the predefined diagnostic tools and in various combinations. Results The data of 365 patients with acute pelvic pain were analyzed, of whom 103 were confirmed to have a PLE. We analyzed five diagnostic tools by logistic regression: Triage Process, History-Taking, Physical Examination, Ultrasonography, and Biological Exams. The combination of History-Taking and Ultrasonography had a C-index of 0.83, the highest for a model combining two tools. Conclusions The use of a standardized self-assessment questionnaire for history-taking and focal ultrasound examination were found to be the most successful tool combination for the diagnosis of gynecological emergencies in a Gynecological ED. Additional tools, such as physical examination, do not add substantial diagnostic value.
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Affiliation(s)
- Catalina Varas
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Marion Ravit
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Camille Mimoun
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Mignot Hospital, Le Chesnay, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
- * E-mail:
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Yuk JS, Shin JY, Park WI, Kim DW, Shin JW, Lee JH. Association between pregnancy and adnexal torsion: A population-based, matched case-control study. Medicine (Baltimore) 2016; 95:e3861. [PMID: 27310967 PMCID: PMC4998453 DOI: 10.1097/md.0000000000003861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to determine the effect of pregnancy on adnexal torsion (AT). We conducted a matched case-control study using the Korean Health Insurance Review and Assessment Service-National Inpatients Sample (HIRA-NIS) from 2009 to 2011. AT patients were defined as women with both a diagnostic code (N835) and a surgical code for AT. The AT patients were randomly matched 1:4 with women without AT by age and year of claim. In total, 545 AT cases and 2180 controls were enrolled from a total of 1,843,451 women. After adjustment for such covariates as age, pregnancy was found to be associated with a lower rate of AT (adjusted odds ratio 0.314, 95% confidence interval [CI] 0.237-0.416, P value <0.01) and ovarian hyperstimulation syndrome was associated with a higher rate of AT (adjusted odds ratio 20.091, 95% CI 3.607-111.908, P value <0.01). We found that pregnancy is a negative risk factor for AT. However, a further study is needed to elucidate the mechanisms underlying these results.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
- Department of Obstetrics and Gynaecology, MizMedi Hospital, Seoul
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Korea
| | - Won I. Park
- Department of Obstetrics and Gynecology, Hankang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Dae Woon Kim
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
| | - Jung Whan Shin
- Department of Obstetrics and Gynaecology, School of Medicine, Eulji University, Daejeon
| | - Jung Hun Lee
- Department of Obstetrics and Gynecology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea
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Béranger-Gibert S, Sakly H, Ballester M, Rockall A, Bornes M, Bazot M, Daraï E, Thomassin-Naggara I. Diagnostic Value of MR Imaging in the Diagnosis of Adnexal Torsion. Radiology 2016; 279:461-70. [DOI: 10.1148/radiol.2015150261] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Selim MF, Haggag MS, Hassan MA. Detorsion or Adnexectomy for Adnexal Torsion and MRI Assessment for Necrosis. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Fouad Selim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Polena V, Huchon C, Varas Ramos C, Rouzier R, Dumont A, Fauconnier A. Non-invasive tools for the diagnosis of potentially life-threatening gynaecological emergencies: a systematic review. PLoS One 2015; 10:e0114189. [PMID: 25723401 PMCID: PMC4344336 DOI: 10.1371/journal.pone.0114189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify non-invasive tools for diagnosis of the major potentially life-threatening gynaecological emergencies (G-PLEs) reported in previous studies, and to assess their diagnostic accuracy. METHODS MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched to identify all eligible studies published in English or French between January 1990 and December 2012. Studies were considered eligible if they were primary diagnostic studies of any designs, with a gold standard and with sufficient information for construction of a 2 × 2 contingency table, concerning at least one of the following G-PLEs: complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Extraction of data and assessment of study quality were conducted by two independent reviewers. We set the thresholds for the diagnostic value of signs retrieved at Sensibility ≥ 95% and LR-≤ 0.25, or Specificity ≥ 90% and LR+ ≥ 4. RESULTS We identified 8288 reports of diagnostic studies for the selected G-PLEs, 45 of which met the inclusion criteria. The methodological quality of the included studies was generally low. The most common diagnostic tools evaluated were transvaginal ultrasound (20/45), followed by medical history (18/45), clinical examination (15/45) and laboratory tests (14/45). Standardised questioning about symptoms, systolic blood pressure<110 mmHg, shock index>0.85, identification of a mass by abdominal palpation or vaginal examination, haemoglobin concentration <10 g/dl and six ultrasound and Doppler signs presented high performances for the diagnosis of G-PLEs. Transvaginal ultrasound was the diagnostic tool with the best individual performance for the diagnosis of all G-PLEs. CONCLUSION This systematic review suggests that blood pressure measurement, haemoglobin tests and transvaginal ultrasound are cornerstone examinations for the diagnosis of G-PLEs that should be available in all gynaecological emergency care services. Standardised questioning about symptoms could be used for triage of patients.
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Affiliation(s)
- Viola Polena
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Catalina Varas Ramos
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Roman Rouzier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Alexandre Dumont
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Institut de Recherche pour le Développement, UMR 216, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
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Huchon C, Dumont A, Chantry A, Falissard B, Fauconnier A. Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology. World J Emerg Surg 2014; 9:46. [PMID: 25180047 PMCID: PMC4150681 DOI: 10.1186/1749-7922-9-46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain. Methods In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation. Results Of 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%. Conclusion A simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.
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Affiliation(s)
- Cyrille Huchon
- Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
| | - Alexandre Dumont
- Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France ; UMR 216, IRD Paris Descartes, 4 Avenue de l'Observatoire, Paris - Université, 75 006 Paris Descartes, France
| | - Anne Chantry
- INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Cochin, Paris, France
| | | | - Arnaud Fauconnier
- Service de gynécologie & obstétrique, CHI Poissy-St-Germain, 10 rue du champ Gaillard, BP 3082 78303, Poissy CEDEX, France ; Equipe d'accueil EA 7285 « Risques, cliniques et sécurité en santé des femmes et en santé périnatale », Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France
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Abstract
Acute abdominal pain represents the cardinal symptom of a large number of intra-abdominal pathologies. Because of multiple organ systems, varied pathology from life threatening to benign, and differences in presentation related to sex and age, identifying a final diagnosis is a challenge. The clinician’s goal for patients with acute abdominal pain is to rapidly identify whether the underlying cause requires an urgent or immediate surgical intervention. By developing a systematic approach to evaluating patients with abdominal pain, clinicians can generate a differential diagnosis to ensure appropriate treatment and improved patient outcomes. The purpose of this article is to provide clinicians with a framework for evaluating the complaint of acute abdominal pain and recognizing patients who require expedited evaluation.
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Affiliation(s)
- Helen F. Brown
- Helen F. Brown is Acute Care Nurse Practitioner, Emergency Department, Anne Arundel Medical Center, Annapolis, MD 21401 . Lynn Kelso is Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Nursing, Lexington
| | - Lynn Kelso
- Helen F. Brown is Acute Care Nurse Practitioner, Emergency Department, Anne Arundel Medical Center, Annapolis, MD 21401 . Lynn Kelso is Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Nursing, Lexington
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Sasaki KJ, Miller CE. Adnexal Torsion: Review of the Literature. J Minim Invasive Gynecol 2014; 21:196-202. [DOI: 10.1016/j.jmig.2013.09.010] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
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Deffieux X, Thubert T, Huchon C, Demoulin G, Rivain AL, Faivre E, Trichot C. [Complications of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:816-32. [PMID: 24210240 DOI: 10.1016/j.jgyn.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
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