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Paillusseau C, Gandar F, Francois C, Schilliger L. UNILATERAL OVARIAN TORSION IN FIVE GECKOS: CLINICAL AND ULTRASOUND FINDINGS. J Zoo Wildl Med 2024; 55:810-818. [PMID: 39255226 DOI: 10.1638/2024-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 09/12/2024] Open
Abstract
Few cases of antemortem ovarian torsion and diagnosis have been described in reptiles. This case series reports clinical and ultrasound findings in five adult (aged 1-6 yr) female geckos (three leopard geckos [Eublepharis macularius], one crested gecko [Correlophus ciliatus], and one gargoyle gecko [Rhacodactylus auriculatus]) diagnosed with unilateral ovarian torsion between 2019 and 2023. All animals presented with acute weakness associated with coelomic distension, and one suffered from chronic diarrhea and cachexia. Coelomic ultrasound examination (12-MHz linear probe) revealed signs of bilateral follicular stasis and oophoritis in all cases (heterogenic follicles ≤1.3 cm diameter) associated with a large anechoic periovarian rim and a hyperechoic chord, consistent with twisted ovarian vessels. Blood supply to ovarian structures was not detected using a Doppler flow, and a unilateral ovarian torsion was diagnosed in all geckos. A bilateral ovariectomy was performed under general anesthesia in all five animals. The mass of the excised ovaries varied between 7 to 15 g (12.7-22.2% of body weight). One gecko died 1 d postsurgery; the four remaining animals were healthy 6 mon postsurgery. Gekkonids are unique among reptiles in that they undergo a monoautochronic ovulation (only one follicle is recruited by each ovary during each ovarian cycle); the presence of multiple vitellogenic follicles on each ovary facilitates the diagnosis of follicular stasis. This condition was present in all five geckos and was suspected to have led to ovarian torsion. This case series emphasizes the value of ultrasound examination for antemortem diagnosis of reproductive disorders in reptiles.
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Igbodike EP, Iwuala IC, Maduako RO, Eleje GU, Akinjo AO, Ubom AE, Ikechebelu JI, Onwudiegwu U, Anunobi CC. Ovarian torsion-detorsion in a 10-year premenarchial female with chronic recurrent abdominal pain misdiagnosed as 'ama-afo' in a suburb: A case report. Int J Gynaecol Obstet 2024; 166:899-902. [PMID: 38504528 DOI: 10.1002/ijgo.15460] [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: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
SynopsisThis case involved a 10‐year‐old female with recurrent abdominal pain misdiagnosed as ‘ama‐afo’. Intraoperative findings showed a left‐sided strangulated/gangrenous tubo‐ovarian mass twisted four times on its pedicle.
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Affiliation(s)
- Emeka Philip Igbodike
- Department of Obstetrics and Gynecology, Havana Specialist Hospital, Surulere, Lagos, Nigeria
- Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria
| | - Ijeoma Chinyere Iwuala
- Department of Obstetrics and Gynecology, Havana Specialist Hospital, Surulere, Lagos, Nigeria
| | | | - George Uchenna Eleje
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Andrea Oludapo Akinjo
- Department of Anatomic and Molecular Pathology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
- Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Uchenna Onwudiegwu
- Department of Obstetrics and Gynecology, Bayelsa Medical University, Yenagoa, Bayelsa State, Nigeria
| | - Charles Chidozie Anunobi
- Department of Anatomic and Molecular Pathology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
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Silberstein T, Freud A, Baumfeld Y, Sheiner E, Weintraub AY, Mastrolia SA, Trojano G, Bernstein EH, Schwarzman P. Influence of ovarian torsion on reproductive outcomes and mode of delivery. Front Med (Lausanne) 2024; 11:1370409. [PMID: 38601114 PMCID: PMC11005820 DOI: 10.3389/fmed.2024.1370409] [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: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose To investigate differences in reproductive outcomes among patients before and following ovarian torsion. Study design In this retrospective cohort study, we investigated the reproductive outcomes of patients who underwent surgery for ovarian torsion between 1988 and 2015 in a tertiary medical center. Data on deliveries before and after ovarian torsion were compared. Results During the study period, 199 women underwent surgery due to ovarian torsion. The majority (91.4%; n = 182) underwent detorsion, and 8.6% (n = 17) underwent unilateral adnexectomy. At the time of the torsion, 27.6% (n = 55) of patients were pregnant. Among women who suffered from ovarian torsion, about half (52%) of the deliveries occurred before the torsion and 48% following the torsion. No significant difference in the live birth rate was noted (p = 0.19). The fertility treatment rate in our cohort was 7.5% before and 5% after the torsion (p = 0.01). In addition, live birth, cesarean delivery, and fertility treatment rates were similar in women who underwent detorsion vs. those who had adnexectomy. Conclusion Surgically treated ovarian torsion does not appear to negatively influence fertility and live birth potential.
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Affiliation(s)
- Tali Silberstein
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Freud
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
| | - Eli Harris Bernstein
- The Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Arun Kumar D, Aiyappan SK. Imaging findings of granulosa cell tumour of right ovary with rupture and torsion presenting as acute abdomen. BMJ Case Rep 2024; 17:e259517. [PMID: 38490713 PMCID: PMC10946348 DOI: 10.1136/bcr-2023-259517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Affiliation(s)
- Deepthi Arun Kumar
- Radiodiagnosis, SRM Medical college hospital and research centre, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Senthil Kumar Aiyappan
- Radiodiagnosis, SRM Medical college hospital and research centre, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
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Choi E, Kim HI, Seo SK, Cho SH, Choi YS, Lee BS, Yun BH. Postoperative outcomes of ovarian preserving surgery in premenopausal women with adnexal torsion. Obstet Gynecol Sci 2023; 66:562-571. [PMID: 37840253 PMCID: PMC10663403 DOI: 10.5468/ogs.23071] [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: 03/07/2023] [Revised: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE We aimed to determine whether ovarian-preserving surgery for adnexal torsion helps preserve ovarian function without increasing the risk of postoperative complications. METHODS We retrospectively evaluated 71 women who were surgically diagnosed with adnexal torsion between January 2015 and December 2019 at Severance Hospital, Yonsei University College of Medicine (ovarian preservation group, 56; oophorectomy, 15). Serum anti-Müllerian hormone (AMH) levels measured within 6 months before surgery were compared to levels measured 6-24 months after surgery. Surgical findings and postoperative complications were compared between the groups. RESULTS There was a borderline significant difference in the decrease in serum AMH levels between the oophorectomy group and ovarian preservation group before and after surgery. There were no significant differences between the groups in terms of fever, infection, or duration of admission. Discoloration of the twisted ovary was found in 27.3% and 33.3% of the patients in the ovarian preservation and oophorectomy groups, respectively. There was no difference in the decrease in serum AMH levels between patients with and those without discoloration. CONCLUSION Ovarian-preserving surgery may not increase postoperative complications in patients with adnexal torsion, even if a twisted mass is suspected to be necrotic. Moreover, the ovarian reserve may not be affected by torsion if the ovary is preserved. Conservative ovarian surgery can be safely performed to preserve the reproductive potential of women with adnexal torsion and cystic masses.
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Affiliation(s)
- Euna Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Hye In Kim
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Si Hyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
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Higashide R, Tsukada T, Ichikawa M, Sakamoto M, Shimabukuro K. Ovarian torsion due to ovarian hyperstimulation syndrome diagnosed by sonographic whirlpool sign in the first trimester of pregnancy: A case report. Radiol Case Rep 2023; 18:3386-3389. [PMID: 37502479 PMCID: PMC10369376 DOI: 10.1016/j.radcr.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Ovarian torsion during pregnancy is a rare condition that needs prompt diagnosis and detorsion in order to preserve ovarian function. Diagnosing ovarian torsion is a difficult procedure especially in pregnant cases since radiation exposure should be avoided. Detecting the whirlpool sign by ultrasonography is a highly useful technique as it is noninvasive, less time-consuming, and radiation-free. Here is a case of ovarian torsion due to ovarian hyperstimulation syndrome diagnosed solely by sonographic features and in which laparoscopic detorsion was promptly performed. A 26-year-old woman in her sixth week of pregnancy visited a tertiary hospital with sudden onset lower abdomen pain. Transvaginal ultrasound detected an 8 cm left ovary and a whirlpool sign between the uterus and left ovary. Ovarian torsion was suspected and laparoscopic surgery was performed. Intraoperatively, an enlarged left ovary was twisted at 540° involving the left fallopian tube. After detorsion, bilateral ovaries were preserved and the postoperative course was uneventful. Ovarian torsion was suspected solely by ultrasonographic features which led to surgical detorsion quickly, resulting in the preservation of bilateral ovaries. Detecting the whirlpool sign when ovarian torsion is suspected is useful, especially in pregnant women.
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Ali S, Dhobale AV, Kalambe MA, Bankar NJ, Hatgaonkar AM. Challenging Diagnosis and Management of an Ovarian Cyst Torsion in a Postmenopausal Woman: A Case Report. Cureus 2023; 15:e47693. [PMID: 38022205 PMCID: PMC10674073 DOI: 10.7759/cureus.47693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Ovarian masses are rare in the postmenopausal age group, and ovarian torsion is a gynecological emergency. We present a case report of a 63-year-old postmenopausal woman who presented a massive abdominal mass with pain that gradually increased during the previous 12 months. A contrast-enhanced computed tomography scan of the abdomen and pelvis suggested a 16.6 cm × 14 cm × 13 cm originating from the right ovary. Total abdominal hysterectomy, bilateral salphingo-oophorectomy, and partial omentectomy were performed in an emergency as the patient's symptoms worsened. A massive cyst was visualized from the right ovary, which had undergone a torsion of three turns. Histopathological analysis revealed a serous cystadenoma. The twisted ovarian cyst typically manifests as an acute abdomen, although there are cases where this presentation can cause a significant delay in diagnosis. Therefore, high clinical suspicion is often necessary to prevent morbidity and mortality.
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Affiliation(s)
- Sara Ali
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anupama V Dhobale
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Minal A Kalambe
- Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawarhal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Anand M Hatgaonkar
- Radiodiagnosis, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Plöger R, Condic M, Ralser DJ, Plöger HM, Egger EK, Otten LA, Mustea A. Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion-Case Report and Review of the Literature. J Clin Med 2023; 12:5923. [PMID: 37762865 PMCID: PMC10531937 DOI: 10.3390/jcm12185923] [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: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine green (ICG) angiography has been shown to sufficiently reflect tissue perfusion with a potential impact on the surgical procedure. Currently, there are only sparse data available on the utilization of ICG in the surgical treatment of ovarian torsion. Here, we describe the successful intraoperative use of ICG in a 17-year-old female patient with ovarian torsion who underwent ovary-preserving surgery. Further, a systematic literature review was performed. Based on the data available to date, the use of ICG in the surgical treatment of ovarian torsion is feasible and safe. The extent to which this might reduce the necessity for oophorectomy has to be evaluated in further investigations.
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Affiliation(s)
- Ruben Plöger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Mateja Condic
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Damian J. Ralser
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Hannah M. Plöger
- Department of Paediatrics, University Hospital Bonn, 53127 Bonn, Germany;
| | - Eva K. Egger
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Lucia A. Otten
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, 53127 Bonn, Germany; (M.C.); (D.J.R.); (E.K.E.); (L.A.O.); (A.M.)
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Pignataro JN, Schindler L. Isolated Fallopian Tube Torsion: Diagnosis and Management of a Gynecologic Emergency. Cureus 2023; 15:e46260. [PMID: 37908916 PMCID: PMC10615115 DOI: 10.7759/cureus.46260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare gynecologic emergency that requires a high index of suspicion and immediate surgical intervention. IFTT is rarely diagnosed preoperatively due to the lack of pathognomonic signs and symptoms. A 15-year-old female with no medical history presented with acute lower abdominal pain, nausea, and a physical exam significant for diffuse abdominal tenderness to palpation. Ultrasound revealed a large cystic adnexal mass with patent vascular flow to the ipsilateral ovary. Vital signs were stable and laboratory evaluation was unremarkable. Due to an uncertain diagnosis and suspicion of incomplete ovarian torsion, a laparoscopy was performed, which revealed an IFTT and ipsilateral hemorrhagic ovarian cyst. Treatment consisted of unilateral salpingectomy with cystectomy. IFTT is a surgical emergency with nonspecific signs and symptoms. A high degree of clinical suspicion is needed for prompt management. Diagnostic laparoscopy can be a useful tool in the setting of an uncertain diagnosis.
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Affiliation(s)
- John N Pignataro
- Clinical Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Lynnett Schindler
- Obstetrics and Gynecology, Liberty University College of Osteopathic Medicine, Lynchburg, USA
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Higashide R, Saito K, Hashido N, Ishikawa T, Miyasaka N. Step-by-step instructions for detecting whirlpool sign in adnexal torsion. J Rural Med 2023; 18:189-193. [PMID: 37448699 PMCID: PMC10336344 DOI: 10.2185/jrm.2023-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/11/2023] [Indexed: 07/15/2023] Open
Abstract
Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst. Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed. Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases. Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.
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Affiliation(s)
- Ryo Higashide
- Department of Obstetrics and Gynecology, Tsuchiura Kyodo
General Hospital, Japan
- Department of Comprehensive Reproductive Medicine, Graduate
School, Tokyo Medical and Dental University, Japan
| | - Kazuki Saito
- Department of Perinatal and Maternal Medicine (Ibaraki),
Graduate School, Tokyo Medical and Dental University, Japan
| | - Nanako Hashido
- Department of Comprehensive Reproductive Medicine, Graduate
School, Tokyo Medical and Dental University, Japan
| | - Tomonori Ishikawa
- Department of Perinatal and Maternal Medicine (Ibaraki),
Graduate School, Tokyo Medical and Dental University, Japan
| | - Naoyuki Miyasaka
- Department of Comprehensive Reproductive Medicine, Graduate
School, Tokyo Medical and Dental University, Japan
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Chang CH, Ding DC. Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study. J Chin Med Assoc 2023; 86:682-687. [PMID: 37185219 DOI: 10.1097/jcma.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). METHODS We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. RESULTS Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. CONCLUSION Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.
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Affiliation(s)
- Chi-Han Chang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan, ROC
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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12
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Misiriyyah N, Qurban K, Beevi A, Paulose L, Margossian H. Adnexal Torsion Associated With Recurrent Ovarian Hyperstimulation Syndrome: A Case Report. Cureus 2023; 15:e36344. [PMID: 37082494 PMCID: PMC10111192 DOI: 10.7759/cureus.36344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Adnexal torsion due to hyperstimulation is one of the well-recognized serious complications of assisted reproductive techniques like in vitro fertilization (IVF). We report a case of a 35-year-old primigravida who presented to the emergency department with complaints of acute severe left iliac fossa pain and nausea. Further history revealed that the patient had previously undergone one cycle of ovulation induction and was diagnosed with ovarian hyperstimulation syndrome (OHSS). After prompt management, she reportedly underwent a cycle of IVF successfully. Her gestational age was five weeks and one day on presentation. A transabdominal ultrasound revealed bilateral enlarged ovaries with adequate blood supply and a single intrauterine gestational sac with a yolk sac. The patient was admitted as a case of recurrent OHSS for conservative management. Despite the initial improvement of symptoms with parenteral analgesia, an emergency laparoscopic surgery was done later due to worsening symptoms. Intraoperative findings were consistent with the suspected diagnosis of adnexal torsion which was managed accordingly. Postoperatively, the patient recovered without complications and was discharged two days later with a plan for outpatient follow-up.
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Borukh E, Ilyaev B, Muminiy SN, Babayev M, Musheyev Y, Levada M. Ovarian Fibroma Presents As Uterine Leiomyoma in a 61-Year-Old Female: A Case Study. Cureus 2023; 15:e36264. [PMID: 37073210 PMCID: PMC10105824 DOI: 10.7759/cureus.36264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Uterine leiomyoma should be considered when a female patient reports symptoms of abdominal pressure and abnormal vaginal bleeding. However, the symptoms of a uterine leiomyoma are vast and overlap with other possible diseases that are difficult to distinguish even with imaging studies. This is why it is important for physicians and healthcare providers to keep an open mind and have a broad differential diagnosis. In this case study, we present a 61-year-old postmenopausal female patient who presented to the emergency department with complaints of pelvic and abdominal pain, as well as vomiting and diarrhea. She was admitted for observation. A complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis revealed no abnormalities; a pelvic ultrasound and CT scan reported possible adnexal torsion. The patient remained stable and the pain had subsided when she was seen the next morning by her gynecologist (GYN) who discharged her to follow-up in the office. Subsequent examinations that aided in the diagnosis included, but were not limited to pelvic and transvaginal ultrasounds, an abdominal and pelvic CT, and a pelvic MRI. In this case, the MRI revealed an 11-cm mass that could represent a torsioned pedunculated necrotic fibroid originating from the uterus. Radiology recommended surgical removal. Upon removal and review of the pathology of the mass, it was revealed to be a torsioned, partially necrotic fibroma that had originated from the ovary and not from the uterus, as imaging had originally suggested.
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Le M, Bonde A, Foster B. The "Double Ovary" Sign: A Unique Sonographic Observation in Isolated Fallopian Tube Torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36880675 DOI: 10.1002/jum.16208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Isolated fallopian tube torsion (IFTT) is a rare subset of adnexal torsion. Timely diagnosis of IFTT is essential for preservation of the fallopian tube. However, a pre-operative diagnosis is challenging due to nonspecific symptoms and findings on physical exam. In addition, ultrasound (US) is typically the initial imaging modality in this setting and adnexal torsion may not be considered when normal ovaries are seen. In this small case series, we introduce the "double ovary" sign, a unique observation on US characterized by two adjacent structures: the ovary and the twisted fallopian tube giving rise to an ovary-like, cystic structure. We present three cases in which IFTT was diagnosed preoperatively.
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Affiliation(s)
- Mai Le
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Apurva Bonde
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Bryan Foster
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
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15
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Lapides A, Ma W, McKinney C, Chuang L. Laparoscopically-treated ovarian torsion in a 32-week pregnancy: A case report. Case Rep Womens Health 2023; 37:e00496. [PMID: 37020693 PMCID: PMC10068008 DOI: 10.1016/j.crwh.2023.e00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Ovarian torsion is a gynecologic emergency which, while rare during pregnancy, is associated with increased risk during pregnancy. Most torsions during pregnancy occur during the first and second trimester, with only 10.5% of cases reported during the third trimester. A 35-year-old woman at 32 weeks and 2 days of gestation presented with right lower quadrant abdominal pain. Transvaginal ultrasound demonstrated a large right ovarian cyst and decreased flow on color Doppler consistent with ovarian torsion. The diagnosis was confirmed via diagnostic laparoscopy with direct visualization of the necrotic, edematous ovarian cyst and pedicle, which had been torsed twice. The pedicle was detorsed and the necrotic cyst was resected while sparing as much of the normal ovary as possible. The patient provided written consent for publication of this case report. Data supports that laparoscopy is a safe and reasonable treatment for ovarian torsion during pregnancy. It is associated with shorter hospital stays and fewer postoperative complications without increasing the risk of obstetric or neonatal complications. Much of this data, however, is obtained from case reports of torsions during the first and second trimester. The incidence of third trimester ovarian torsion is estimated to be 5-10% of torsion cases that occur in pregnancy. This case demonstrates a successful laparoscopic treatment of a third-trimester torsion in a woman who went on to deliver a healthy baby girl by spontaneous vaginal delivery.
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16
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Pacione L. The Acute Female Nongravid Pelvis: A Review of Appropriate Clinical Applications of Sonography, Computed Tomography, and Magnetic Resonance Imaging. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2023. [DOI: 10.1177/87564793221147639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The objective of this literature review was to provide a summary of the primary concerns in evaluating ovarian cysts and compare the diagnostic roles of each imaging technique, in an emergent setting. Materials and Methods: A literature review of the imaging evaluation of functional ovarian cysts, emergent complications, and relevant case studies was performed using peer-reviewed articles. The literature search was conducted using PubMed, The Wiley Online Library, and Google Scholar search engines. Results: Sonography, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrate comparable accuracy in the diagnosis of functional ovarian cysts and ovarian torsion. While sonography is the preferred method of imaging the female pelvis, CT and MRI demonstrate similar diagnostic capabilities. Conclusion: Functional ovarian cyst rupture/hemorrhage and ovarian torsion can be accurately demonstrated using sonography, CT, and MRI.
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17
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Agha Majidi M, Arab M, Ghodssi-Ghassemabadi R, Nouri B, Ghavami B, Sheibani K. Torsion among Women with Acute Lower Abdominal Pain: A Retrospective Cross-Sectional Study. Med J Islam Repub Iran 2022; 36:147. [PMID: 36654847 PMCID: PMC9832935 DOI: 10.47176/mjiri.36.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Lower abdominal or pelvic pain is a common complaint among women and one of the most challenging findings to evaluate. We performed the present study to construct a new algorithm for predicting the chance of ovarian torsion among women with acute lower abdominal pain. Methods: This diagnostic retrospective cross-sectional study was performed on all female individuals who were referred to Imam Hossein Medical Center, Tehran, Iran, with the chief complaint of acute lower abdominal pain, and underwent laparotomy between 2010 and 2016. Clinical and paraclinical findings were evaluated to construct a predictive model for ovarian torsion. The variables were compared in 2 groups. The first group included individuals with a final diagnosis of ovarian torsion and the second group included those individuals with any diagnosis other than ovarian torsion. All data were compared between these 2 groups using SPSS software Version 21 to find the related findings with a predictive value for ovarian torsion. Results: A total of 372 participants were evaluated, of whom 116 participants (31.2%) had ovarian torsion (case group) and 256 participants had other diagnoses for their lower abdominal pain (control group). Nausea and vomiting (p < 0.001), tenderness (p < 0.001), the size of ovarian mass (p = 0.004), and the percentage of polymorphonuclear (p < 0.001) showed significant relationships with ovarian torsion as the final diagnosis. Multiple logistic regression models were constructed to predict the factors affecting ovarian torsion, and a scoring system was designed to predict ovarian torsion, with a sensitivity of 77.59% (68.9%- 84.8%) and specificity of 74.61% (68.8% 79.8%). Conclusion: The proposed model is suitable for predicting ovarian torsion and its necessary information is readily available from individuals' history, examination findings, laboratory results, and an ultrasound exam.
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Affiliation(s)
- Mona Agha Majidi
- Imam Hossein Medical Center, Shahid Beheshti University of Medical
Sciences,Tehran, Iran
| | - Maliheh Arab
- Imam Hossein Medical Center, Tehran, Iran, Corresponding author:Maliheh Arab,
| | | | - Behnaz Nouri
- Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Ghavami
- Obstetrics and Gynecilogy Department, Arash Women's Hospital, Tehrtan Univercity
of Medical Sciences, Tehran, Iran
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18
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Topcu A, Ozturk A, Deniz E, Duman Ozturk S, Arpa M, Atak M. The effects of amiodarone in ovarian injury due to oxidative stress and inflammation caused by ischemia-reperfusion. Immunopharmacol Immunotoxicol 2022; 44:1022-1031. [PMID: 35838634 DOI: 10.1080/08923973.2022.2102991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Ovarian ischemia constitutes 2-3% of all gynecological emergencies. New-generation therapeutic agents need to be discovered, in addition to invasive interventions capable of reducing the risk of potential ovarian ischemia to a minimum and protecting against potential adverse outcomes. AIMS To investigate the effects of amiodarone (AMD) on ischemia-reperfusion-induced oxidative stress and inflammation-induced ovarian damage. METHODS The control group, received intraperitoneal (i.p.) injection of saline solution. The ischemia group (I-Group), was subjected to ischemia-induced injury without drug administration. The ischemia + AMD (50 mg/kg) group was subjected to ischemia injury and also received i.p. 50 mg/kg AMD prior to induction of ovarian ischemia. The ischemia-reperfusion (I/R group) was exposed to ischemia and reperfusion-induced injury without drug administration. The I/R + AMD (50 mg/kg) group underwent I/R injury together with i.p. administration of 50 mg/kg AMD prior to induction of ovarian I/R. The Sham + AMD group received intraperitoneal (i.p.) injection of 50 mg/kg AMD alone. In this study performed thiobarbituric acid reactive substances (TBARS), thiol (-SH), interleukin 1 Beta (IL-1β), interleukin 6 (IL-6), toll-like receptor 4 (TLR4) and nuclear factor-kappa B(NF-κβ). RESULTS Increased oxidative stress and inflammation as a result of ovarian I and I/R application activated the cascade. AMD was not sufficient to reduce the oxidative stress and inflammation. TLR4 and NF-kβ, which were up-regulated by triggering oxidative stress and inflammation, were not regressed by the effects of AMD. CONCLUSIONS AMD, used as an antiarrhythmic agent, was found to be insufficient, despite its antioxidant and anti-inflammatory properties, to reduce the experimentally induced ovarian tissue damage.
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Affiliation(s)
- Atilla Topcu
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Aykut Ozturk
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Esra Deniz
- Department of Pharmacology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seda Duman Ozturk
- Department of Pathology, Recep Tayyip Erdogan University Education and Research Hospital, Rize, Turkey
| | - Medeni Arpa
- Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehtap Atak
- Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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19
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Muacevic A, Adler JR, Benner C, Chassee T. Ovarian Torsion and Its Remediation in a Three-Year-Old Girl. Cureus 2022; 14:e32132. [PMID: 36601187 PMCID: PMC9806735 DOI: 10.7759/cureus.32132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/03/2022] Open
Abstract
Ovarian torsion is a rare, emergent occurrence seen in the premenarchal population. If detected promptly, ovarian torsion can be treated via detorsion. We present a case of a three-year-old girl whose ovary spontaneously torsed and was corrected via ovarian detorsion. The patient presented with sudden-onset abdominal pain and emesis; a transabdominal ultrasound with Doppler was performed, which led to the diagnosis of ovarian torsion. The patient was directly taken into surgery for correction, after which she quickly recovered and was subsequently discharged. The choice of ovarian detorsion to protect fertility in pediatric patients is supported by this case and by the related literature. The key to safeguarding fertility in these patients lies in rapid detection, which remains a challenge in the pediatric population. By raising widespread awareness of the use of Doppler ultrasound as well as symptom presentation, the protection of fertility in cases of pediatric ovarian torsion can be improved.
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20
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Duan Y, Hoer B, Little A. Twisting Ovaries: Three Cases of Ovarian Torsion. Cureus 2022; 14:e30496. [PMID: 36415430 PMCID: PMC9674204 DOI: 10.7759/cureus.30496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Ovarian torsion is a medical emergency that should be considered for every female presenting with abdominal pain. This series consists of three cases of females of varying ages presenting with abdominal pain who were all ultimately diagnosed with ovarian torsion. It highlights the variability in presentation, physical examination, and other factors related to the diagnosis.
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21
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Chen Y, Liu M, Zhang M, Yang M, Weng Z, Wu Q, He S. Ultrasonographic scoring system for the diagnosis of adnexal torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:525-531. [PMID: 35244941 DOI: 10.1002/jcu.23178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To establish the utility of an ultrasonographic scoring system for the diagnosis of adnexal torsion. METHODS We retrospectively analyzing 358 adnexal torsion cases. Using Pearson's χ2 test we determined whether ultrasonographic signs were significantly associated with adnexal torsion. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of the system. Ultimately by using binary logistic regression we established a precise and convenient scoring system. RESULTS The torsion score was based on five criteria that were identified to be independently associated with adnexal torsion: (1) abnormal position of the index adnexa (odds ratio [OR], 2.311); (2) presence of a mass or cyst (OR, 3.495); (3) unilateral ovarian enlargement (OR, 3.051); (4) vascular pedicle twisting (OR, 2.105); and (5) peripheral hypervascularity of the corpus luteum with ovarian edema(encapsulating cyst sign) (OR, 4.164).patients with torsion who scored 0, have a predicted diagnosis rate of 20.9%; patients whose scores were 1,2 have a predicted probability of 41.8% and 66.15%, respectively. For patients with torsion scores of 3, 4, and 5, predicted diagnosis rates were 84.16%, 93.52%, and 98.27%, respectively. CONCLUSION The ultrasonographic scoring system is feasible and precisely diagnoses adnexal torsion using ultrasound.
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Affiliation(s)
- Yan Chen
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Meilian Zhang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Minmin Yang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Suhui He
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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22
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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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23
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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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24
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SUNAR M, YAZICI GN. Deneysel İskemi / Reperfüzyon Modeli Uygulanmış Dişi Sıçanlarda Tuba Uterina Dokusuna Pycnogenol ’un Etkisinin Değerlendirilmesi. DICLE MEDICAL JOURNAL 2022. [DOI: 10.5798/dicletip.1086382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Emergency treatment in gynecology using different methods of surgery. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. Improving surgical treatment of urgent genital pathology based on comparing the effectiveness of different methods of surgery.
Materials and methods. 170 women were selected and divided into three groups. Group 1 included women with acute pelvic inflammatory disease (aPID); to 2nd group – 60 women with intra-abdominal bleeding (IAB); to 3rd group - 50 women with impaired blood supply to tumors of the internal genitalia (uterus and ovaries) (IBSTIG). Each group was divided into two equivalent subgroups depending on the method of treatment: laparoscopic or laparotomy.
During the study, all examined patients had a medical history, gynecological examination, ultrasound examination, surgical treatment by laparoscopy or laparotomy.
Results. The average duration of laparoscopic operations in patients in subgroup 1.1 was 50.4±7.2 minutes and 80.3±10.1 minutes in subgroup 1.2 – with laparotomy method. Intraoperative blood loss was significantly lower in subgroup 1.1 compared with subgroup 1.2 (210.7±31.4 ml and 375.9±44.5 ml) (p <0.01). In the postoperative period in subgroup 1.1, which included women with emergencies due to aPID and in which operations were performed laparoscopically, the maximum temperature rise after surgery was 37.6±0.04 °C, which was significantly lower than in subgroup 1.2, which included women with emergencies due to aPID and in which operations were performed by laparotomy, this figure was 38.0±0.08 °C (p <0.001). The mean duration of the postoperative period in patients of subgroup 1.1 was significantly shorter compared to subgroup 1.2 (7.2±0.6 and 10.2±1.0 days) (p <0.05).
The average duration of operations in subgroup 2.1 was significantly shorter than in subgroup 2.1 (39.8±2.1 and 59.1±2.5 minutes, respectively) (p <0.001). Intraoperative blood loss was on average significantly lower in subgroup 2.1 (189.1±19.8 and 388.5±37.2 ml, respectively) (p <0.05).
In subgroup 3.1, which included women with IBSTIG and underwent surgical treatment by laparoscopy, the average duration of operations was significantly shorter than in subgroup 3.2, where such women with such pathology received surgical treatment by laparotomy (62.1±4.9 and 89.6±7.8 minutes, respectively) (p <0.01). Blood loss was significantly lower in subgroup 3.1 in contrast to subgroup 3.2 (101.7±10.1 ml and 283.3±12.9 ml, respectively) (p <0.001).
Conclusions. The use of laparoscopy for the treatment of urgent genital pathology could increase the effectiveness of surgical treatment. In addition, this method reduces the duration of surgery and surgical blood loss. As a result, it makes it possible to improve the postoperative period.
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Acute Presentation of Large Size Clear Cell Ovarian Carcinoma as Double Torsed Ovarian Tumor. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010089. [PMID: 35056398 PMCID: PMC8780965 DOI: 10.3390/medicina58010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
We report a 46-year-old patient who presented to the emergency department with complaints of acute abdominal pain, nausea, and vomiting. An abdominal CT scan revealed a large (207 × 155 × 182 mm) thin-walled inhomogeneous tumor connected to the uterus and right ovary. Emergency surgery laparotomy was performed. Inside the abdominal cavity, a 30 × 30 cm heterogenous, dark blue tumor in the right adnexa area, torsed two times, weighing 3700 g was found. Histological examination revealed right ovary clear cell carcinoma. We emphasize the rare nature of the histology and presentation of this case report. Ovarian clear cell carcinomas are relatively rare malignancies, presenting in 5 to 10% of ovarian malignant tumors in the west.
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27
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Petousis S, Chatzakis C, Westerway SC, Abramowicz JS, Dinas K, Dong Y, Dietrich CF, Sotiriadis A. World Federation for Ultrasound in Medicine Review Paper: Incidental Findings during Obstetrical Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:10-19. [PMID: 34702644 DOI: 10.1016/j.ultrasmedbio.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Although the prevalence of incidental findings revealed during an obstetric ultrasound examination is low, the findings may include adnexal and cervical masses, uterine or urinary congenital malformations, free fluid in the pouch of Douglas or tortuous vessels (varices). Adnexal masses are the most common finding and vary in imaging characteristics. They are mainly unilateral, cystic masses with a low risk of malignancy that are treated conservatively. The International Ovarian Tumor Analysis scoring models may be helpful in differentiating benign from malignant masses. For those masses >5 cm, follow-up is recommended, and resection could be considered to avoid risk of torsion, rupture and hemorrhage, which may compromise pregnancy outcome. Uterine masses such as fibroids are commonly diagnosed early in the first trimester and should be followed up during pregnancy to evaluate any changes. Transabdominal and transvaginal ultrasound is the first-line test for the diagnosis of such incidentalomas; however, magnetic resonance ultrasound may have a useful role in excluding malignancy potential. As a result of their low frequency and the lack of good evidence, there are no specific guidelines on the management of incidentalomas detected at obstetric scans. Their management should follow the related general guidelines for ovarian, cervical and uterine masses, with individualized management depending on the pregnancy status.
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Affiliation(s)
- Stamatios Petousis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Christos Chatzakis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Konstantinos Dinas
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
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Chang P, Leyland N, Scattolon S. Ovarian Torsion Occurring Nine Days after Ipsilateral Dermoid Cystectomy. Gynecol Minim Invasive Ther 2021; 10:262-264. [PMID: 34909387 PMCID: PMC8613495 DOI: 10.4103/gmit.gmit_24_20] [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: 06/12/2020] [Revised: 07/13/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022] Open
Abstract
Ovarian torsion (OT) is a gynecological emergency that requires prompt treatment and management. It is associated with risk factors such as ovarian cysts and prior pelvic surgery. Diagnosis and treatment require surgery to examine the adnexa, correct the torsion, and determine if cystectomy or oophorectomy are required. We reported the case of a 34-year-old woman who presented 9 days after a dermoid cystectomy with sudden onset abdominal pain. An ultrasound showed abnormal blood flow to the ovary. She then underwent a repeat laparoscopy revealing a necrotic and twisted ovary on the same side that had a cystectomy. The surgeons proceeded with a right oophorectomy. Following surgery, the patient reported no concerns with no ongoing bleeding or pain. OT can present in the short-term postoperatively to an ovarian cystectomy, likely as a result of mechanical forces secondary to structural changes of the ovary. The role for prophylaxis against OT is unclear in those with significant risk factors for torsion.
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Affiliation(s)
- Pauline Chang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nicholas Leyland
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - Sarah Scattolon
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
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29
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Reddy R. Ovarian Dermoid (Mature Cystic Teratoma) in a Postmenopausal Woman: Incidence of Sonographic Signs. Cureus 2021; 13:e17581. [PMID: 34646635 PMCID: PMC8483449 DOI: 10.7759/cureus.17581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
Ovarian dermoid is a common surgically treatable cause of female infertility. Although the fat component of mature cystic teratoma (MCT) appears hyperechoic on ultrasonography, sometimes it poses a diagnostic challenge to differentiate from a complex ovarian cyst / hemorrhagic cyst. The varied presentation of MCT on ultrasonography is due to varying proportions of components belonging to all three germ cell layers such as epithelium, hair, bone, tooth, and cartilage. This case report describes the high-resolution ultrasonography appearance of MCT in a 48-year-old nulliparous post-menopausal woman and provides an elaborative note on how reliable diagnostic signs of MCT on ultrasonography and prompt recognition of the entity has a favorable outcome on prognosis.
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30
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An Unusual Presentation of Recurrent Ovarian Torsion in an Adolescent Female. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Werner S, Zottola C, Steinberg J, Pearson B, Katz A. Ovarian teratoma with pituitary tissue: A case report. Case Rep Womens Health 2020; 29:e00279. [PMID: 33364180 PMCID: PMC7750138 DOI: 10.1016/j.crwh.2020.e00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Ovarian cysts and specifically ovarian teratomas are a common finding in young patients. These cysts display histological cell types from all three cells lines: endodermal, ectodermal and mesodermal origins. A 22-year-old woman who displayed classic signs of cortisol excess – excessive weight gain, difficultly losing weight and abdominal striae – was found to have a 10 cm mature teratoma cyst. This patient presented with ovarian torsion, a common complication of ovarian cysts, and was treated surgically. Pathology was significant for an ovarian teratoma with pituitary secreting cells, most significantly cells secreting adrenocorticotropic hormone (ACTH). Ovarian torsion is a common gynecologic emergency occurring with a variety of ovarian cysts. Ovarian dermoid cysts are benign mature cystic teratomas that are composed of ectodermal, endodermal and mesodermal elements. Rarely these dermoid tumors will secrete hormones. Pituitary cells within an ovarian dermoid can increase systemic adrenocorticotropic hormone (ACTH) levels. ACTH-secreting ovarian dermoid cysts can cause a Cushing-like syndrome.
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Affiliation(s)
- Sarah Werner
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, 100 East 77th street, NY 10075, USA
| | - Cristina Zottola
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, 100 East 77th street, NY 10075, USA
| | - Jordan Steinberg
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, 100 East 77th street, NY 10075, USA
| | - Barry Pearson
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, 100 East 77th street, NY 10075, USA
| | - Adi Katz
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Northwell Health, 100 East 77th street, NY 10075, USA
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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Mandelbaum RS, Smith MB, Violette CJ, Matsuzaki S, Matsushima K, Klar M, Roman LD, Paulson RJ, Matsuo K. Conservative surgery for ovarian torsion in young women: perioperative complications and national trends. BJOG 2020; 127:957-965. [PMID: 32086987 PMCID: PMC7772940 DOI: 10.1111/1471-0528.16179] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion. DESIGN Population-based retrospective observational study. SETTING Nationwide Inpatient Sample in the USA (2001-2015). POPULATION In all, 89 177 ovarian torsions including 20 597 (23.1%) conservative surgeries and 68 580 (76.9%) oophorectomies. METHODS (1) Trend analysis to assess utilisation of conservative surgery over time, (2) multivariable binary logistic regression to identify independent factors associated with conservative surgery and (3) inverse probability of treatment weighting with a generalised estimating equation to analyze perioperative complications. MAIN OUTCOME MEASURES Trends, characteristics and complications related to conservative surgery. RESULTS Performance of conservative surgery increased from 18.9 to 25.1% between 2001 and 2015 (32.8% relative increase, P = 0.001) but decreased steadily after age 15, and sharply declined after age 35 (P < 0.001). On multivariable analysis, younger age exhibited the largest effect size for conservative surgery among the independent factors (adjusted odds ratios 3.39-7.96, P < 0.001). In the weighted model, conservative surgery was associated with an approximately 30% decreased risk of perioperative complications overall (10.0% versus 13.6%, odds ratio 0.73, 95% confidence interval 0.62-0.85, P < 0.001) and was not associated with venous thromboembolism (0.2 versus 0.3%, P = 0.457) or sepsis (0.4 versus 0.3%, P = 0.638). CONCLUSION There has been an increasing utilisation of conservative surgery for ovarian torsion in the USA in recent years. Our study suggests that conservative surgery for ovarian torsion may not be associated with increased perioperative complications. TWEETABLE ABSTRACT Conservative surgery for ovarian torsion may not be associated with increased perioperative complications.
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Affiliation(s)
- RS Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - MB Smith
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - CJ Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - S Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - K Matsushima
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - M Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - LD Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - RJ Paulson
- Division of Reproductive, Endocrinology, and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - K Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
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Uludağ Ö, Doğukan M, Duran M, Annac E. Effects of Prostaglandin Analogue Iloprost Treatment on Distant Organ Damage Following Ovarian Ischemia/Reperfusion Injury in Rats: An Experimental Study. Cureus 2020; 12:e8695. [PMID: 32699692 PMCID: PMC7370693 DOI: 10.7759/cureus.8695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Ischemia/reperfusion (I/R) injury causes oxidative stress, which, in turn, may impair the oxidant/antioxidant balance in tissues and cause damage to the tissues. The local effects of I/R injury can be typically observed in the related organ while systemic effects can be observed predominantly in the heart, brain, lung, and kidney. In this study, we aimed to evaluate the effects of iloprost on heart tissues after an ovarian I/R injury in an experimental rat model. Materials and methods A total of 32 female Sprague Dawley rats were used for the experiment. The rats were divided into four groups with eight rats each: Group I, control group; Group II, ischemia group; Group III, I/R group; Group IV, I/R + iloprost group. Surgical intervention was performed in each group and after the procedures, heart tissues were obtained and examined histopathologically. Results No significant pathological finding was found in Group I and II while degeneration of muscle fibers and interstitial edema was observed in group III and dilation of the vessels was detected in Group IV. No fibrosis or inflammation was observed in any group. Conclusion Iloprost provided protection against I/R injury and thus may be an alternative treatment for I/R injury.
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Affiliation(s)
- Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
| | - Mevlüt Doğukan
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adiyaman, TUR
| | - Mehmet Duran
- Anesthesiology and Reanimation, Adiyaman University Education and Research Hospital, Adiyaman, TUR
| | - Ebru Annac
- Histology and Embryology, Adıyaman University Faculty of Medicine, Adiyaman, TUR
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Abstract
Most adnexal masses are benign, incidental findings of pregnancy which resolve spontaneously. They may present clinically due to haemorrhage, rupture, torsion and mass effect. Aetiological classification includes ovarian benign, ovarian malignant, non-ovarian, gynaecological, non-ovarian non-gynaecological and an additional subset of pathologies unique to pregnancy. Ultrasound is the first-line imaging modality for the evaluation of adnexal masses. This may be supplemented with magnetic resonance imaging. Tumour markers support evaluation of malignant potential, but interpretation of results in pregnancy is challenging. Surgical intervention requires consideration of gestation, lesion characteristics and presence of complications. Laparoscopy is preferred owing to shorter operative time, quicker recovery and resultant lower thrombotic risk. Post-viability, fetal wellbeing and assessment must be considered. Management of the pregnancy may include cardiotocography, steroids, non-teratogenic antibiotics and tocolytics. In rare cases, particularly related to malignancy, termination of pregnancy may be required to enable immediate management where there are concerns for maternal wellbeing.
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Affiliation(s)
- Sachintha Senarath
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Alex Ades
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.,Department of Gynaecology, Royal Women's Hospital, Parkville, Australia.,Department of Gynaecology, Epworth Hospital, Richmond, Australia
| | - Pavitra Nanayakkara
- Department of Gynaecology, Royal Women's Hospital, Parkville, Australia.,Department of Gynaecology, Epworth Hospital, Richmond, Australia
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Postmenopausal adnexal torsion: rare case report. MENOPAUSE REVIEW 2020; 19:49-51. [PMID: 32699544 PMCID: PMC7258374 DOI: 10.5114/pm.2020.95295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023]
Abstract
Most ovarian and/or adnexal torsions occur in reproductive age and are less common in postmenopausal age. A 49-year-old menopausal woman presented to the Emergency Department with abdominal pain. She had a palpable pelvi-abdominal mass and abdominal tenderness on examination. Departmental ultrasound and magnetic resonance imaging (MRI) showed a large multilocular right adnexal cyst (15 × 12 cm) containing fluid with variable signal intensities on both T1 and T2 sequences (stained glass appearance) - most probably mucinous cystadenoma. The studied woman signed an informed consent form and agreed to exploratory laparotomy and adnexectomy. After the pre-operative investigations, which were done according to the hospital protocol, including CA-125 (26 IU/ml) and anaesthesia consultation, she was scheduled for laparotomy. At laparotomy an ovarian cyst originating from the right ovary was found with evidence of torsion of the infundibulopelvic and utero-ovarian ligaments (adnexal torsion). The right adnexa including the right ovary containing the ovarian cyst and the right fallopian tube was excised (adnexectomy). The histological examination of the excised adnexa confirmed the diagnosis of mucinous cystadenoma of the ovary. This report represents a rare case of an adnexal torsion in postmenopausal woman, to highlight that adnexal torsion can occur at any age and that the presence of ovarian mass or cyst predispose to adnexal torsion at any age.
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37
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Simstein R, Merenich W, Graber J, Ferrell M. A case report of ovarian torsion following ovarian transposition for cervical cancer. Emerg Radiol 2020; 27:569-572. [DOI: 10.1007/s10140-020-01776-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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38
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Ameliorative effect of nicorandil in ovarian ischemia-reperfusion-induced injury in rats: role of potassium channel. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1599-1610. [PMID: 32266443 DOI: 10.1007/s00210-020-01854-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Ovarian torsion is a gynecological emergency that leads to serious outcomes. Nicorandil (NIC) is an ATP-sensitive potassium (KATP) channel activator that protects the heart from ischemia. The current study aimed to investigate the role and mechanism of action of NIC in ovarian ischemia-reperfusion (OIR) and possible KATP participation. Twenty-four female albino rats were classified into 4 groups: sham control, OIR, OIR + NIC, OIR + NIC+ glibenclamide (GLB) groups. Serum anti-Müllerian hormone (AMH), ovarian malondialdehyde (MDA), total nitrites (NOx) contents, and superoxide dismutase (SOD) activity were evaluated. Bax and Bcl2 mRNA were also assessed. Histological and immunohistochemical (anti-COX-2 and anti CD68) studies were done. The OIR non-treated group showed histopathological ovarian injury with decreased AMH level. Ovarian MDA, NOx, and Bax mRNA and the expression of COX-2 and CD68 were increased; however, SOD activity and Bcl2 mRNA level were decreased by OIR. NIC significantly ameliorated the histopathological ovarian injury with the restoration of AMH level. NIC significantly corrected oxidative stress and apoptotic biomarkers with decreased COX-2 and CD68 immunostaining. GLB co-administration significantly decreased the protection afforded by NIC. These results imply that NIC has a protective role against OIR via antioxidant, anti-inflammatory, and anti-apoptotic effects and such protection relies, at least partially, on the KATP channel.
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39
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Hanafy AK, Mujtaba B, Yedururi S, Jensen CT, Sanchez R, Austin MT, Morani AC. Imaging in pediatric ovarian tumors. Abdom Radiol (NY) 2020; 45:520-536. [PMID: 31745573 DOI: 10.1007/s00261-019-02316-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The spectrum of ovarian tumors in the pediatric population differs significantly from that in adults. Germ cell tumors are the predominant class of ovarian tumors in children, whereas epithelial tumors are the most common in adults. Ultrasonography is the modality of choice for the initial evaluation of pediatric ovarian tumors. Determining the diagnosis based on imaging may prove difficult, and combining the imaging findings with the clinical scenario is very helpful in reaching a differential diagnosis during clinical practice. We will discuss the spectrum of ovarian neoplasms in the pediatric population and describe their clinical, pathologic, and imaging characteristics. A few unique entities related to ovarian tumors, such as growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and hereditary ovarian tumor syndromes, are also discussed. In addition, we will review several entities that may mimic ovarian neoplasms as well as their distinct imaging features.
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Affiliation(s)
- Abdelrahman K Hanafy
- Diagnostic Radiology, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, 78229, USA
| | - Bilal Mujtaba
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Sireesha Yedururi
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Corey T Jensen
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ramon Sanchez
- Radiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Mary T Austin
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ajaykumar C Morani
- Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
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40
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Tonolini M, Foti PV, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion. Insights Imaging 2019; 10:119. [PMID: 31853900 PMCID: PMC6920287 DOI: 10.1186/s13244-019-0808-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Ganla KN, Choudhary RA, Vora PH, Athavale UV. Sildenafil Citrate: Novel Therapy in the Management of Ovarian Torsion. J Hum Reprod Sci 2019; 12:351-354. [PMID: 32038089 PMCID: PMC6937764 DOI: 10.4103/jhrs.jhrs_52_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/25/2019] [Accepted: 11/01/2019] [Indexed: 11/05/2022] Open
Abstract
Ovarian torsion is defined as partial or complete rotation of ovarian vascular pedicle, leading to the obstruction of venous outflow and arterial inflow. It is an emergency condition with an incidence of 2%–15% in patients with adnexal masses. The main risk in ovarian torsion is an ovarian mass or an enlarged ovary with a long pedicle. Due to the rotation of ovarian tissue axis on its vascular pedicle, there is compression of vessels followed by stromal edema, hemorrhagic infarction, and necrosis of adnexa. Expedient diagnosis poses a difficult challenge because clinical presentation is a variable and often misleading. We report a case of right ovarian torsion after oocyte retrieval for in vitro fertilization, where vaginal sildenafil citrate was successfully used to reduce ovarian edema by improving venous drainage. It also helped in maintaining ovarian tissue perfusion and preventing reperfusion injury and spontaneous detorsion of the ovary without any surgical intervention.
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Affiliation(s)
- Kedar N Ganla
- Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, Maharashtra, India
| | - Rana A Choudhary
- Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, Maharashtra, India
| | - Priyanka H Vora
- Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, Maharashtra, India
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Clinical and pathological features of women with adnexal masses admitted as emergency cases to the Gynaecology Department of West Kazakhstan University. MENOPAUSE REVIEW 2019; 18:180-183. [PMID: 31975986 PMCID: PMC6970418 DOI: 10.5114/pm.2019.90377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/31/2019] [Indexed: 02/01/2023]
Abstract
Aim of the study To detect the clinical and pathological features of women with adnexal masses (AMs) admitted as emergency cases to the Gynaecology Department of West Kazakhstan University. Material and methods A retrospective analysis of the data of women with AMs admitted as an emergency cases to the Gynaecology Department of West Kazakhstan University. The collected data include: age, age of menarche and age of menopause, presenting symptoms, admission criteria – either self-referral or refereed from another department, ultrasound findings, associated pregnancy, associated pathology of the female genital tract, and post-operative histological results of surgically excised AMs (gold standard). Results 77.04% (245/318) of the studied AMs were found in the reproductive age group. The main causes for surgical intervention for the studied AMs was ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%. The available histological results of the surgically managed AMs showed the following: functional ovarian cyst in 36.2% (115/318), benign ovarian neoplasms (BONs) in 18.55% (59/318), and borderline malignant ovarian tumours in 0.63% (2/318). 44.34% of the studied AMs were associated with pregnancy, 49.3% with chronic tubo-ovarain diseases such as salpingo-oophoritis, 14.8% with cervical pathology and pelvic inflammatory diseases, 11.3% with uterine leiomyomas, and 4.4% with endometrial hyperplasia. Conclusions AMs were more common in the reproductive age group (77.04%), and 44.34% of the studied AMs were associated with pregnancy. The main causes of surgical intervention for the studied AMs were ruptured ovarian cyst in 27.1% or adnexal torsion in 9.7%.
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Gomes MM, Cavalcanti LS, Reis RL, Silva EJDCE, Dutra JB, de Melo-Leite AF. Twist and shout: magnetic resonance imaging findings in ovarian torsion. Radiol Bras 2019; 52:397-402. [PMID: 32047334 PMCID: PMC7007053 DOI: 10.1590/0100-3984.2018.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic “whirlpool sign”. The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.
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Affiliation(s)
| | | | - Rainier Luz Reis
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil
| | - Eduardo Just da Costa E Silva
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil.,Hospital das Clínicas de Pernambuco da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Joanna Braynner Dutra
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil.,Hospital da Mulher do Recife, Recife, PE, Brazil
| | - Andréa Farias de Melo-Leite
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil.,Clínica Lucilo Ávila Jr., Maximagem, Recife, PE, Brazil
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Halimeh R, Tomassian S, El Hage M, Metri N, Bersaoui M, Daou R, Anastasiadis E. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Case Rep Obstet Gynecol 2019; 2019:1093626. [PMID: 31815026 PMCID: PMC6877964 DOI: 10.1155/2019/1093626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.
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Affiliation(s)
- Rawad Halimeh
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Serge Tomassian
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Maria El Hage
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Nicole Metri
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Marianne Bersaoui
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rafi Daou
- Faculty of Medicine, University of London, St. Georges, Nicosia, Cyprus
| | - Elie Anastasiadis
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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45
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Ghosh A, McKay R. A Missed Diagnosis of Ovarian Torsion in a Patient with Bilateral Ovarian Dermoid Cysts: A Case Report. Cureus 2019; 11:e5963. [PMID: 31803550 PMCID: PMC6874289 DOI: 10.7759/cureus.5963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ovarian torsion is a gynecological emergency that occurs when there is twisting or torsion of the ovary around its ligamentous supports. If left untreated, it results in loss of blood supply to the ovary and the fallopian tube with resultant infarction and loss of function. Because the presenting symptoms and signs provide a wide differential diagnosis, it can be difficult to diagnose ovarian torsion in the emergency setting. We present a case of a missed diagnosis of ovarian torsion which resulted in the loss of an ovary in a young female with bilateral large ovarian dermoid cysts.
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Affiliation(s)
- Agrima Ghosh
- Surgery, Peterborough City Hospital, Peterborough, GBR
| | - Rebecca McKay
- Obstetrics and Gynecology, Peterborough City Hospital, Peterborough, GBR
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Kanayama S, Kaniwa H, Tomimoto M, Zhang B, Nishioka K, Oi H. Laparoscopic detorsion of the ovary in ovarian hyperstimulation syndrome during the sixth week of gestation: A case report and review. Int J Surg Case Rep 2019; 59:50-53. [PMID: 31103953 PMCID: PMC6599433 DOI: 10.1016/j.ijscr.2019.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/09/2019] [Accepted: 04/27/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Ovarian torsion in ovarian hyperstimulation syndrome (OHSS) is a relatively rare but serious complication in pregnant women. A delay in treatment increases the risk for functional loss of the ovary and early termination of pregnancy. In this report, we present the case of a 40-year-old female with OHSS who experienced ovarian torsion that was successfully treated with laparoscopic detorsion. PRESENTATION OF CASE A 40-year-old pregnant woman in the 6th week of gestation who had conceived following in vitro fertilization presented to us with severe and persistent lower abdominal pain. Ultrasound examination revealed a viable singleton intrauterine pregnancy and bilateral enlarged ovaries with scanty ascites. Approximately 14 h after symptom onset, exploratory laparoscopy was performed. The right ovary was found to be twisted once around over the pedicle, and laparoscopic detorsion was completed. Postoperative follow-up was uneventful, and she successfully delivered a healthy infant at 38 weeks of gestation. DISCUSSION Although the reports on successful laparoscopic surgery for pregnant women with ovarian torsion are becoming more frequent, there are few reports on laparoscopic surgery for ovarian torsion in OHSS during the early first trimester. Optimal management of ovarian torsion during pregnancy needs to be explored for these patients. CONCLUSION Immediate explorative laparoscopic surgery is a potentially safe and useful strategy for treating ovarian torsion during the early first trimester of pregnancy.
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Affiliation(s)
- Seiji Kanayama
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan.
| | - Hiroko Kaniwa
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Masako Tomimoto
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Bo Zhang
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Kazuhiro Nishioka
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
| | - Hidekazu Oi
- Department of Obstetrics and Gynecology, Nara Hospital, Kinki University, Faculty of Medicine, 1248-1 Otuda-Chou, Ikoma, Nara, 630-0293, Japan
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Koc K, Erol HS, Colak S, Cerig S, Yildirim S, Geyikoglu F. The protective effect of propolis on rat ovary against ischemia-reperfusion injury: Immunohistochemical, biochemical and histopathological evaluations. Biomed Pharmacother 2019; 111:631-637. [DOI: 10.1016/j.biopha.2018.12.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/07/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022] Open
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Wang Z, Zhang D, Zhang H, Guo X, Zheng J, Xie H. Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: A retrospective study. Medicine (Baltimore) 2019; 98:e14321. [PMID: 30702612 PMCID: PMC6380708 DOI: 10.1097/md.0000000000014321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures.A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients' clinical characteristics, surgical procedures, and postoperative recovery were analyzed.Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases.Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.
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Affiliation(s)
- Zengyan Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
- Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University
| | - Dan Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
- Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University
| | - Huanxiao Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
| | - Xu Guo
- Medical Examination Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingxuan Zheng
- Deparment of Neurology, People's Hospital of Yangjiang, Guangdong, China
| | - Hongzhe Xie
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University
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Huang C, Hong MK, Chu TY, Ding DC. A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015. PeerJ 2018; 6:e5995. [PMID: 30533300 PMCID: PMC6284449 DOI: 10.7717/peerj.5995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/24/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents). Methods This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy. Results The laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery. Discussion Acute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Tawian, Taiwan
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50
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Magnetic resonance imaging findings in ovarian torsion post in vitro fertilization. Radiol Case Rep 2018; 13:1154-1158. [PMID: 30233749 PMCID: PMC6138859 DOI: 10.1016/j.radcr.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022] Open
Abstract
Patients who get pregnant after being treated with in vitro fertilization (IVF) are at significantly increased risk of ovarian torsion compared to the general population and also in comparison to patients who get pregnant normally [1,2]. The risk is further increased in patients who develop ovarian hyperstimulation syndrome [1]. This possibility should be considered in this group of patients presenting with acute abdominal pain and immediate management should be commenced. Here, we report 2 patients who received treatment for infertility with IVF and developed ovarian torsion and we discuss their management including the imaging workup. The first case is a 34-year-old woman at 11 + 3 weeks of gestation after IVF who presented with a 12-hour acute right lower abdominal pain with nausea and vomiting. She underwent an ultrasound examination and then further evaluated with magnetic resonance imaging which showed asymmetric enlargement of the right ovary and stromal edema and a diagnosis of ovarian torsion was made. The patient underwent laparoscopic detortion and the ovary was salvaged. The second case is a 33-year-old woman at 9 weeks of gestation after IVF who presented with intermittent abdominal pain, vaginal bleeding, and nausea and vomiting for 5 days but became worse on the fifth day. Ultrasound and subsequently magnetic resonance imaging were performed which confirmed hyperstimulation syndrome. Abnormal location of the left ovary anterior to the uterus with higher volume as well as the clinical progression raised the possibility of ovarian torsion and prompted a diagnostic laparoscopy which showed right ovarian torsion and detortion was performed.
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