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Verma M, Bhuria V, Chauhan M, Nanda S, Dahiya P, Singhal SR. Adnexal Torsion: A Retrospective Analysis From a Tertiary Care Teaching Hospital in Northern India. Cureus 2021; 13:e17792. [PMID: 34660002 PMCID: PMC8496559 DOI: 10.7759/cureus.17792] [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: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Background Adnexal torsion is an acute gynecological emergency presenting with acute abdomen which can be missed owing to non-specific symptoms. Among reproductive-age women, conservative surgery is preferred. The present study was a retrospective analysis of adnexal torsion cases reported to a tertiary care teaching hospital in Northern India. The purpose of the study was to describe the demography, clinical features, diagnostic and treatment modalities, and prognosis of adnexal torsion cases. Methods Surgically proven adnexal torsion case records were retrieved and data were entered in an excel sheet from a period of two and half years from January 2018 to June 2020. Results There were 28 cases with an age range of 7-85 years (median age 24 years) with lower abdominal pain and nausea/vomiting symptoms. The majority were in the reproductive age group (71.4%). A Colour Doppler was done which detected 75% (12/16) of the ovarian torsion cases. The size of the adnexal torsion was 5-10 cm in 60.7% with right-sided torsion seen in 57.14%. Detorsion and salpingo-oophorectomy was done in 14 (50%) and 11 (39.2%) cases, respectively. Histopathological examination revealed hemorrhagic/necrotic infarcts (54.2%) and dermoid cysts (33.3%). Conclusions Owing to non-specific symptoms, adnexal torsion is diagnosed with strong clinical suspicion as routine ultrasonography diagnosed only 7.1% in the present study. Conservative surgery is preferred in the reproductive age group.
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Affiliation(s)
- Menka Verma
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Vandana Bhuria
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Meenakshi Chauhan
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Smiti Nanda
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Pushpa Dahiya
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
| | - Savita R Singhal
- Obstetrics and Gynaecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences (PGIMS) Rohtak, Rohtak, IND
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Gupta A, Gadipudi A, Nayak D. A Five-Year Review of Ovarian Torsion Cases: Lessons Learnt. J Obstet Gynaecol India 2020; 70:220-224. [PMID: 32476769 DOI: 10.1007/s13224-020-01319-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to analyse risk factors, surgical findings, ovarian salvage rate and histology of ovarian mass. We reviewed 81 cases of surgically proven ovarian torsion retrospectively from June 2014 to June 2019 at a tertiary care referral centre in South India. Demographic, clinical and surgical details of all patients were noted from the medical records. Mean age of the patients was 26 years. Most of the patients were nulliparous and had a pre-existing ovarian mass of size > 5 cm. Ovarian salvage rate was 43.2%. Concomitant cystectomy with detorsion was done in 30 patients without increase in blood loss or complications. Extensive necrosis was present in 78.2% of oophorectomy specimens. Most common histology of ovarian mass in cystectomy specimens was simple ovarian cyst.
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Affiliation(s)
- Avantika Gupta
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry, 605006 India
| | - Avanthi Gadipudi
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry, 605006 India
| | - Deepthi Nayak
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry, 605006 India
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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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Feng JL, Zheng J, Lei T, Xu YJ, Pang H, Xie HN. Comparison of ovarian torsion between pregnant and non-pregnant women at reproductive ages: sonographic and pathological findings. Quant Imaging Med Surg 2020; 10:137-147. [PMID: 31956537 DOI: 10.21037/qims.2019.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differences in the ultrasonographic features and histological diagnosis of ovarian torsion in pregnant and non-pregnant women have not been defined. A better characterization of these features may help improve the accuracy of preoperative diagnosis. The present study aimed to compare the clinical characteristics, sonographic findings, operative procedures, and histological spectrum of ovarian torsion in pregnant and non-pregnant women. Methods This was a retrospective investigation of female patients at reproductive age with ovarian torsion between January 2010 and May 2017. Each patient received a detailed preoperative ultrasound, and the diagnosis was confirmed by surgery. The clinical characteristics, ultrasonic features, operative procedures, and histological diagnosis of ovarian torsion were retrieved from medical records and were compared in non-pregnant and pregnant patients according to the method of conception. Results The overall preoperative ultrasonic detection rate of ovarian torsion was 0.84, which was significantly different between pregnant and non-pregnant women. The presence of ovarian edema and abnormal adnexal positions also differed between pregnant and non-pregnant women. The ultrasonic features were not significantly different between the two pregnant sub-groups. The most common histologic diagnoses in the pregnant group and the non-pregnant group were a normal ovary and teratoma, respectively. The incidence of ovarian neoplasm was significantly lower in pregnant women. There were significant differences in the surgical procedures between the groups based on neoplastic or non-neoplastic lesions. Conclusions Ovarian edema, absence/decreased blood flow in the ovary, and the whirlpool sign were reliable ultrasonic markers for ovarian torsion at reproductive ages. The preoperative ultrasonic detection rate of ovarian torsion was higher in pregnant women, and ovarian edema was more common. The clinical features of ovarian torsion in pregnant women were similar, independent of the method of conception. In women with ovarian torsion, the incidence of non-neoplastic lesions was more frequent in pregnant women, whereas neoplastic lesions were more common in non-pregnant women. Ultrasonography provides useful parameters for the preclinical diagnosis of ovarian torsion to improve patient management.
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Affiliation(s)
- Jie-Ling Feng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ting Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yong-Jian Xu
- Center for Information Technology & Statistics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Pang
- Department of Medical Records Management, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Lazăr C, Vozian M, Pantea V, Svet I, Mishina A, Tagadiuc O. The effect of controlled reperfusion on experimental ovarian torsion. RUSSIAN OPEN MEDICAL JOURNAL 2019. [DOI: 10.15275/rusomj.2019.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The objective of our research was to study the effect of controlled reperfusion on lactate and advanced oxidation protein products (AOPP) in experimental ovarian torsion (OT), and to evaluate the possibility to reduce the reperfusion injuries applying the ON-OFF technique of reperfusion. Material and Methods — Lactate and AOPP were measured in serum and ovarian homogenates of 70 females rats, divided equally into 7 groups: no intervention (nr. 1); laparotomy (nr. 2); 3 hours OT (nr. 3); 3 hours OT + 1 hour (nr. 4) or 24 hours (nr. 6) of simple reperfusion (SR); 3 hours OT + 1 hour (nr. 5) or 24 hours (nr. 7) of controlled reperfusion (ON-OFF). The results were analyzed using Welch's ANOVA. Results — OT produced an increase of serum (66%, p<0.001) and homogenate (38%, p=0.006) lactate, that tended to return to baseline in 24 hours despite the type of reperfusion. AOPP had grown in OT animals serum (20%, p=0.007) and homogenate (26%, p>0.05) and continued to rise in the serum after SR, while in ON-OFF technique groups – decreased by about 20% (p<0.01). Homogenate AOPP levels rised after reperfusion in all groups. Conclusion — Lactate is a biomarker for ischemia in OT. Increased AOPP in experimental groups indicates that there is a degree of oxidative stress that can affect the cells after the restoration of the blood flow. Therefore, the correct management of the condition that reduces reactive oxygen species production, such as controlled method of reperfusion, could be appropriate to prevent additional injuries.
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Affiliation(s)
- Cornelia Lazăr
- Nicolae Testemitanu State University of Medicine and Pharmacy
| | - Marin Vozian
- Nicolae Testemitanu State University of Medicine and Pharmacy
| | | | - Inna Svet
- Nicolae Testemitanu State University of Medicine and Pharmacy
| | | | - Olga Tagadiuc
- Nicolae Testemitanu State University of Medicine and Pharmacy
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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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