Table Of Contents
Adnexal Torsion
An adnexal torsion occurs when the ovary, fallopian tube (or both), or a paraovarian mass twists around itself. This results in vascular congestion, tissue edema and necrosis of the structures invovled. Torsion is an GYNAECOLOGIC EMERGENCY. It is classicaly associated with ovarian or paratubal cysts (risk is highest if the cyst is between 6 – 10 cm). Torsion can also occur at any time in prgnancy but is most common in the first trimester.
- Signs and symptoms
- Lower abdominal pain
- Sharp, severe, and unilateral
- May remit after a few hours and relapse in intermittent torsion
- Nausea and vomiting
- Lower abdominal pain
- Physical examination
- Rigidity and guarding
- Tender palpable adnexal mass on pelvic exam (may not always be present)
- Investigations
- Doppler ultrasound: to visualize blood flow in the adnexa. No definitive ultrasound sign can be used to diagnose torsion
- Absent venous flow (early torsion)
- Absent arterial and venous flow (late torsion)
- Enlarged ovary > 6 cm
- Free pelvic fluid
- Doppler ultrasound: to visualize blood flow in the adnexa. No definitive ultrasound sign can be used to diagnose torsion
- Treatment
- Surgical detorsion
- Unilateral salpingo-oophorectomy
