The Management of Adnexal Torsion: Ovaries can be Saved By Early Diagnostic Laparoscopy and Detorsion

Objective: To determine the surgical results of laparoscopy and laparatomy in patients with adnexal torsion. Material and Methods: Twenty-eight patients with diagnosis of adnexal torsion in a period of two years were included in this retrospective analysis. Data regarding age, gravida, parity, size of the adnexal mass, delay between the first symptoms and the surgical procedure, the outcome of the operation and the duration of hospitalization were recorded and compared between the patients who had laparoscopy and those who had laparotomy. Results: Ten of the patients were managed by laparoscopy while 18 patients had laparotomy. The most frequent presenting symptom was pelvic pain. In 58.1% of the cases pain was located at the right side. The mean age of the patients was 21.1 +/- 5.9 years at the laparoscopy group and 28.2 +/- 9.1 years at the laparotomy group (p<0.05). The mean duration of hospital stay was shorter in the laparoscopy group [1.9 +/- 1.2 versus 2.9 +/- 1.2 days respectively] (p<0.05). Median delay between the first symptoms and the surgical procedure were 6.3 +/- 2.5 hours and 11.7 +/- 4.1 hours at the laparoscopy and the laparotomy groups respectively (p<0.05). Velocity loss in Doppler ultrasonography was noted in 46.4% of the patients. Salpingo-oophorectomy was performed in 11 (39.3%) of the cases and detorsion in 16 (57.1%) of cases. Detorsion of the ovaries were successful at 9 cases with laparoscopy and 7 cases with laparotomy. There was one case of isolated fallopian tube torsion managed by laparoscopic salpingectomy. The total number of pregnant cases was four. Detorsion was successful in two of the cases (one by laparoscopy) at first and second trimester. Conclusion: When adnexal torsion is suspected, the diagnosis can only be achieved by surgery. Arrangements should be made for laparoscopy as soon as possible. Treatment is essentially based on detorsion of the adnexa; even it has a necrosed appearance. Patients who had laparoscopy have a short duration of hospital stay with a high rate of detorsion.