Introduction
Adnexal torsion (TA) also known as ovarian torsion involves the torsion of all adnexal components (fallopian tubes and ovaries), resulting in impaired blood flow. TA has a reported prevalence of 2.7 % and an incidence of 4.9 out of 100,000 women. Adnexal torsion in children is a rare event, and preventing adnexal torsion in children remains controversial. The mean age of the patients was five and a half years (range: two months to ten years). However, many studies show benefits in preventing ovarian torsion and conclude that longer ovarian cords might correlate with the development of ovarian torsion. In addition, in situations where the ovarian ligaments are congenitally long, patients have recurrent torsion.
What Is Ovarian Torsion?
Ovarian torsion also referred to as adnexal torsion or torsion, implies the twisting of the ovary and the part of the fallopian tube. It can be intermittent or persistent and leads to venous, arterial, and lymphatic stasis. Gynecologic surgical intervention is necessary to stop ovarian necrosis in this situation. Age distribution for ovarian torsion in epidemiology is bimodal, particularly in young and older women after menopause. Approximately 20 % of cases occur during pregnancy. An ovary with prolonged infarction may have a more complex presentation with cystic or hemorrhagic degeneration peripherally displaced follicles with central stoma follicular ring sign. Affected ovaries are displaced toward the midline, and a twisted pedicle can be identified in the adnexa, most commonly in front of the uterus. The uterus shifted to the affected side with minimal accumulation of free liquid fat in the adnexa. Spontaneous torsion has also been reported. The clinical presentation includes pain in the pelvic area, vomiting, and belly mass.
What Is the Risk Factor of Ovarian Torsion?
Ovarian torsion is seen in women during their reproductive years, but it occasionally occurs in prepubescent girls. The risk factors that can increase the risk of getting ovarian torsion are listed below:
1. Cyst: A cyst on the ovary is the biggest risk factor for ovarian torsion as it can cause the ovary to become unbalanced and push it to turn on itself. The ovary is attached to the uterus and the walls of the pelvis the same as the ball on a string. And if one puts a cyst on it, it makes it uneven by weighing it down and becomes more likely to wrench on itself.
2. Pregnancy: When a female ovulates, an egg is discharged from the follicle. It then closes itself off and forms the corpus luteum (a hormone-secreting system). If one does not get pregnant, the corpus luteum smashes down and is reabsorbed by the body. If one becomes pregnant, the corpus luteum fills with blood or liquid and becomes a cyst. This type of cyst is typical and occurs mostly in early pregnancy. It often vanishes on its own, but it can induce ovarian torsion.
3. Hormonal Medicines: Consuming the hormones pills that trigger ovulation (for infertility) can promote the ovaries to form cysts, increasing the likelihood of ovarian torsion.
What Are the Investigations for the Diagnosis of Adnexal Torsion?
The ovarian torsion also known as adnexal torsion is diagnosed with the help of the following investigations:
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CT Scan (Computed Tomography):The appearance of a twisted ovarian peduncle on CT is of ovarian torsion. Non-contrast CT suggests hemorrhagic necrosis. A lack of contrast can be observed. Hemorrhagic necrosis is a sign of non-viability.
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Doppler Test: Doppler flow is highly specific for torsion, but normal flow does not completely rule out torsion.
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Complete Blood Picture: Blood tests to learn more about the type of cyst.
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Aspiration: Cyst aspiration with torsion.
The expert may wait one to two months to notice if the cyst persists. Then, the expert inspected again after one or two menstrual cycles. Finally, an ultrasound can test the cyst's location and extent. If necessary, surgery can be performed if the cyst is very large.
What Is the Treatment For Ovarian Torsion?
Immediate surgery is required to stop ovarian necrosis. Most ovaries are irreparable. An abscess or peritonitis may develop if the necrotic ovary is not removed. It may also get infected. Mortality from ovarian torsion is rare. Diagnosis should be considered in the case of an enlarged edematous ovary, with or without a fallopian tube. Emergency surgery is required when a cyst has ruptured and is bleeding into the abdomen or there is ovarian torsion. Some of the treatment procedures are:
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Cystectomy: The cyst is eliminated without putting off the ovary. Cystectomy can be performed through laparoscopy or a larger abdominal incision (laparotomy).
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Ovariectomy: The whole ovary, including the cyst, is removed.
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Salpingo-Oophorectomy: The procedure involves the fallopian tube, ovary, and cyst being eliminated.
Oophoropexy Procedure:
Always look laparoscopically for an ovarian mass, causing the torsion surgeon to make a small incision in the abdomen. With a lighted camera, the surgeon can see the cyst. A laparoscopy occurs when the ultrasound shows a cyst unlikely to go away or resolve independently. The ovarian cyst is removed and sent for analysis. Laparoscopy is also done when providers have concerns about ovarian torsion or bleeding from the cyst. Both situations can be medical emergencies. The main primary complication is that ruptured ovarian cysts can cause fluid to leak from the cyst or bleed into the abdomen.
What Caution Should One Follow to Prevent Ovary Torsion?
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One should avoid strenuous activity diagnosed with a large cyst until it shrinks and disappears, as extreme activity can cause ovarian torsion.
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Birth control pills (BC) can be prescribed to stop ovulation. By stopping ovulation, one can save new cysts from forming. However, taking birth control pills will not help a cyst that is already there to go away.
Can a Woman Become Pregnant When Affected With Torsion?
Women can still become pregnant if at least one ovary is present and vital or functional. Consult the doctor in cases related to:
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Conceiving after the operation.
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Fever over 101° Farenheit.
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Redness at the surgical site.
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A drain exits the surgical site.
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Heavy vaginal bleeding.
Conclusion
The results of several studies show that the two main risk factors for adnexal torsion were ovarian pathology and the stretching and hypermobility of the ovarian ligament. Therefore, reducing pathologic indications and performing unabsorbable sutures and multipoint fixation to restore normal functionality and structure.