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Adnexal torsion

Definition
Adnexal torsion refers to the rotation of the ovary and fallopian tube, which can lead to ischemia and potential necrosis if not promptly addressed.
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Pathophysiology
Adnexal torsion is caused by the twisting of the adnexa, often due to enlarged adnexal masses or specific anatomical variations. For instance, benign tumors and polycystic ovaries can predispose individuals to torsion.
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Epidemiology
The incidence of adnexal torsion in the US is estimated at 4.9 per 100,000 person-years.
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Disease course
Clinically, adnexal torsion often presents with sudden-onset, intermittent, non-radiating abdominal pain associated with nausea and vomiting. This is the most common clinical symptom in adolescent patients.
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Prognosis and risk of recurrence
The prognosis of adnexal torsion is largely dependent on early diagnosis and prompt treatment. If adnexal torsion is suspected, surgical intervention should be performed as soon as possible to minimize trauma and ischemia to the ovary.
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Key sources
The following summarized guidelines for the evaluation and management of adnexal torsion are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023; 2017) and the American College of Obstetricians and Gynecologists (ACOG 2019; 2016).
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Guidelines

1.Screening and diagnosis

Diagnosis: suspect adnexal torsion in female patients presenting with acute abdominal pain.
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2.Diagnostic investigations

Pelvic ultrasound
Obtain ultrasound with and without color flow Doppler as the imaging modality of choice in patients with suspected adnexal torsion.
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Recognize that decreased or absent color Doppler flow, increased total ovarian volume, and abnormal adnexal volume ratios may be suggestive of adnexal torsion.
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3.Surgical interventions

Surgical detorsion and cystectomy, indications, SOGC: perform surgery as soon as possible, recognizing that prompt diagnosis and referral to a surgeon minimize trauma and ischemia to the ovary when torsion is suspected.
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  • Surgical detorsion and cystectomy (technical considerations)

4.Specific circumstances

Adolescent patients, evaluation: recognize that the most common clinical symptom of adnexal torsion in adolescent patients is sudden-onset, intermittent, non-radiating abdominal associated with nausea and vomiting.
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  • Adolescent patients (management)