This study aimed to compare the clinical characteristics and surgical and histological outcomes of premenopausal and postmenopausal patients with adnexal torsion.

Adnexal torsion during pregnancy is a gynecological emergency. Delayed diagnosis and treatment can cause ovarian necrosis and fetal loss. This study assessed the clinical characteristics, treatment and outcomes of adnexal torsion in pregnant women.

We sought to investigate and compare the clinical presentation, ultrasound findings, surgical characteristics, and causes of adnexal torsion among three groups: pediatric and adolescent population, reproductive-age women, and pregnant women.Two hundred twenty-seven surgically confirmed episodes of adnexal torsion in 199 patients treated in our department from January 2008 to December 2014 were retrospectively analyzed.Abdominal pain duration of >24 hours before emergency room presentation was more common in pediatric and adolescent patients compared with reproductive-age and pregnant women (42.3% vs. 28.4% and 15.5%, respectively, p = 0.04). However, there was no difference between the groups in the time interval from their emergency room admission to surgery. Torsion of "normal adnexa" occurred in 11/44 (25.0%) of pediatric and adolescent patients, 30/99 (30.3%) of reproductive-age patients, and 12/56 (21.4%) of pregnant patients, while torsion involving multicystic ovaries occurred in 0%, 4%, and 32.1%, respectively, torsion involving paraovarian cysts occurred in 20.5%, 14.1%, and 1.8%, respectively, and torsion involving benign dermoid cysts occurred in 4.5%, 15.2%, and 5.4%, respectively (p < 0.001). Torsion involving supposedly functional ovarian cysts occurred in 45.5%, 34.3%, and 69.6%, respectively (p < 0.001). The torsion recurrence rates were 18.2% in the pediatric subjects, 19.2% in reproductive-age women, and 10.7% in pregnant women (p = 0.3).The presentation of adnexal torsion is similar in pediatric and reproductive-age and pregnant women, although the underlying adnexal pathology may be different. Functional ovarian cysts cause the majority of torsion cases in pregnant women. Recurrence of torsion may occur in any age group.

To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters.

We evaluated and compared the clinical and pathological differences between pregnant and non‐pregnant women with adnexal torsion.

Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic “whirlpool sign”. The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.

Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. RSNA, 2021.

Összefoglaló. Terhességben az élettani és anatómiai változások miatt bizonyos patológiás szervi eltérések nem specifikus tünettannal járhatnak. A várandósság alatt fellépő hasi panaszok esetén lényeges felállítani a gyors és pontos diagnózist, a minél korábbi adekvát terápia érdekében. A klinikai tünetek hátterében többek között állhatnak szülészeti betegségek, illetve appendicitis, megnagyobbodott ovariumcysta, nephrolithiasis vagy diverticulitis is. Esetismertetésünkben egy 32 hetes gravida ellátását prezentáljuk, aki jobb alhasi panaszok miatt jelentkezett a Szegedi Tudományegyetem Szülészeti és Nőgyógyászati Klinikáján. A magzati paraméterek megfelelőek voltak. A klinikai vizsgálatok appendicitis gyanúját vetették fel, mely miatt laparoszkópia történt. Torquálódott jobb oldali tuba uterina miatt jobb oldali salpingectomiát végeztünk, az appendix kóros elváltozása nem igazolódott. Magzati, illetve anyai szövődmény a posztoperatív szakban nem volt. A további terhesgondozás során szövődményt nem észleltünk, majd a betöltött 40. terhességi héten hüvelyi úton egészséges újszülött született. A méhfüggelék megcsavarodásának operatív megoldása laparoszkópos úton alkalmazható módszernek tekinthető terhességben is. Az adnexcsavarodás ritka sürgősségi nőgyógyászati kórképnek számít, bár szakirodalmi adatok alapján az adnexum torsiójának rizikója fokozott lehet a terhesség korai szakaszában, kiváltképp asszisztált reprodukciós technikák alkalmazása esetén. Várandósság alatt hirtelen jelentkező alhasi panaszok esetén az anamnesztikus adatok tükrében, a klinikai vizsgálatok során szükséges az adnextorsio lehetőségére is gondolni. Orv Hetil. 2021; 162(35): 1418-1421. Summary. Due to physiological and anatomical changes in pregnancy, certain pathological organ abnormalities may be associated with non-specific symptoms. In the case of abdominal complaints during pregnancy, it is important to make a quick and accurate diagnosis to apply an early adequate therapy. The cause of the clinical symptoms can be obstetrical diseases, appendicitis, large ovarial cyst, rarely nephrolithiasis or diverticulitis. Through our case study, we present the treatment of a 32-week gravida. Examination of the pregnant patient occured at the Department of Obstetrics and Gynecology of the University of Szeged due to right lower abdominal pain. The fetal parameters were satisfactory. We assumed appendicitis, so after proper preparation laparoscopy was performed. Salpingectomy was performed because of torqued right fallopian tube and no pathological changes were detected on the appendix. In the postoperative period, there were no fetal or maternal complications. During further care of pregnancy, there were no complications and a healthy newborn was born by vaginal delivery at the 40th week of gestation. The operative procedure of adnexal rotation by laparoscopy can be considered as an applicable method even in pregnancy. Adnexal torsion is a rare emergency gynecological disease, although literature data suggest an increased risk in early pregnancy, especially in the case of assisted reproductive technology. In the case of sudden abdominal pain during pregnancy, in the light of anamnestic data, it is recommended to consider the possibility of adnexal torsion, too. Orv Hetil. 2021; 162(35): 1418-1421.

The objective of this meta-analysis is to investigate and compare the pregnancy outcomes of laparoscopy and open surgery in the treatment of ovarian tumors during pregnancy.Search was conducted using MEDLINE, EMBASE, and Cochrane Databases from January 1990 to November 2018. A broad search strategy was used to identify studies comparing laparoscopy and open surgery in pregnancy. Inclusion criteria included comparative studies with the quantitative outcome data on gravida. Two authors independently reviewed and assessed for the quality of included studies according to the Newcastle-Ottawa Scale. Data were extracted for fetal loss, preterm delivery, duration of surgery, blood loss and length of hospital stay.Nine retrospective trials were identified involving 985 patients. No statistical significance was found in fetal loss between laparoscopy and open surgery (P value = 0.334). The pooled estimate for preterm labor statistically significantly decreased for laparoscopy group (P value = 0.014). Reduced operative blood loss was found in laparoscopy group by 83.81 ml (P value = 0.015). Duration of operation may be longer in the laparoscopy group, but without statistical significance (P value = 0.346). Length of hospital stay was shorter in the laparoscopy group with reduction of 1.95 days (P value < 0.001).The available low-grade evidence suggests that laparoscopic surgery might be a feasible alternative for pregnant women with adnexal masses.

A 30‐year‐old nulliparous woman was transferred under suspicion of acute appendicitis, due to the sudden onset of severe right lower quadrant pain at 31 weeks and 4 days of gestation. Magnetic resonance imaging showed a cystic mass measuring 40 mm in diameter in the right lower abdomen. Because the right ovary without edematous swelling was noted adjacent to the cystic mass, isolated tubal torsion was strongly suspected. Emergency gasless laparoendoscopic single‐site surgery showed isolated torsion of the right fallopian tube with a paratubal cyst. The right ovary was not involved in this torsion. Because the color tone of the distal portion of the fallopian tube did not recover sufficiently after detorsion, right salpingectomy was performed. Postoperatively, the infusion of magnesium sulfate was initiated due to increased uterine contraction and continued until 36 weeks of gestation. At 38 weeks and 1 day of gestation, uneventful vaginal delivery yielded a healthy female infant.

The aim of our study was to compare the clinical and surgical characteristics of pregnant and nonpregnant women with surgically verified ovarian torsion, as well as the differences among 3 trimesters during pregnancy.

To analyse populational trends and perioperative complications following conservative surgery versus oophorectomy in women <50 years of age with ovarian torsion.

\n Objective To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT).