Objective: To evaluate our experience with adnexal torsion (AT) in 36 patients and the outcomes of the patients who were managed conservatively via laparoscopy.
Material and methods: A prospective study was conducted on 36 patients who underwent operations for AT via laparoscopy between January 2008 and December 2009. Data including age, previous history, time of onset of symptoms, time of admission to hospital, gray-scale and color Doppler US findings, time interval between hospital admission and surgery, type of intervention, operative findings and postoperative gray-scale and Doppler US findings were recorded.
Results: In 29 (80.5%) patients, a preoperative diagnosis of AT was confirmed clinically. The mean age of the patients was 26.5, with a range of 11 to 44. Ovarian blood flow was assessed by color Doppler US ultrasonography in 30 patients preoperatively. In 11 (36.6%) patients, this was found to be normal. In 19 (63.3%) patients, ovarian blood flow was found to be pathological or absent. Laparoscopic conservative treatment was performed in 34 patients. In two patients, salpingo-oophorectomy was performed. No thromboembolic complications were seen. Postoperative ultrasonographic examinations confirmed normal ovarian morphology and Doppler blood flow in all patients with no recurrence.
Conclusion: Early diagnosis and treatment are key factors in managing AT. According to the results of the present study, given its demonstrated safety and benefits, in women of reproductive age, a conservative approach of untwisting the adnexa and salvaging the ovary via laparoscopy should be considered in AT cases in which the time from the onset of symptoms to surgery does not exceed 44 hours, regardless of the color and number of twists.
Amaç: Laparoskopi ile konservatif yaklaşım uyguladığımız 36 adneksiyal torsiyon (AT) hastasının sonuçlarını belirlemek.
Gereç ve yöntemler: Ocak 2008-Aralık 2009 tarihleri arasında prospektif olarak planlanan çalışmada 36 hastanın verileri (yaş, önceki hikaye, semptom başlangıç zamanı, hastaneye başvuru süresi, USG bulguları, hastenye başvurudan cerrahiye kadar geçen süre, yapılan girişim ve operatif bulgularile postoperatif USG ve Doppler bulguları) belirtilmiştir.
Bulgular: Yirmidokuz hastada (%80.5) klinik olarak AT tanısı konulmuştur. Hastaların ortalama yaşı 26.5. Otuz hastada preoperatif doppler USG yapılmıştır. Onbir hastada doppler normaldir (%36.6). 19 hastada dopplerde patolojik kan akımı veya akım yokluğu gözlenmiştir (%63.3). 2 hastaya salpingoooferektomi yapılmıştır. Tüm vakalarda postoperatif doppler normal olarak bulunmuştur ve rekürrens gözlenmemiştir.
Sonuç: AT da erken tanı ve tedavi over fonksiyonları açısından çok önemlidir. L/S ile overin detorsiyonu semptom başlangıcından sonra 44. saate kadar mümkündür.
Keywords: Adnexal torsion; conservative management; detorsion; laparoscopy; ultrasonography.