Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women

Yaakov Melcer, Ron Maymon, Marina Pekar-Zlotin, Zvi Vaknin, Moty Pansky, Noam Smorgick

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Purpose: The aim of this study was to investigate the association of clinical, laboratory and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion. Methods: The study included 199 reproductive age women > 16-year-old who underwent urgent laparoscopy for suspected adnexal torsion between January 2008 and December 2014. The association of various parameters with adnexal torsion was analyzed with a multivariate logistic regression analysis and described as odds ratios (OR) ± 95% confidence intervals (CI). Results: Adnexal torsion was surgically diagnosed in 111/199 (55.8%) cases. On the multivariate logistic regression analysis, complaints of nausea/vomiting (OR 4.5, 95% CI 1.8–11.1), peritoneal irritation signs (OR 100.9, 95% CI 4.2–2421.9), elevated white blood cell count > 11,000 cells/mL (OR 3.7, 95% CI 1.3–10.8), presence of free pelvic fluid on ultrasound (OR 34.4, 95% CI 6.7–177.9), ultrasound findings suggestive of ovarian edema (OR 4.2, 95% CI 1.5–11.6), ultrasound findings suggestive of benign cystic teratoma (OR 7.8. 95% CI 1.2–49.4) and location of the ultrasound pathology on the right side (OR 4.7. 95% CI 1.9–11.9) were positively associated with adnexal torsion, while ultrasound findings suggestive of hemorrhagic corpus luteum cyst (OR 0.04, 95% CI 0.008–0.2) were negatively associated with adnexal torsion. By combining these eight parameters, the ROC curve was calculated, yielding an area under the curve of 0.93, 95% CI 0.90–0.97 (p < 0.0001). Conclusion: Routine clinical, laboratory and grayscale ultrasound findings may be incorporated into the emergency room workup of women with suspected adnexal torsion. Laparoscopy should be considered in all patients with suspected adnexal torsion.

Original languageEnglish
Pages (from-to)685-690
Number of pages6
JournalArchives of Gynecology and Obstetrics
Volume297
Issue number3
DOIs
StatePublished - 1 Mar 2018
Externally publishedYes

Keywords

  • Adnexal torsion
  • Laparoscopy
  • Prediction
  • Reproductive age women
  • Ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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