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Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology. Though it is more common in reproductive age group, it can occur in extremes of age group. So, we had analysed the clinical presentation, surgical characteristics, and causes of adnexal torsion among adolescent population, reproductive-age women, and postmenopausal women.Methods: Patients with adnexal torsion who were treated in department of obstetrics and gynecology, SRM Medical College Hospital and Research Centre from October 2016 to March 2019 were retrospectively analyzed.Results: Among the 53 cases of adnexal torsion during the study period, maximum (38, 71.6%) were in the reproductive age group. There were three patients with ovarian torsion during pregnancy. Acute pain abdomen was the significant presenting symptom in adolescent group compared to other two group (100% versus 80.6% versus 40%, p = 0.03). Adnexal pathology was in the ovary in 76% and isolated tubal pathology in 5%. Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients (100%), as opposed to conservative surgery- detorsion and cystectomy in premenopausal women (56%). In Adolescent patients 62% had polycystic ovaries as intraoperative finding. Histopathology were benign except for a patient in postmenopausal age group who had granulosa cell tumour.Conclusions: An early identification of adnexal torsion is necessary in order to achieve conservative treatment in order to maximize the future reproductive potential in younger patients.
RESUMO
Of the above nine fatalities, four deaths could have been averted if early complete radical treatment had been done in cases 1, 4, 5, and 6. These cases were operated on too late after metastasis had already occuredIn two cases-8 and 9 - only the hormonasl test, in conjunction with adbdominopelvic examination done bimonthly, if not monthly, after the abortion, could have diagnosed the disease at a time when the radical removal of the affected organ might have ended in cure. The only treatment of generalized abdominal chorioepithelioma is X-ray, not surgeryIn two patients - 2 and 7 - though the hysterectomy was done respectively 42 days and 29 days after the D & C for mole in case 2 and 1-1/2 months of incomplete abortion in case 7, the uterine growth was well advanced and metastasis had already occured in other parts of the body. These are the cases that should have been hysterectomized within five days, if not immediately, after the D & C. The responsibility of the early diagnosis lies in the ability of the pathologist to detect malignancy in the curettings. In elderly patients, as number 2, who show Acosta-Sisons clinical signs of malignant mole as (a) too great discrepancy in the size of the uterus (4-1/2 months pregnancy) and the age of amenorrhea (1 month); (b) the mole of the small cyst variety admixed with much placenta-like tissue, the safest treatment for the patient is complete hysterectomy either with the mole in the situ or immediately after D & C, in conjunction with blood transfusionWith patients like case 3 where in spite of the early subtotal hysterectomy done 32 days after the D & C for mole, the uterine growth was greatly advanced, besides showing smaller foci near the cut end of the uterus, one should consider the possibility of the presence of similar foci in the cervical stump which may later either grow in situ or be transported into other regions where they may grow. Such cases should be treated by deep X-ray post-operatively and should be followed up for at least two years for hormonal test and bimanual examination to detect the presence of any abnormality in the pelvic region.(summary)