Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management.

This retrospective study aimed to evaluate the sonographic diagnosis and management strategy of symptomatic adnexal torsion at a teaching hospital in Hyderabad, India. All women with abdominal pain and preoperative or operative diagnosis of adnexal torsion from January 2011 to December 2015 were included. A total of 76 women with 78 episodes were included; 28 (36%) occurred during pregnancy. The ovarian mass (in 71%) and pregnancy (in 35%) constituted the most common risk factors. The overall sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of ultrasound were 75%, 27%, 86%, 15% and 68%, respectively. Ultrasonography was more sensitive in detecting torsions in the non-pregnant subgroup but had a higher specificity during pregnancy. An oophorectomy was performed in 9% of the women due to gangrene. Benign paraovarian cysts and teratomas were the most frequent lesions to undergo torsion. The obstetric outcome was good, the miscarriage rate being 5%. Impact statement What is already known on this subject? Adnexal torsion presents a diagnostic and therapeutic challenge. There are various sonographic criteria that aid in the clinical diagnosis. Discoloured ovaries do not routinely warrant removal. What the results of this study add? The sonographic diagnosis is inaccurate in a third of the cases. Torsion without the involvement of the ovary does not exhibit any of the classic ultrasound findings other than a torted pedicle and therefore a sonographic diagnosis may be difficult. Discoloured ovaries had a normal appearance at future surgeries, reinforcing the concept that an oophorectomy (after detorsion) should be the exception rather than the rule even if the ovary is bluish black. What the implications are of these findings for clinical practice and/or further research? Training in pelvic ultrasound to complement clinical judgement and regular audits of treatment must be conducted in order to minimise pitfalls in diagnosis and management. An ultrasound examination cannot be used as a sole diagnostic criterion to confirm or exclude torsion and a clinical assessment takes precedence.