Higashide Ryo, Saito Kazuki, Hashido Nanako, Ishikawa Tomonori, Miyasaka Naoyuki
Department of Obstetrics and Gynecology, Tsuchiura Kyodo General Hospital, Japan.
Department of Comprehensive Reproductive Medicine, Graduate School, Tokyo Medical and Dental University, Japan.
J Rural Med. 2023 Jul;18(3):189-193. doi: 10.2185/jrm.2023-002. Epub 2023 Jul 7.
Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst. Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed. Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases. Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.
附件扭转是一种常见的妇科急症，及时诊断至关重要，因为延误可能导致卵巢功能障碍。尽管漩涡征对诊断卵巢囊肿扭转可靠，但技术难点阻碍了超声检查人员对其的应用。在此，我们通过关注扭转起源于子宫与盆腔壁之间的间隙这一事实，开发了一种可视化该征象的系统方法。必须通过子宫的横向成像确定扭转的起源，并追踪扭转的韧带至卵巢囊肿。两名分别为56岁（病例1）和28岁（病例2）的女性因下腹痛前来我院就诊。经阴道超声检查显示，病例1右侧有一个7厘米的卵巢囊肿，病例2在Douglas窝有一个5厘米的囊肿；两例均检测到双侧卵巢正常及漩涡征。在病例1和病例2的腹腔镜引导下，确认并切除了一个卵巢囊肿和一个卵巢旁囊肿。我们的逐步方法使我们能够识别漩涡征并确认附件扭转，从而在两例中均促成了及时手术。采用系统程序有助于经验不足的从业者检测到漩涡征。
