Adnexal Torsion

Adnexal Torsion

Adnexal torsion is a relatively rare condition in which the ovary and fallopian tube become twisted, disrupting blood flow to the organs.

Causes

In the majority of cases, adnexal torsion occurs when the ovary is dysfunctional; particularly in women of reproductive age. The condition most commonly affects the right ovary.

Risk factors for adnexal torsion include:

·         Pregnancy;

·         Use of synthetic hormones to stimulate ovulation; and

·         Enlargement of the ovary, often due to benign tumours.

Disease pathway

Disrupted blood supply to the fallopian tube and ovary restricts the supply of oxygen and essential nutrients to the organs. This may, in turn, result in the death (necrosis) of cells in the organ.

Symptoms and diagnosis

When the ovary twists, the patient may experience a sharp, severe pain in the pelvic region, occasionally accompanied by vomiting and nausea.

Prior to and after this pain, women may also have intermittent cramps over a time frame of days to weeks.

Based on consideration of symptoms and a physical examination, doctors are usually able to diagnose the condition. The results of an ultrasound can also be used to confirm the diagnosis, as well as indicating the state of blood supply to the ovary.

Treatment

Immediate treatment is required following the diagnosis of adnexal torsion. There are several options for treatment.

Laparoscopy involves the insertion of thin surgical instruments through small incisions made in the abdomen. Doctors will then try to untwist the ovary and fallopian tube.

A laparotomy requires doctors to make a larger incision in the abdomen, through which they can directly see the affected organ and untwist it accordingly.

If the blood supply was entirely cut off, causing the tissue to die, removal of the fallopian tube and ovary is necessary.

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