October 2010, Volume 60, Issue 10
Letter to the Editor
Madam, Adnexal torsion is reported to be the fifth most common gynaecologic emergency in women of reproductive age with a prevalence of 2.7%.It was mentioned in a recent study by Arab M et al1 that adnexal torsion is underdiagnosed and also that Gray-scale sonographic findings like simple cyst (52.5% cases), serous cystadenoma (18% cases), mucinous cystadenoma (11% cases) and dermoid cysts (11% cases) are valuable besides clinical findings to suspect adnexal torsion. Its a challenging working diagnosis for clinicians and the diagnostic dilemmas from the initial clinical assessment to final diagnosis are discussed in Table.
Delayed diagnosis may lead to eventual loss of ovary and tube, and this can have detrimental effect on the woman's life both physically and psychologically especially if she has not completed her family. In the developed world; missed or delayed diagnosis carries a risk of litigation and medico legal challenges for doctors. This short review of diagnostic dilemmas highlights the fact that ovarian torsion presentation can be misleading (blood and radiological findings can be normal), therefore clinicians should think broadly as early conservative treatment with laparoscopy can save the ovary.
Junaid Rafi
Registrar Obstetrics and Gynecology, Scarborough General Hospital,
Woodlands Drive, Scarborough, North Yorkshire, UK.
References
1.Arab M, Tehranian A, Mohammadi AG, Hashemieh M. Review of gray-scale ultrasonographic findings: A Valuable guide to suspect Adnexal Torsion. Pak J Med Sci 2010; 26: 300-3.
2.Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. Ovarian cyst torsion in a toddler. Am J Emerg Med 2009; 27: 632.e1-3.
3.Medscape Online. (Cited 2010 May 12). Available from URL: http://emedicine.medscape.com/article/795994-overview.
4.Bar-On S, Mashiach R, Stockheim D, et al. "Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?". Fertil Steril 2010; 93: 20125. doi:10.1016/j.fertnstert.2008.12.022.
5.Gandhi R, Bahri N, Parekh H, Chudasama S, Doshi N, Muniya C. Ovarian Torsion With Ruptured Ovarian Haemorrhage With Massive Hemoperitoneum In A Case Of ITP. The Internet Journal of Radiology 2010; 11.
6.Medscape Online. (Cited 2010 May 12). Available from URL: http://emedicine.medscape.com/article/795994-diagnosis.
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