医学
扭转(腹足类)
卵巢扭转
普通外科
医学物理学
重症监护医学
外科
作者
Erica J. Chang,Leslie K. Palacios-Helgeson,Claire Gould
出处
期刊:Current Opinion in Obstetrics & Gynecology
[Ovid Technologies (Wolters Kluwer)]
日期:2022-07-28
卷期号:34 (4): 196-203
被引量:10
标识
DOI:10.1097/gco.0000000000000787
摘要
Purpose of review Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. Recent findings Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A ’whirlpool’ sign, ’follicular ring’ sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18–20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. Summary Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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