The patients were divided into three categories based on the period from the onset of symptoms to surgical management: acute (≤24h), subacute (2days) and chronic
adnexal torsions (≥3days). Cases, in which the onset of symptoms was unspecified, were included in the chronic
adnexal torsion group. Then, a retrospective comparative study of acute (49 patients) and chronic
adnexal torsion (45 patients) was performed. Laparoscopic surgery was performed as a primary
surgical procedure.
RESULTS: In chronic
adnexal torsion, surgery was performed at a median of 9days (range: 3-270days) after the onset of symptoms. The apparent onset of symptoms was not noted in 2 cases. All cases with acute
adnexal torsion received emergency surgery. In contrast, emergency surgery was performed only in 13 patients with chronic
adnexal torsion. Patients with chronic
adnexal torsion were significantly older than those with acute
adnexal torsion. Isolated tubal torsion was more frequent in chronic
adnexal torsion. With the exception of 2 cases with chronic
adnexal torsion in which laparotomic conversion was required due to severe adhesion, and 2 cases with acute
adnexal torsion with advanced gestational age, who were managed by initial
laparotomy, laparoscopic surgery was successful. Unilateral
salpingo-oophorectomy was the most frequent
surgical procedure in both groups. When confined to the patients who expressed a wish for adnexal preservation, adnexal
cystectomy or detorsion was possible in 60.9% of the acute torsion cases and 57.1% of the chronic
adnexal torsion cases. Severe
necrosis of the adnexal tissue and extensive pelvic adhesion were the more frequent associated conditions in chronic
adnexal torsion. Among the patients who were successfully managed by laparoscopic surgery, the duration of surgery was significantly longer in the patients with chronic
adnexal torsion. Severe
necrosis that makes a pathological diagnosis difficult was the most frequent finding in cases of chronic
adnexal torsion.
CONCLUSION: