Significance of Color Doppler Sonography in the Conservative Therapy of Adnexal Torsion

Abstract

Torsion of the adnexa is a well-known gynecologic cause of an acute surgical abdomen. Delay in diagnosis, inability to distinguish strangulation from necrosis, and fear of embolus dislodgement have made adnexectomy the accepted method of management of adnexal torsion. This condition occurs most commonly in the reproductive years, yet methods to preserve viable ovarian tissue have not been routinely used or evaluated. Therefore, in order to ascertain if color Doppler sonography(CDS) can detect adnexal viability, ultrasonography with CDS of the ovarian pedicle was performed in 27 patients in whom torsion of the ovarian tumor was confirmed surgically. We were able to identify a twisted vascular pedicle of the ovarian tumor by ultrasonography in 24 of 27 patients(88% detectability). In 10 patients in which pedicle arterial and venous blood flow was observed, the pathology specimens revealed normal, or edema with congestion, or early hemorrhage, but in the 9 cases where only arterial blood flow was observed or where there was no blood flow at all, pathology revealed hemorrhagic necrosis in all cases. In 5 cases where there was arterial blood flow the tumor was managed conservatively, either by detorsion or cytectomy, after which there was no cases of embolism or tumor recurrence during follow up ultrasonography. Normal follicular development and ovulation was also observed in these patients. In conclusion, for young women who are of child-bearing age in whom torsion of benign adnexal tumors is suspected, CDS should be conducted to detect torsion of the tumor and ascertain whether pedicle venous blood flow is present or not. If such blood flow is detected, the adnexa is considered to be viable and detorsion or cystectomy may be performed, thus preserving the ovary.