Adnexal torsion in pregnancy – relying on a six-year hospital experience in solving this problem

Abstract

Introduction Adnexal torsion is a serious complication in pregnancy that can lead to ovarian ischemia and necrosis. This retrospective study aimed to provide clinically driven guidelines for treatment of adnexal torsion during pregnancy.

Case report We analyzed data from 10 patients who underwent surgery for adnexal torsion between 2018 and 2023. The most common symptoms were pelvic pain, nausea, and vomiting. Laparoscopy and laparotomy were equally performed, with the choice depending on factors like trimester and tumor size. Unfortunately, adnexectomy was the most common surgery due to delayed presentation and advanced necrosis. Despite this, pregnancy outcomes were favorable, with most patients delivering live babies.

Discussion The most frequent adnexal tumor in pregnancy is the corpus luteum cyst. Several studies suggest laparoscopic management of adnexal torsion in pregnancy with excellent maternal and fetal outcomes. Both delayed diagnosis and intervention can lead to adnexal necrosis and hence increase the risk of miscarriage and maternal morbidity

Conclusion Expectant management is not recommended. Due to the increased risk of miscarriage and maternal morbidity, laparoscopy (detorsion and cystectomy) is the safest and most effective type of surgery in the first trimester. Laparotomy might be more appropriate in the third or late second trimester or with a very large adnexal mass.

Keywords: adnexal torsion; pregnancy; laparoscopy; laparotomy