The clinical management of ovarian torsion: case series of 66 patients

Abstract

Objectives: We evaluated the accuracy of using enhanced computed tomography (CT) findings in the diagnosis of ovarian torsion and using preoperative levels of C-reactive protein (CRP) as a marker for adnexal necrosis.
Subjects: Sixty-six patients who were surgically treated for ovarian torsion between January 2009 and August 2012 at our institution were included in this study.
Methods: We retrospectively studied: (1) the relationship between the presence of pathological necrosis and the time from the onset of ovarian torsion to the operation, (2) the relationship between pathological necrosis and the preoperative CRP value, (3) differences between macroscopic and pathological findings of necrosis, (4) the incidence of observing significant findings (fallopian tube thickening or twisted pedicle) related to adnexal torsion when using enhanced CT for the diagnosis of ovarian torsion.
Results: (1) There was a significant difference (P = 0 .03) in the incidence of pathological necrosis in patients who had experienced ovarian torsion of < 12 h (25% incidence of necrosis) and patients who had experienced ovarian torsion of ≥ 24 hr (60% incidence of necrosis). (2) Twenty-two cases of ovarian torsion were CRP positive and 44 cases were CRP negative. There was a significant difference in the percentage of the CRP positive cases and CRP negative cases which showed pathological necrosis, (63.6% and 31.8%, respectively, P = 0.02). (3) Forty-one of the 66 torsion cases showed macroscopic necrosis; however, 29.2% of these were not pathological necrosis. (4) Of the 66 torsion cases, 75.6% showed some significant findings on enhanced CT scans.
Conclusions: (1) A prolonged time from the onset of ovarian torsion to an operation leads to pathological necrosis. (2) The CRP value is a good surrogate marker for the presence of pathological necrosis. (3) Macroscopic findings sometimes misdiagnose ovarian necrosis. (4) Enhanced CT helps in the accurate diagnosis of ovarian torsion.