Adnexal torsion: Can the adnexa be saved?

Objective: Our purpose was to identify which cases of adnexal torsion may be managed with adnexal conservation. Study Design: A retrospective chart review was conducted on all patients diagnosed with adnexal torsion between Feburary 1983 and February 1993 at four hospitals in the Emory University system. Results: Fifty-nine patients ranging in age from 23 months to 73 years (mean 31.9 years) were reviewed. Almost half of the patients were nulliparous. Lower abdominal pain (83%) and an adnexal mass (72%) were the most common presenting findings, but in general clinical findings were nonspecific. Most patients were treated with extirpative therapy of the affected adnexa. Untwisting of the adnexa was performed in 10 patients; however, adnexal conservation was accomplished in only one patient. There were no thromboembolic complications in any of the patients. Conclusions: Adnexal torsion is a diagnostic challenge, often with nonspecific symptoms. There is growing evidence that untwisting the involved adnexa to observe for tissue reperfusion and viability is safe. However, significant delay in surgical intervention may result in irreversible tissue necrosis, rendering the adnexa unsalvageable.