Adnexal Torsion

What Is Adnexal Torsion?

Adnexal are the fallopian tubes and ovaries. Torsion is when the adnexa twist inside the pelvis. Torsion causes disruption in the blood flow to and from the adnexa, potentially causing tissue death (necrosis) and damage.

What Causes Adnexal Torsion?

Adnexal torsion may involve the fallopian tube, ovary or both. No one knows why adnexal torsion happens, but a mass on the tube or ovary can increase the likelihood of torsion. However, even completely normal adnexa can become twisted.

Other suggested causes of adnexal torsion include looser ligaments connecting the adnexa to the pelvic wall and uterus and/or the relatively small size of a young woman’s uterus compared to her adnexa.

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What Are the Signs and Symptoms of Adnexal Torsion?

Adnexal torsion typically presents with a sudden onset of pelvic pain, frequently associated with nausea and vomiting. Patients often appear ill, like they have an appendicitis or kidney stone.

How Is Adnexal Torsion Diagnosed?

Adnexal torsion is a clinical diagnosis that requires a high level of suspicion. No one blood test or radiological imaging study can confirm or rule out torsion. The only way to know for sure whether a patient is experiencing adnexal torsion is to perform a diagnostic laparoscopy in the operating room. If a patient is suspected of having an adnexal torsion, based on symptoms, physical examination, blood work, or pelvic ultrasound, it is a surgical emergency that requires immediate diagnostic laparoscopy.

How Is Adnexal Torsion Treated?

Adnexal torsion requires emergency surgery to detorse (untwist) the adnexa to preserve blood flow and prevent permanent damage. This surgery can usually be done laparoscopically, with the goal to detorse and not remove the adnexa.

If there is an adnexal mass present, sometimes it can be removed at the time of the emergency surgery. Occasionally, a second procedure will be necessary to go back and remove the adnexal mass once the swelling and inflammation from the torsion has resolved.