Torsion of the uterine adnexa - Pathologic correlations and current management trends

OBJECTIVE: To evaluate the clinical and pathologic correlates of specimens removed for the diagnosis of adnexal torsion and to evaluate trends in the management of torsion. STUDY DESIGN: Cases of ovarian or adnexal torsion (N = 104) were identified retrospectively over a period extending from January 1987 to March 1998 by the coding of ovarian, fallopian tube or adnexal torsion. Statistical eval uation was by chi (2) analysis using the Bonferroni inequality correction w hen appropriate. RESULTS: Neoplastic and functional tumors of the ovary composed >90% of the diagnoses at microscopic evaluation, with cancer diagnosed in <1% of cases . Laparoscopy was attempted in 47 (46%) cases, and adnesa-sparing procedure s were performed in 20 (19%) patients. Patients treated in the latter half of the study were not less likely to undergo laparotomy than those treated in the first half; however, conversion from laparoscopy to laparotomy was s ignificantly less common in the latter half. Patients in this study were mo re likely to receive an adnexa-sparing operation than historical controls, but torsion is most commonly associated with a benign process. A more-conse rvative approach to the treatment of this process is becoming increasingly common, as seems warranted in light of the low incidence of malignancy. The need for conversion from a laparoscopic to an open approach appears to hav e been waning over the last decade; that may correlate with an increased co mfort level in gynecologists with laparoscopic approaches.