Epidemiology
Adnexal torsion is thought to account for approximately 3% of all gynaecological surgical emergencies.[3][4] It is one of the commonest causes of acute pelvic pain in non-pregnant women.[5] The highest incidence is in reproductive-age women, with 80% of all cases occurring in females aged <50 years, but it can occur in children and older women.[5][6] The post-menopausal period accounts for around 10% of cases of adnexal torsion.[5]
Just over half (56%) of patients in a large series of adnexal torsion had an ovarian mass, mostly with benign histology, including dermoid cysts and para-ovarian cysts.[5] Anything that enlarges the ovary, such as pregnancy and ovulation induction with gonadotrophins, also predisposes women to torsion.[7][8][9][10][11] The risk of ovarian torsion is approximately 5 in 10,000 in pregnancy, with the highest incidence between 6 and 14 weeks of gestation.[12] In patients undergoing ovulation induction with gonadotrophins, the incidence of adnexal torsion is 3% for those who have ovarian hyperstimulation syndrome.[5] In contrast to adults, adnexal torsion in paediatric and adolescent patients involves an ovary without an associated mass or cyst in as many as 46% of cases.[1]
Risk factors
Neoplasms account for 46% of anatomical abnormality-related cases.[6]
Predisposes the ovary to swing on its vascular pedicle.
Includes benign neoplasms such as cystic teratomas, and serous and mucinous adenomas. In adults, 1.1% to 2% of all neoplasms are malignant. This percentage is lower in children.[3][13][16][18][19][20] Adnexal masses 6 to 8 cm in size pose the greatest risk.[21]
Ovarian enlargement is common with ovulation induction and therefore predisposes the patient to torsion.[7][8][9][10][11]
In patients undergoing ovulation induction with gonadotrophins, the incidence of ovarian torsion is as high as 6%, and 16% for those who have ovarian hyperstimulation syndrome.[22]
May twist on its own pedicle or cause torsion of the adnexa.
Reported at the time of surgery in 2% of cases.[16]
Although fairly uncommon in pregnancy, the risk of ovarian torsion is approximately 5 in 10,000 and it can cause high patient morbidity and fetal mortality if not immediately treated.[12] The highest incidence is between 6 and 14 weeks of gestation.[12]
Displacement of adnexa due to enlarging uterus may predispose the ovary, especially if enlarged, to rotate on its pedicle.[7]
Sudden physical movements have been associated with ovarian torsion.
May be caused by coughing, hiccupping, defecation, and vomiting. May push ovary to rotate on its pedicle.[23]
Can result in larger, more mobile ovaries that may be more prone to torsion.[24]
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