TY - JOUR
T1 - Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women
AU - Melcer, Yaakov
AU - Maymon, Ron
AU - Pekar-Zlotin, Marina
AU - Vaknin, Zvi
AU - Pansky, Moty
AU - Smorgick, Noam
N1 - Publisher Copyright:
© 2017, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Purpose: The aim of this study was to investigate the association of clinical, laboratory and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion. Methods: The study included 199 reproductive age women > 16-year-old who underwent urgent laparoscopy for suspected adnexal torsion between January 2008 and December 2014. The association of various parameters with adnexal torsion was analyzed with a multivariate logistic regression analysis and described as odds ratios (OR) ± 95% confidence intervals (CI). Results: Adnexal torsion was surgically diagnosed in 111/199 (55.8%) cases. On the multivariate logistic regression analysis, complaints of nausea/vomiting (OR 4.5, 95% CI 1.8–11.1), peritoneal irritation signs (OR 100.9, 95% CI 4.2–2421.9), elevated white blood cell count > 11,000 cells/mL (OR 3.7, 95% CI 1.3–10.8), presence of free pelvic fluid on ultrasound (OR 34.4, 95% CI 6.7–177.9), ultrasound findings suggestive of ovarian edema (OR 4.2, 95% CI 1.5–11.6), ultrasound findings suggestive of benign cystic teratoma (OR 7.8. 95% CI 1.2–49.4) and location of the ultrasound pathology on the right side (OR 4.7. 95% CI 1.9–11.9) were positively associated with adnexal torsion, while ultrasound findings suggestive of hemorrhagic corpus luteum cyst (OR 0.04, 95% CI 0.008–0.2) were negatively associated with adnexal torsion. By combining these eight parameters, the ROC curve was calculated, yielding an area under the curve of 0.93, 95% CI 0.90–0.97 (p < 0.0001). Conclusion: Routine clinical, laboratory and grayscale ultrasound findings may be incorporated into the emergency room workup of women with suspected adnexal torsion. Laparoscopy should be considered in all patients with suspected adnexal torsion.
AB - Purpose: The aim of this study was to investigate the association of clinical, laboratory and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion. Methods: The study included 199 reproductive age women > 16-year-old who underwent urgent laparoscopy for suspected adnexal torsion between January 2008 and December 2014. The association of various parameters with adnexal torsion was analyzed with a multivariate logistic regression analysis and described as odds ratios (OR) ± 95% confidence intervals (CI). Results: Adnexal torsion was surgically diagnosed in 111/199 (55.8%) cases. On the multivariate logistic regression analysis, complaints of nausea/vomiting (OR 4.5, 95% CI 1.8–11.1), peritoneal irritation signs (OR 100.9, 95% CI 4.2–2421.9), elevated white blood cell count > 11,000 cells/mL (OR 3.7, 95% CI 1.3–10.8), presence of free pelvic fluid on ultrasound (OR 34.4, 95% CI 6.7–177.9), ultrasound findings suggestive of ovarian edema (OR 4.2, 95% CI 1.5–11.6), ultrasound findings suggestive of benign cystic teratoma (OR 7.8. 95% CI 1.2–49.4) and location of the ultrasound pathology on the right side (OR 4.7. 95% CI 1.9–11.9) were positively associated with adnexal torsion, while ultrasound findings suggestive of hemorrhagic corpus luteum cyst (OR 0.04, 95% CI 0.008–0.2) were negatively associated with adnexal torsion. By combining these eight parameters, the ROC curve was calculated, yielding an area under the curve of 0.93, 95% CI 0.90–0.97 (p < 0.0001). Conclusion: Routine clinical, laboratory and grayscale ultrasound findings may be incorporated into the emergency room workup of women with suspected adnexal torsion. Laparoscopy should be considered in all patients with suspected adnexal torsion.
KW - Adnexal torsion
KW - Laparoscopy
KW - Prediction
KW - Reproductive age women
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85038616015&partnerID=8YFLogxK
U2 - 10.1007/s00404-017-4628-x
DO - 10.1007/s00404-017-4628-x
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AN - SCOPUS:85038616015
SN - 0932-0067
VL - 297
SP - 685
EP - 690
JO - Archives of Gynecology and Obstetrics
JF - Archives of Gynecology and Obstetrics
IS - 3
ER -