Conservative therapy of adnexal torsion employing color Doppler sonography

Study Objective. To ascertain if color Doppler sonography (CDS) can detect viability of adnexa in torsion. Design. Concurrent, nonrandomized study (Canadian Task Force classification II-2). Setting. Tertiary medical care center in a university hospital. Patients. Twenty-seven women suspected of having torsion of the ovary in which a benign tumor was present. Interventions. Color Doppler sonography of the ovarian pedicle suggested torsion. Laparoscopy or laparotomy was performed in 19 patients and confirmed the diagnosis. Measurements and Main Results. We identifed a twisted vascular pedicle of the ovarian tumor by CDS in 24 (88%) of 27 women. Pedicle arterial and venous blood flow was observed in 10 women; pathology specimens revealed normal tissue, edema with congestion, or early hemorrhage. In all nine in whom only arterial blood flow or no blood flow was observed, pathology revealed hemorrhagic necrosis. In five women with arterial and venous blood flow the tumor was managed conservatively, either by detorsion or cystectomy, after which no embolism or tumor recurrence was seen at follow-up ultrasonography. Normal follicular development and ovulation occurred in these patients. Conclusion. For women of childbearing age in whom torsion of benign adnexal tumors is suspected, CDS should be performed to confirm the diagnosis and ascertain whether or not pedicle arterial and venous blood flow is present. If such blood flow is detected, the adnexa is considered to be viable and detorsion or cystectomy may be performed thus preserving the ovary. It is recommended that further studies with a larger group be undertaken to provide a basis for statistical analysis.