Adnexal Torsion a Five-years Retrospective Review in Two Hospitals.

Abstract

BACKGROUND Adnexal torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Objective: To describe the clinical profile and therapeutic approaches of adnexal torsion in the Ethiopian setting. METHODS A retrospective cross sectional descriptive chart review ofwomen with surgically proven adnexal torsion was conducted in two teaching hospitals from Jan 1 2007 - Dec 31, 2011. RESULTS A total of 53 women with AT were analyzed. About 33(62%) of torsion occurred in the age group of 20 - 29 years. The most common symptoms were lower abdominal pain 52 (98.1 %) followed by nausea and vomiting 46 (86.8%), whereas, the common physical findings were lower abdominal tenderness 49(92.5%) and palpable pelvic mass 40 (76.9%). Adnexal torsion was considered in the diferential diagnosis upon initial evaluation only in 27 (51%) of the cases. Of the study subjects, only 7(13.2%) had surgery within 24 hours of arrival to the facility and the mean time from initial evaluation to surgery was 53.8±44.5 hours. Moderately positive correlation was observed between ultrasound and intra-operative adnexal size measurement (r = 0.716, p = 0.000). Using non-parametric independent sample test, none of the clinical profile categories studied show significant difference in mean time from initial evaluation to surgery. Despite the overwhelmingly benign pathology, most 46 (86.8%) ofpatients underwent adnexectomy_with only 3(5.7%) adnexal salvage rate. CONCLUSION Delayed surgical intervention and low ovarian salvage rate inspite of predominantly benign pathology was observed. Therefore, high degree of suspicion, especially in patients with high risk factors, and timely intervention must be exercised in an effort to salvage the adnexae.

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