Chronic adnexal torsion: An under-recognized disease entity

Area of Science:

• Gynecology
• Surgical Pathology

Background:

• Adnexal torsion, a gynecological emergency, is typically categorized as acute.
• Chronic adnexal torsion represents a less understood variant with distinct clinical and surgical features.

Purpose of the Study:

• To compare the incidence, clinical background, and surgical characteristics of chronic adnexal torsion versus acute adnexal torsion.
• To highlight chronic adnexal torsion as a distinct disease entity.

Main Methods:

• A retrospective comparative study involving 49 patients with acute adnexal torsion and 45 with chronic adnexal torsion.
• Patients were classified based on symptom onset to surgical management: acute (≤24h), subacute (2 days), and chronic (≥3 days).
• Laparoscopic surgery was the primary surgical approach.

Main Results:

• Chronic adnexal torsion cases presented significantly later (median 9 days) and involved older patients compared to acute cases.
• Isolated tubal torsion, severe necrosis, and extensive pelvic adhesions were more common in chronic adnexal torsion.
• Laparoscopic surgery was largely successful, though longer operative times were noted in chronic cases; unilateral salpingo-oophorectomy was frequent, but adnexal preservation was possible in over 57% of cases desiring it.

Conclusions:

• Chronic adnexal torsion is a distinct and frequently encountered gynecological condition.
• It poses significant diagnostic and therapeutic challenges.
• Recognition of chronic adnexal torsion is crucial for appropriate management.