Autoamputation of the uterine adnexa due to torsion

Abstract

Uterine adnexa torsion is an urgent surgical condition defined as total or partial twisting of an ovary and/or a fallopian tube on its vascular axis, causing circulatory failure. The diagnosis establishing before the operation is difficult due to absence of pathognomonic features of the clinical picture and instrumental diagnostics. In case of torsion the ovary is usually rotating around the infundibular-pelvic and uterine-ovarian ligaments, which causes vascular compression; ischemia and necrosis are progressing, leading to such complications as pelvithrombophlebitis, bleeding, infections, peritonitis, as well as calcification and autoamputation. Classical clinical picture of the uterine adnexa torsion is a sudden onset of continuous/intermittent pelvic or abdominal pain varying from moderate to severe, diffuse or isolated on one side. Pain syndrome could be of various duration, from several days to several months, and there could be such temporal episodes of pain in past history indicating prior partial torsion. This state can be accompanied by nausea, vomiting, fever, painful and frequent urination. The most precise instrumental diagnostics method in case of uterine adnexa torsion is colour Doppler ultrasonography, however, the final diagnosis is established only during the surgery. If the ovary is ischemic, adnexal detorsion is recommended, in case of necrosis adnexectomy is performed. When examining ultrasound of the pelvic organs, the left ovary is not visualized. In our clinical case, according to the results of MRI of pelvic organs, the 38-year old patient had a cyst in posterior cul-de-sac with hemorrhagic or high-protein contents, and also the left ovary was not visible. During the laparoscopy an autoamputation of the left uterine adnexa due to torsion was found, as well as presence of necrotizing lesion in posterior cul-de-sac. Thus, laparoscopy is the only reliable method for diagnosing and treating adnexal torsion.