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Uterine appendage torsion
Medical expert of the article
Last reviewed: 05.07.2025
Torsion of the appendages includes torsion of the ovary and sometimes the fallopian tube, which can lead to disruption of the arterial blood supply and the development of ischemia. Torsion of the appendages is a rare pathology, but is most often found in women of reproductive age. This disease is usually an indicator of ovarian pathology.
What causes adnexal torsion?
Risk factors include pregnancy, ovulation induction, ovarian enlargement greater than 4 cm (e.g., benign tumors or hyperstimulation with ovulation induction drugs). Torsion of normal appendages is rare, but occurs more frequently in children than in adults.
Symptoms of adnexal torsion
Torsion of the adnexa is characterized by the appearance of sudden severe pain in the lower abdomen, sometimes nausea and vomiting. For many days and sometimes weeks before the sudden pain, intermittent fever may appear, as well as colicky abdominal pain, which spontaneously passes. Increased pain may be determined with movement of the cervix, a unilateral tumor in the adnexa is palpated, and peritoneal symptoms are determined.
Diagnosis of adnexal torsion
Torsion of the adnexa may be suspected based on typical symptoms and unexplained peritoneal symptoms, increased pain with cervical movement, and palpation of the adnexal tumor without signs of pelvic inflammation. The diagnosis may be confirmed by color transvaginal Doppler ultrasonography. If the diagnosis is confirmed, immediate laparoscopy or laparotomy is performed.
[ Treatment of adnexal torsion
Treatment of adnexal torsion involves preserving the ovary and fallopian tube by untwisting them during laparoscopy or laparotomy. Salpingo-oophorectomy is performed when there is nonviable tissue that may not have yet undergone necrosis.