Pregnancy complicated with adnexal torsion:Clinical and ultrasonic manifestations
Objective To observe the clinical and ultrasonic characteristics of pregnancy complicated with adnexal torsion(AT).Methods Clinical and ultrasonic data of 20 pregnant women with AT diagnosed by ultrasound and confirmed by surgery were retrospectively reviewed,and the outcomes were followed.Results Among 20 patients,left side and right side AT occurred in 8 and 12 cases,respectively,all with abdominal pain accompanied by lower abdominal tenderness on the affected side,5 cases with nausea and vomiting,2 cases with nausea without vomiting.Ultrasound detected ovarian mass in 18 cases and uniform ovarian enlargement in 2 cases.Punctate blood flow signals in the affected ovary were observed in 15 cases,and pedicle like structures with detectable torsion in the accessory area present as"vortex sign"were noticed in 15 cases.Radial arrangement of sinus follicles in the cortex around the ovary,known as"follicular ring sign"was found in 1 case,ovarian stromal edema was observed in 3 cases,while abdominal and pelvic fluid accumulation were detected in 16 cases.Laparoscopic and open exploratory surgeries were performed in 11 and 9 cases(combined cesarean section in 5 cases),respectively,and 90° to 1 800° torsions were found during operations.Among 18 cases with ovarian masses appendectomy or cyst dissection was performed in 9 and 7 cases,respectively,while ovarian and fallopian tube derotation was performed in 2 cases.Fifteen cases underwent follow-up,pregnancy continued to term in 9 cases,and then 7 cases underwent spontaneous delivery and 2 cases underwent cesarean sections,while 6 cases continuing pregnancy without significant abnormalities.Conclusion Pregnancy complicated with AT mainly characterized by abdominal pain accompanied by nausea and vomiting.Ultrasound often displayed large ovarian mass or ovarian enlargement and the characterized twisted pedicle like structures adjacent to the ovaries.
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