Autoamputation of the uterine adnexa due to torsion

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

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.

Full Text

Restricted Access

About the authors

Larisa A. Romanova

St. Petersburg State Pediatric Medical University

Email: l_romanova2011@mail.ru

MD, PhD, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Nikolay N. Rukhlyada

St. Petersburg State Pediatric Medical University

Email: nickolasr@mail.ru

MD, PhD, Dr. Med. Sci., Professor of the Department of Obstetrics & Gynecology

Russian Federation, Saint Petersburg

Anna N. Taits

St. Petersburg State Pediatric Medical University

Email: annataits1@rambler.ru

MD, PhD, Associate Professor, Head Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Anna A. Malysheva

Autoamputation of the uterine adnexa due to torsion

Email: malisheva.anyuta@yandex.ru

Gynecologist, Department of gynecology

Russian Federation, Saint Petersburg

Kristina A. Dudova

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: dr.kristinaandreevna@gmail.com

Resident doctor, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

References

  1. Boyarsky CYu, Gaidukov SN, Chinchaladze AS. Factors which can predict ovarian reserve. Journal of obstetrics and women’s diseases. 2009;58(2):65–71. (In Russ.)
  2. Gasymova DM, Rukhliada NN, Melnikova MA. Function of the only ovary after surgical treatment the complications of benign tumors and tumor formations of ovaries in women of reproductive age. Emergency medical care. 2017;18(1):34–38. (In Russ.) doi: 10.24884/2072-6716-2017-18-1-34-38
  3. Malysheva AA, Abramova VN, Reznik VA, et al. Clinical case of interstitial tubal pregnancy treatment with mifepristone and misoprostol. Pediatrician (St. Petersburg). 2017;8(6):114–117. (In Russ.) doi: 10.17816/PED86114-117
  4. Rukhlyada NN, Gasymova GM, Novikov EI, Mel’nikova MA. Otsenka ovarial’nogo rezerva v neotlozhnoi ginekologii. Uchebnoe posobie. Moscow: Stiks, 2014. (In Russ.)
  5. Taits AN, Ivanov DO, Rukhlyada NN, Malysheva AA. Opyt diagnostiki i lecheniya grudnykh detei s opukholevymi obrazovaniyami yaichnikov. Proceedings of the 2th All-Russian scientific and practical conference “Sovremennye problemy podrostkovoi meditsiny i reproduktivnogo zdorov’ya molodezhi. Krotinskie chteniya”. 29–30 Nov 2018, Saint Petersburg. P. 59–66. (In Russ.)
  6. Yur’ev VK. Metodologiya otsenki i sostoyanie reproduktivnogo potentsiala devochek i devushek. Problems of Social Hygiene, Public Health and History of Medicine. 2000;(4):3–5. (In Russ.)
  7. Bharathi A, Gowri M. Torsion of the fallopian tube and the haematosalpinx in perimenopausal women — a case report. J Clin Diagn Res. 2013;7(4):731–733. doi: 10.7860/JCDR/2013/5099.2896
  8. Khaitov D, Gabbur N. Contralateral recurrence of fallopian tube torsion: A case report. Case Rep Womens Health. 2021;30:e00307. doi: 10.1016/j.crwh.2021.e00307
  9. Konoplitskyi VS, Korobko YuYe. Assessment of the influence of uterine appendages torsion on their pathomorphological changes in the experiment. Wiadomości Lekarskie. 2021;74(8):1876–1884. doi: 10.36740/WLek202108117
  10. Lee KH, Song MJ, Jung IC, et al. Autoamputation of an ovarian mature cystic teratoma: a case report and a review of the literature. World J Surg Oncol. 2016;14:217. doi: 10.1186/s12957-016-0981-7
  11. Malhotra V, Dahiya K, Nanda S, Malhotra N. Isolated torsion of the fallopian tube in a perimenopausal woman: A rare entity. J Gynecol Surg. 2012;28(1): 31–33. doi: 10.1089/gyn.2011.0020
  12. Laufer MR, Sharp HT, Levine D, Chakrabarti A. Ovarian and fallopian tube torsion. UpToDate.
  13. Rizk DE, Lakshminarasimha B, Joshi S. Torsion of the fallopian tube in an adolescent female: a case report. J Pediatr Adolesc Gynecol. 2002;15(3):159–161. doi: 10.1016/s1083-3188(02)00149-3
  14. Sankaran S, Shahid A, Odejinmi F. Autoamputation of the fallopian tube after chronic adnexal torsion. J Minim Invasive Gynecol. 2009;16(2):219–221. doi: 10.1016/j.jmig.2008.11.014
  15. Spinelli C, Piscioneri J, Strambi S. Adnexal torsion in adolescents. Curr Opin Obstet Gynecol. 2015;27(5):320–325. doi: 10.1097/GCO.0000000000000197
  16. van der Zanden M, Nap A, van Kints M. Isolated torsion of the fallopian tube: a case report and review of the literature. Eur J Pediatr. 2011;170:1329–1332. doi: 10.1007/s00431-011-1484-8

Supplementary files

Supplementary Files
Action
1. Fig. 1. Magnetic resonance imaging of pelvic organs

Download (184KB)
2. Fig. 2. Pelvic lesion in posterior cul-de-sac

Download (81KB)
3. Fig. 3. Absence of uterine adnexa on the left

Download (71KB)
4. Fig. 4. Biopsy (fragments of necrotized tissue of left uterine adnexa due to torsion)

Download (165KB)

Copyright (c) 2022 Romanova L.A., Rukhlyada N.N., Taits A.N., Malysheva A.A., Dudova K.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 69634 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies