Surgical Results and Current Status of Adnexal Torsion Management, with a Comparison of Entire Adnexal Torsion and Isolated Fallopian Tube Torsion: A Single-center Study.

Objectives: We aimed to evaluate the results of surgery for adnexal torsion at Fukushima Red Cross Hospital over the 10-year period from 2013 to 2023. Materials and Methods: In cases of adnexal torsion, we evaluated the incidence, torsion site, symptoms, and presence or absence of necrosis and bleeding. Results: Among 1243 surgeries for ovarian tumor performed during the study period, there were 43 cases (3.5%) of adnexal torsion. Of these, 39 cases (91%) were entire ovarian torsion (ovarian and fallopian tube torsion [OFTT]) and 4 cases (9%) were isolated fallopian tube torsion (IFTT). The incidence of ovarian tumors was higher with OFTT, while paraovarian cysts and hydrosalpinx were more common with IFTT. Compared with IFTT, OFTT was associated with more frequent abdominal pain, emergency surgery, and necrosis on pathological diagnosis. Furthermore, in 53% (10/19) of cases with no necrosis on postoperative pathological examination, there was a change in color to dark purple or black that was suspected to represent necrosis during surgery. Conclusion: Adnexal torsion can lead to necrosis of the ovary or fallopian tube; thus, it is important to make an accurate diagnosis and provide appropriate treatment as soon as possible. When selecting a surgical procedure in reproductive-aged women, it is recommended that ovarian function - sparing procedures be actively considered, except in cases of advanced necrosis, with the understanding that there is often a discrepancy between intraoperative macroscopic necrosis findings and pathological necrosis that identified by postoperative pathological examination (discrepancy rate was 31% in this study).