Current approach to the management of adnexal torsion

Introduction. In the structure of urgent gynecological practice, ovarian torsion ranks fifth, which is usually diagnosed in women of reproductive age. To date, there is no single standard for assessing the viability of the ovary and choosing a conservative or radical operation for patients with ovarian torsion, in this regard, there is a need to search for potential predictors that determine the validity of the choice of the volume of surgical intervention.

Aim. To optimize management tactics for patients with uterine torsion.

Materials and methods. In a retrospective study, an analysis of 55 case histories of patients admitted to a gynecological hospital with a diagnosis of ovarian torsion was carried out. Depending on the organ-preserving and organ-removing surgical treatment, the patients were divided into two groups. The analysis of the studied indicators was carried out using correlation, regression, factor and ROC analysis.

Results. The results of the study demonstrated that only a visual assessment of the state of the ovarian torsion to unjustified organ-removing interventions in 57.1% of patients. Based on correlation, factor, regression and ROC analysis, diagnostically significant predictors determining the volume of surgical intervention were determined.

Conclusions. Based on the retrospective analysis, an algorithm for managing patients with ovarian torsion was developed: at stages A and B according to the clinical classification of ovarian torsion damage, regardless of the studied criteria, organpreserving treatment – detorsion must be performed; at stage C, special attention is paid to D-dimer values: at D-dimer <1450 ng/ml – detorsion, and only at D-dimer >1490 ng/ml – organ-preserving surgery.

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