| Author's Name: |
Dr Mohammed BHIHI, M Bhihi, M.Roueijel, J.el azzaoui, N Zeraidi, A Lakhdar, A Baidada & A Kharbach |
| Subject Area: |
Health Science |
| Subject |
Other |
| Section |
Case Studies |
Keyword:
torsion, cyst, ovarian, appendage.
Abstract
The Torsion of annex represents with the extra uterine pregnancy the two great gynecological surgical emergencies. It affects all age groups from the antenatal period to menopause. It is almost always unilateral. Its association with pregnancy is far from being rare. The diagnosis of appendages torsion in its acute form is to be evoked every time a woman consults for pain of pelvic abrupt installation, especially when she is known having an adnexal tumor, often waiting for surgery. The association with an episode of vomiting is very suggestive in a woman with acute pelvic pain associated with an ovarian cyst.
Pelvic ultrasound should be done urgently. It is carried out by two methods (supra pubic and endo-vaginal). Its main interest is to visualize an adnexal pathological formation and understand its different parameters: size, structure, topography, associated signs.
The color pulsed echo -Doppler detects a decrease or even a clear stop of the vascular flow in the lombo-ovarian pedicle; Nevertheless, a normal Doppler does not eliminate an adnexal twist (60%).
The operative indication for laparoscopy must be applied urgently to preserve the function of the ovary in case of clinical semiology and ultrasound discovery of an adnexal tumor. It assures a triple role: diagnosis, prognosis and treatment by laparoscopy.
This way poses problems in ovarian tumor exceeding the umbilicus or in advanced term pregnancy. In 15% of cases, laparoconversion is practiced. The gesture on the twisted appendage will depend on the patient`s age, the desire for pregnancy, and the evaluation of its vitality after detorsion and immersion in physiological saline at 37 ° C.
Conservative treatment is feasible in 70-80% of cases. Ovariopexy by plication of the utero-ovarian ligament should be reserved only for cases of twisting on perfectly normal appendages (in case of elongation of the utero-ovarian ligament) and in the case of recurrences. It should be noted that the twisting of a twisted appendix does not increase the thromboembolic risk postoperative. The subsequent fertility is correct with more than 70% of pregnancy occurring in women desiring a child.