Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate?
OBJECTIVE
To reevaluate the rate of correct diagnosis of ovarian torsion (OT) in our department.


METHODS
Retrospective computerized chart review.


METHODS
Tertiary referral center.


METHODS
Seventy-eight women who underwent laparoscopy for suspected OT.


METHODS
Laparoscopy.


METHODS
Rate of true diagnosis of torsion, correlation with Doppler studies.


RESULTS
The preoperative diagnosis of OT was confirmed in only 36 (46.1%) of the patients. Immediate operation (<10 hours) after admission (n = 48) was associated with a statistically significantly higher likelihood of operatively confirming OT (56.2% vs. 28.6%). We found that the lack of ovarian blood flow on Doppler sonography was a good predictor of OT; women with pathologic flow were statistically significantly more likely to have OT (77% vs. 29%). The sensitivity and specificity of abnormal ovarian flow for OT were 43.8% and 91.7%, respectively, with a positive and negative predictive value of 78% and 71%, respectively.


CONCLUSIONS
Despite 20 years of research, the accuracy of the preoperative diagnosis of OT remains low. The urge to operate can be attributed to the importance of preserving ovarian function in young women as well as to the availability and the low associated complication rate of laparoscopy.
Bar-On
Shikma
S
Lis Maternity Hospital, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel.
Mashiach
Roy
R
Stockheim
David
D
Soriano
David
D
Goldenberg
Motti
M
Schiff
Eyal
E
Seidman
Daniel S
DS
D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D018447:Medical Futility; D010049:Ovarian Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D010053:Ovary / Q000098:blood supply / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014102:Torsion Abnormality / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color