title: High Rate of Gangrenous Adnexal Torsion: Dilemma of a Missing Silent Cancer
abstract: Background: Adnexal torsion results in ischemia of structures distal to twisted pedicle and acute onset of pain is
  responsible for about 3% of all gynecologic emergencies. Ovarian torsion classically occurs in a pathological enlarged
  ovary, as with cancer, but diagnosis remains a challenge. Objective: Our purpose was to evaluate clinical risk factors
  predictive of torsion with gangrenous adnexa. Material and methods: A retrospective descriptive study and chart
  review of surgically proven ovarian torsion/adnexal torsion cases at the Obstetrics and Gynecology Department of
  Prapokklao Hospital, Chanthaburi, Thailand between January 2011 and December 2015 was conducted. Result:
  Seventy-eight cases were identified. Mean age at presentation was 35.5 years. The average maximum diameter of the
  ovarian tumors was 10.8 cm. The percentage of gangrenous ovarian cysts in this study was 46.2 (36/78). The precision
  to determine the pathological site by patient, physician and ultrasonography was 8.5, 24.2 and 83.3 percent, respectively
  with statistically significant variation. Conclusion: Ovarian/adnexal torsion remains a challenge condition especially
  in young nulliparous women. Sophisticated investigation does not guarantee ovary preservation. Combining clinical
  acumen, appropriate tests and detailed consideration may be the best practice at the present time.
authors.affiliation: Department of Obstetrics and Gynecology, Prapokklao hospital, Chanthaburi, Thailand. Email: panysanan@yahoo.com
authors.forename: Kanchanok
authors.initials: K
authors.lastname: Sukkong
authors.forename: Panya
authors.initials: P
authors.lastname: Sananpanichkul
authors.forename: Prasong
authors.initials: P
authors.lastname: Teerakidpisan
authors.forename: Kornkarn
authors.initials: K
authors.lastname: Bhamarapravatana
authors.forename: Komsun
authors.initials: K
authors.lastname: Suwannarurk
keywords: Adnexal torsion; ovarian torsion; gangrenous ovary; prediction of torsion