Laparoscopy for adnexal torsion in pregnant women

OBJECTIVE: To report on six cases of adnexal torsion in pregnant women treated by operative laparoscopy. STUDY DESIGN: A retrospective study. Between January 1989 and March 1996, 26 patients with adnexal torsion were treated by operative laparoscopy. Of these patients, six were pregnant (23%). The types of operative procedure and outcome were diagnosis studied. RESULTS: Adnexal torsion occurred between 6 and 13 weeks of amenorrhea. Two cases involved hyperstimulation, 3 cases a functional cyst and I case a dermoid cyst. In 4 cases laparoscopic treatment consisted of untwisting followed by puncture of the ovarian cyst; in 1 case it involved intraperitoneal cystectomy and in another simple untwisting of the adnexa. The immediate postoperative history was uncomplicated. In one patient with ovarian hyperstimulation, torsion recurred three weeks after the initial operation. No miscarriages occurred. CONCLUSION: In the hands of skilled surgeons, laparoscopy is well suited to the diagnosis and treatment of adnexal torsion occurring during the first trimester of pregnancy. Beyond 16 weeks or when there is any suspicion of torsion on a suspected tumor, it is preferable to use laparotomy.