Adnexal Torsion: A Study

Adnexal torsion is the twisting of the vascular pedicle of an ovary, an ovary with cyst, a fallopian tube, or a paratubal cyst. It results in ischemia of the structure distal to twisting with an acute onset of pain. It accounts for 2.7% to 7.4% of gynecological emergencies. The most common age group affected is the reproductive age group. Early diagnosis and management of adnexal torsion helps in preservation of fertility; however, its diagnosis is challenging.

In adnexal torsion, ischemia followed by reperfusion causes accumulation of activated neutrophils. This in turn releases reactive oxygen species (ROS) which leads to an increase in inflammatory parameters such as white blood cell (WBC) count, neutrophils, and neutrophil-lymphocyte ratio (NLR). Adnexal torsion is associated with high inflammatory burden. Along with clinical and radiological findings, if hematological parameters can provide additive benefit in the diagnosis of adnexal torsion, then we can be more accurate and plan the management accordingly.

This study aimed to identify the diagnostic value of neutrophil/lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts. This was a retrospective study conducted over five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on a proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of adnexal torsion was evaluated.

A total of 125 patients were included in the article (adnexal torsion group n = 25, untwisted unruptured ovarian cyst group n = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on the surgeon’s skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. The most common adnexal pathology to undergo torsion was serous cyst.

Adnexal torsion, a gynecological emergency, when inaccurately diagnosed could lead to damage of ovaries ultimately affecting fertility. Complete blood count is the informative proinflammatory marker which is a cheap test and usually performed before every surgery. However, its importance in adnexal torsion has not been studied in detail. Current evidence shows that these blood parameters are useful in diagnosing and prognosticating in cases of ischemic diseases such as acute coronary syndrome, acute ischemic stroke, and acute mesenteric ischemia.

Comparing the NLR between two groups, there was a statistically significant difference. NLR > 3 was found to be predictive of the AT group with a moderate sensitivity (76%) and high specificity (91%) with an AUC value (0.835) of good significance. If the NLR ratio is ≥3, there is a 26 times higher possibility of an adnexal mass being an adnexal torsion. USG and color Doppler have a sensitivity of 22%–66%, which is found to be lesser than that of NLR supported by various studies including the present study. NLR has been a popular inflammatory marker and is important these days. NLR is superior to WBC in the estimation of undesired outcomes within the inflammatory process and surgical conditions.

In summary, preoperative neutrophil-lymphocyte ratio (NLR) can be a predictive marker for diagnosis of adnexal torsion and can differentiate adnexal torsion from ovarian cysts.

Source: Asmita Ghimire, Sailaja Ghimire, Asmita Shrestha; Hindawi Obstetrics and Gynecology International

https://doi.org/10.1155/2023/3585189