Acute ovarian and fallopian tube torsion

Introduction to acute ovarian and fallopian tube torsion Normal fallopian tubes and ovaries are extremely active and can be rotated 90° without symptoms. If a complete torsion occurs and fails to be diagnosed and treated in time, it may cause necrosis or even gangrene in the attachment, leading to serious consequences such as peritonitis. In order to retain their normal reproductive function, children and young patients should be diagnosed early. basic knowledge The proportion of illness: 0.0005% Susceptible people: adult women Mode of infection: non-infectious Complications: shock

Acute ovarian and fallopian tube torsion

(1) Causes of the disease

Congenital factor

(1) The fallopian tube, the ovarian mesangium is too long or the length of the fallopian tube is mutated. It has a spiral shape and is easy to bend.

(2) The distal mesenteric membrane of the fallopian tube is underdeveloped or excessively free.

(3) genital malformations, such as the single-horned uterus, asymmetrical on both sides, become the cause of attachment torsion.

2. acquired factors

(1) Fallopian tube lesions, increased weight, such as hydrosalpinx or fallopian tube blood without adhesion.

(2) The ovary is prolapsed due to physiological cysts (follicles or corpus luteum cysts) and is prone to twisting.

(3) There is a history of sterilization surgery using Pomeroy surgery (fallopian tube double-fold ligation), and the distal end of the free fallopian tube is prone to torsion.

(4) autonomic dysfunction, abnormal tubal peristalsis.

3. External factors

(1) Pregnancy or uterine tumor, the uterus is raised, and the attachment rises to the abdominal cavity, and the activity space increases.

(2) Abrupt changes in body position, such as sudden rotation or violent turn over.

(3) pelvic congestion in premenstrual or ovulatory period.

(4) The drug causes fallopian tube spasm.

All of the above factors are the cause of the attachment's own torsion. Under the combined effect of one or several factors, it can cause completeness, acute, irreversible torsion or incompleteness, and intermittent torsion.

(two) pathogenesis

After the attachment is reversed, the blood supply to the supply accessory is blocked, and the venous and lymphatic circulation disorders begin. The arterial perfusion continues to cause attachment edema, thickening, and the reversal of the torsion continues to cause intravascular thrombosis. First, the vein develops into the artery. If the arteriovenous thrombosis is unwinded quickly, the attached blood perfusion can be quickly restored, and the organ can be completely restored, such as complete torsion without unwinding. From simple vein and lymphatic circulation disorder, it quickly enters the arterial circulatory occlusion, and the fallopian tube ovary changes rapidly. Deep black, necrosis, gangrene, if still not treated, can develop infection into abdominal pancreatitis, children's attachments can be absorbed after torsion and necrosis, and other side reasons for laparotomy only found one side of the attachment, but the urinary system It can be found without any abnormality, and it is an important identification basis for the absence of malformation on the congenital side. If it is not completely absorbed, calcification may occur.

If the rotation is not complete, the arterial perfusion is not completely occluded, resulting in an increase in venous pressure, which may cause epidural hemorrhage in the superficial vein rupture of the attachment. The surface of the ovary is hemorrhagic-like purplish red, and the ovary is seen with blood clots. Hemorrhagic infarction can be found, and sometimes due to degeneration of ovarian surface tissue and adhesion to other pelvic organs, severe ovaries may become parasites.

If it is not completely reversed, only the venous return and lymphatic system circulation will be blocked. The arterial blood supply is not seriously tired and timely, and it can be automatically untwisted. The attachment can be completely recovered within a few hours or days, but the affected ovary may have interstitial corpus luteum in the future. Clinical manifestations of masculinization; excessive estrogen secretion, premature puberty in early menarche, ovarian edema due to incomplete reversal, severe cases may also be associated with Meig syndrome (ascites and pleural cavity) liquid).

Acute ovary, fallopian tube self-torsion prevention

Active treatment of fallopian tubes and uterine lesions to prevent the occurrence of torsion. Once the diagnosis is clear, surgery should be performed immediately. According to the intraoperative fallopian tube ovary condition, the corresponding treatment was carried out. The blood supply in the ischemic area is restored, and the tissue is basically damaged, and conservative treatment is given.

Acute ovarian and fallopian tube torsion complications Complications

If the torsion continues and cannot be processed in time, the body temperature may rise slightly, and the occurrence of necrosis and secondary infection may cause high fever, which may be accompanied by chills and increased abdominal pain.

Abdominal examination: Abdominal muscle tension, tenderness, deep pressure on the affected side of the lower abdomen has tenderness, and secondary infection has rebound tenderness.

Acute ovarian, fallopian tube self-torsion symptoms Common symptoms Acute abdominal pain, abdominal pain, high fever, nausea, chronic abdominal pain, chills, abdominal muscle tension, abdominal pain, shock uterine bleeding, pelvic mass

According to the clinical manifestations can be divided into complete and partial attachment torsion.

Complete torsion is an acute course of disease, sudden severe acute abdominal pain, mostly in abrupt position changes, such as rotation, after turning over, usually unilateral, the right side is higher than the left side (3:2), possibly the left sigmoid colon The attachment activity is limited, while the right cecum and the end of the ileum are relatively more active, giving the attachment more room for movement. Some patients may have a similar history of pain, may have reversed and self-unwinding, and the symptoms are automatic. disappear.

The severity of unilateral abdominal pain is directly proportional to the degree of blood flow obstruction and the degree of concurrent edema, and rapid nausea and vomiting occurs. For example, the torsion at the beginning is complete, the venous return is completely blocked, and acute abdominal pain and nausea and vomiting occur simultaneously. If the degree of torsion is light, sometimes it can be self-unwinding, the pain disappears on its own, but there is a possibility of re-emergence. The pain of intermittent torsion is also intermittent, and the intermittent time varies with the frequency of attacks, from hours to days. In the first few months, the initial pain is usually in the lower abdomen or pelvic pain or armpits, and can also be radiated to the thigh or back (the chest 10-dominated skin area). Lomano (1974) analyzed 42 cases of attachment torsion patients with pain: abdominal pain Gradually increasing the proportion of 62%, sudden occurrence of 38%, Nichols (1985) statistics 10% of patients with chronic abdominal pain with intermittent exacerbations, envisaged to reverse recurrent episodes, the symptoms of the episodes during the interval to reduce or disappear.

If the ovary has a corpus luteum before the torsion, the hormone concentration suddenly drops after the torsion, and then withdrawal uterine bleeding may occur. At this time, attention should be paid to the identification of the ectopic pregnancy.

If the torsion persists and cannot be processed in time, there may be a slight increase in body temperature, and a high fever may occur after the occurrence of necrosis secondary infection, which may be accompanied by chills, abdominal pain is aggravated, abdominal examination: abdominal muscle tension, tenderness, deep pressure under the affected side There is tenderness in the abdomen, and there is rebound tenderness after secondary infection. Double-conspiratory diagnosis: normal accessory torsion may not reach the mass, but the attachment area may be noticeably tender.

Examination of acute ovarian and fallopian tube torsion

Annexes with torsion and necrosis can have white blood cell counts and neutrophils.

B-mode ultrasonography revealed a swollen attachment, and the tumor image was non-specific. Doppler ultrasound to detect ovarian blood flow velocity can be clearly diagnosed.

Diagnosis of acute ovarian and fallopian tube torsion

diagnosis

diagnosis

Sudden onset of pain, sudden, sometimes occurs after a sudden change of position, and to the right side of the tender attachment mass, you can make a definite diagnosis, but this is only a typical symptom of complete attachment torsion, such as incomplete torsion The pain is intermittent or chronic persistent. The diagnostic accuracy rate is only 70%. For example, if the preoperative diagnosis is accessory torsion and the result is other lesions, the correct rate is reduced to 40%, using B-ultrasound, CT, abdominal cavity. Mirror and other auxiliary diagnosis, as long as there is sufficient understanding of the attachment torsion, especially in children with abdominal pain, anal diagnosis or B-ultrasound found pelvic mass, should consider the possibility of attachment torsion, further detailed examination, can be early diagnosis, timely treatment, make accessories Restore normal function.

The disease should be identified with the following various lesions:

Differential diagnosis

1. Ectopic pregnancy: delayed menstruation, acute abdominal pain and vaginal bleeding, uterine rectal litter tenderness occurs more in ectopic pregnancy and pelvic endometriosis, -HCG quantitative test reaches a certain concentration can be clearly diagnosed, although about 20 % of patients with torsion have an intrauterine pregnancy at the same time, relying on B-scan to show that the intrauterine embryo sac can identify the attachment to reverse the intrauterine pregnancy and ectopic pregnancy.

2. Acute pelvic inflammatory disease (PID): abdominal pain, tenderness is generally bilateral, acute torsional abdominal pain episodes are more sudden and intense than PID, PID can touch bilateral inflammatory masses, while acute torsion lumps are generally single Side, and more spherical, PID also has a related medical history: if there is a history of PID episodes, sexual life disorders, sexual partners have a history of smelting, or recently placed an intrauterine device such as intrauterine surgery, can assist in diagnosis.

3. Appendicitis: abdominal pain is generally transferred from the upper abdomen to the lower right abdomen, anal examination: no pain in the attachment area, no abnormal findings in the pelvis; attachments are reversed, abdominal pain is sudden, accompanied by nausea and vomiting, and appetite inflammation occurs with nausea and vomiting Gradually, the disease progresses gradually. Anyone who complains of right lower quadrant pain and laparotomy cannot diagnose the appendicitis should investigate the abnormality of the pelvic organs.

4. Accessory mass: Accessory masses that have not been twisted generally do not cause pain unless the mass is ruptured, twisted or internalized.

5. Ovarian follicles or corpus luteum rupture: symptoms are not as severe as torsion, such as no longer bleeding, symptoms can disappear within 1 to 2 days, the onset time is related to the menstrual cycle, often in the middle of menstruation or a few days before menstruation, rarely nausea and vomiting Symptoms are severe and persistent. The pelvic examination has signs such as fullness and tenderness of the uterus rectum.

6. Kidney stones: abdominal pain is severe paroxysmal pain, radiating to the labia majora, but with seasonal ribs, rib angles or back slamming pain, accompanied by hematuria, no abdominal muscle spasm, no attachment mass touch, there are Recurrent episodes of previous medical history, intravenous pyelography can confirm the diagnosis.

7. Acute degeneration of uterine fibroids: rare, abdominal pain is more dramatic, accompanied by fever, pedicled subserosal fibroids easily confused with the disease, can be clearly identified by laparoscopy or B-ultrasound, fortunately, the same disease, misdiagnosis Surgery has no effect on the patient.

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