Nichtsimultane, bilaterale Adnextorsion innerhalb von 6 Wochen - Fallbericht und Übersicht zum Management

Zusammenfassung

Eine 31-jährige Patientin wurde sechs Wochen nach pelviskopischer einseitiger Adnexektomie wegen Adnextorsion erneut notfallmäßig pelviskopiert. Dabei konnte die ebenfalls torquierte kontralaterale Adnexe zurückgedreht, fixiert und erhalten werden. Insgesamt erscheint das Risiko der kontralateralen Adnextorsion gering. Da es sich jedoch häufig um Frauen mit Kinderwunsch handelt, sollten neuere Erkenntnisse aus der Literatur zunehmend zum Versuch der Organerhaltung führen. Thromboembolische Komplikationen spielen dabei offensichtlich keine Rolle. In speziellen Fällen ist eine kontralaterale Adnexfixierung angezeigt.

Abstract

A 31-year-old patient developed an adnexal torsion. The adnexa was removed laparoscopically. Six weeks later she presented again with abdominal pain. Another emergency laparoscopy was carried out and showed a contralateral adnexal torsion. It was managed by unwinding and fixation of the adnexa. Altogether the risk of a contralateral torsion of the adnexa is minor. Most patients are fertile women with children desire. According to current findings in literature, increasing attention should be paid to preserve the adnexa in these circumstances. It can be expected that in the majority of cases presenting with “black-bluish” ischemic adnexa normal ovarian function recovers after detorsion. The fear of thromboembolic complications after unwinding the torsion is not justified as such problems were not described in literature. But it should be considered that a malignant tumour could be the reason for the torsion. In special cases a fixation of the other adnexa is necessary.

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