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Revista chilena de obstetricia y ginecología

versión On-line ISSN 0717-7526

Resumen

ZAMBONI T, Milena et al. Manejo conservador de la torsión anexial: ¿una alternativa o una obligación frente a un posible error de apreciación por parte del cirujano?. Rev. chil. obstet. ginecol. [online]. 2011, vol.76, n.4, pp.248-256. ISSN 0717-7526.  http://dx.doi.org/10.4067/S0717-75262011000400007.

Background: Adnexal torsion constitutes one of the major surgical emergencies in gynecology commonly leading to adnexal removal based on visual assessment of vascular damage. Aims: The goal of present study is to establish the accuracy of the surgeon's visual impression in correctly doing the decision-making. Methods: All cases of adnexal torsion undergoing surgery between January 2006 and July 2009 were recruited. A pathological review was conducted in all cases undergoing adnexal removal to assess the presence of irreversible vascular damage. A correlation was done between pathologist and surgeon assessment using pathological report as gold standard. Results: During the period of study a total of 51 patients were operated. The average age was 35.5 ± 2 years (range: 8-80 years). The 72.6% of cases was approached by laparoscopy and in 60.7% of cases adnexal removal was done. In 38.7% of those cases treated with adnexal removal a massive ischemic necrosis or complete infarction was demonstrated at biopsy. As longer the time interval was between diagnosis and surgery, major the incidence was of vascular damage (log regression, p<0.01). Slight agreement was observed between surgeon and pathologist (kappa 0.2 ± 0.16, p<0.02). Sensitivity, specificity, positive and negative predictive values for visual assessment of ischemic necrosis done by surgeon were 88.9%, 26.3%, 36.4%, 83.3% respectively. Conclusions: This study demonstrates that visual assessment has a low positive predictive value for irreversible vascular damage. In those cases with presumptive diagnosis of adnexal torsion, an early surgical approach should be prompted to preserve the adnexa.

Palabras clave : Adnexal torsion; ovary; infarction; ischemic necrosis.

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