Ultrasound-guided cyst aspiration for management of acute adnexal torsion.

Objective: Ultrasound-guided cyst aspiration is a potential treatment for acute adnexal torsion that can be performed in the outpatient setting, offering an alternative to emergency laparoscopic surgery. The objective of this study was to describe our initial experience with aspiration of acutely torted adnexal cysts.

Methods: This was a retrospective single-center study, in which we identified all patients who underwent ultrasound-guided cyst aspiration in our center between February 2008 and September 2023. Indications for the procedure were ultrasound diagnosis of adnexal torsion due to an ovarian cyst and clinical symptoms of acute adnexal torsion. Success was defined as the avoidance of emergency surgery for adnexal torsion related to the same cyst. We extracted clinical data, ultrasound scan findings, procedural details and clinical outcomes from our clinical database.

Results: Overall, 46 patients underwent ultrasound-guided cyst aspiration for the management of adnexal torsion, 24 (52%) of whom were pregnant. At ultrasound examination, all 46 cysts had unilocular morphology, and in 96% (44/46) of cases, the cyst content was anechoic. Cyst aspiration was performed transabdominally in 30 (65%) patients and transvaginally in 16 (35%) patients. A total of 39 (85%) patients experienced complete resolution of symptoms immediately after ultrasound-guided cyst aspiration. One procedure was abandoned owing to patient discomfort and six (13%) patients reported non-resolution or short-term recurrence of symptoms, necessitating emergency laparoscopy in seven patients. No complications occurred as a result of ultrasound-guided cyst aspiration. Three patients had cyst aspiration more than once. Follow-up data were available for 29/39 (74%) patients who had successful ultrasound-guided cyst aspiration and received a subsequent ultrasound assessment in our clinic. In 8/29 (28%) patients, the cyst had completely resolved. In total, 4/21 (19%) patients with a persistent cyst opted for elective surgical intervention, while 17/21 (81%) continued conservative management at the last follow-up. Overall, 25/29 (86%) of those followed up after successful ultrasound-guided cyst aspiration, and at least 25/46 (54%) of all patients, avoided any form of surgical treatment.

Conclusions: Ultrasound-guided cyst aspiration is an effective treatment for the management of acute adnexal torsion due to a cyst with unilocular morphology and anechoic or hypoechoic fluid content. With the use of this technique, emergency hospital admission and surgery were avoided in the majority of patients. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.