産科・婦人科 / 救急

卵巣・付属器捻転 — 管理パス

突然の片側骨盤痛+悪心。ドプラ正常でも除外不可。疑えば緊急腹腔鏡評価。

根拠：ACOG。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。

ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。

ステップ 1 · Clinically suspected torsion?
Sudden unilateral pelvic pain + nausea — is torsion clinically suspected?
💡 Gynecological emergency. Sudden severe unilateral lower abdominal/pelvic pain (often sharp, may radiate to the groin) + nausea/vomiting; risk factors = enlarged ovary/mass (>5 cm), pregnancy, reproductive age. First-line transvaginal/pelvic Doppler ultrasound ('whirlpool sign', enlarged ovary); normal Doppler flow does not exclude torsion (do not decide on Doppler alone). Labs are usually normal.

パス全体像

  1. 【判断】Clinically suspected torsion?
    Sudden unilateral pelvic pain + nausea — is torsion clinically suspected?（Gynecological emergency. Sudden severe unilateral lower abdominal/pelvic pain (often sharp, may radiate to the groin) + nausea/vomiting; risk factors = enlarged ovary/mass (>5 cm), pregnancy, reproductive age. First-line transvaginal/pelvic Doppler ultrasound ('whirlpool sign', enlarged ovary); normal Doppler flow does not exclude torsion (do not decide on Doppler alone). Labs are usually normal.）
    • Torsion clinically suspected → Suspected torsion → laparoscopic detorsion, preserve ovary
    • Not supportive, consider other causes → Not supportive
  2. 【終点】Not supportive
    急性骨盤痛の他原因（出血性嚢胞、PID、虫垂炎、異所性妊娠）と鑑別。疑えば緊急腹腔鏡。
  3. 【終点】Suspected torsion → laparoscopic detorsion, preserve ovary
    Surgical emergency, laparoscopy 可及的速やかに: detorsion (untwist) + ovary preservation (untwist evenの場合dusky/edematous; >90% recover function; blue-black ≠ necrosis); perform adnexectomy onlyに対しclear necrosis, suspected malignancyまたは閉経後 status. Time-sensitive (prolonged 虚血 causes lossのfunction), early gynecology consult; a negative laparoscopy is acceptable.

よくある質問

卵巣・付属器捻転 — 管理パスはどの臨床課題を扱う診療パスですか？
突然の片側骨盤痛+悪心。ドプラ正常でも除外不可。疑えば緊急腹腔鏡評価。
卵巣・付属器捻転 — 管理パスの主要な意思決定ステップは何ですか？
Clinically suspected torsion?
卵巣・付属器捻転 — 管理パスはどのような対応方針を示しますか？
Not supportive：急性骨盤痛の他原因（出血性嚢胞、PID、虫垂炎、異所性妊娠）と鑑別。疑えば緊急腹腔鏡。；Suspected torsion → laparoscopic detorsion, preserve ovary：Surgical emergency, laparoscopy 可及的速やかに: detorsion (untwist) + ovary preservation (untwist evenの場合dusky/edematous; >90% recover function; blue-black ≠ necrosis); perform adnexectomy onlyに対しclear necrosis, suspected malignancyまたは閉経後 status. Time-sensitive (prolonged 虚血 causes lossのfunction), early gynecology consult; a negative laparoscopy is acceptable.
卵巣・付属器捻転 — 管理パスのうち直ちに対応が必要な状況はどれですか？
Suspected torsion → laparoscopic detorsion, preserve ovary：Surgical emergency, laparoscopy 可及的速やかに: detorsion (untwist) + ovary preservation (untwist evenの場合dusky/edematous; >90% recover function; blue-black ≠ necrosis); perform adnexectomy onlyに対しclear necrosis, suspected malignancyまたは閉経後 status. Time-sensitive (prolonged 虚血 causes lossのfunction), early gynecology consult; a negative laparoscopy is acceptable.
卵巣・付属器捻転 — 管理パスはどのガイドラインに基づいていますか？
ACOG adnexal torsion; UpToDate ovarian/tubal torsion · 準拠：ACOG

出典

  • ACOG adnexal torsion; UpToDate ovarian/tubal torsion

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