**5.2. Therapy**

Treatment of TOA historically was surgical with most women having a total abdominal hysterectomy and bilateral salpingo-oophorectomy Management of TOAs has changed drastically in the past decades with the advent of broad-spectrum antibiotics (ampicillin, clindamycin, and flagyl) and continues to evolve with improved imaging and drainage techniques. Recently antibiotics, surgical intervention, with either conventional surgery or laparoscopy to be in use.

#### **Adnexal torsion**

Adnexal torsion is an uncommon gynecologic emergency that is caused by the twisting of the ovary, fallopian tube, or both along the vascular pedicle. It is a rare gynecologic emergency of women at reproductive ages. Usually adnexal torsion is a process of benign tumors. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. The causes of adnexal torsion include functional and pathologic ovarian cysts, paraovarian cysts, ovarian hyper stimulation, adhesions, ectopic pregnancy, and congenital malformations. Classically, patients present with sudden onset, severe, unilateral lower abdominal pain that worsens intermittently over many hours. Nausea and vomiting occur in approximately 70% of patients, mimicking a gastrointestinal source of pain and further obscuring the diagnosis. Colored Doppler sonography with its non-invasive modality detects blood flow patterns within the ovarian vascular networks and gives important information about the diagnosis of torsion. Laparoscopy surgery must be the choice for less post operative morbidity, and a better cosmetic appearance. Detorsion must be performed even in necrotic appearing adnexa because of a high rate of survival of ovaries even looking necrotic. Salpingooophorectomy may be indicated if severe vascular compromise, peritonitis, or tissue necrosis is clearly evident.
