WHAT IS IT?
Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports.
WHAT CAUSES IT?
Mechanical twisting of the ovary is ultimately responsible for this process. Given that the suspensory ligament
WHY IS IT A PROBLEM?
Impeding blood flow: this issue of ovarian torsion becomes especially problematic when the blood supply to the ovary becomes compromised.
WHAT MAKES US SUSPECT IT?
Ovarian physiologic cyst (functional cyst, corpus luteum), ovarian neoplasm
Common Chief Complaints:
- Abdominal pain
- Pelvic pain
History Of Present Illness
Onset: typically the onset of the pain is acute.
- Nausea/vomiting can often be present in patients with this condition.
Physical Exam Findings
- Abdominal tenderness will often be present.
- Adnexal mass may be palpated
Ultrasound (with Doppler): this study can help demonstrate absent blood flow to the ovary that has been twisted.
MRI: while not the first imaging study that will be ordered, in some contexts ultrasound may not be able to visualize the ovary/provides inconclusive results. If suspicions are high enough ordering an MRI for the workup of a possible ovarian torsion can be justified.
AT WHAT POINT DO WE CONFIDENT IN MAKING THE DIAGNOSIS?
Loss of Doppler flow to the ovary seen on ultrasound generally will help make the diagnosis.
WHAT ELSE ARE WE WORRIED ABOUT?
Infarction/necrosis of the ovary: prolonged ischemia (secondary to torsion) can lead to permeant ovarian damage.
HOW DO WE TREAT IT?
Laparoscopy with detorsion to restore blood flow to the ovary.
Ovarian cystectomy to remove cysts that may be responsible for the torsion
Oophorectomy may be required if the ovarian becomes necrotic or there is malignancy present
HOW WELL DO THE PATIENTS DO?
The prognosis of the patient will depend on how quickly this condition is diagnosed, and how quickly the ovary is re-perfused.
ARCHIVE OF QUESTIONS
Page Updated: 08.23.2016