Ovarian Torsion

Ovarian Torsion

 

Definition

Ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. This results in extreme lower abdominal pain.

Description

Ovarian torsion occurs infrequently only in females. In can occur in women of all ages, but most women that experience this are younger. Approximately 70-75% of cases occur in women under 30 years old. About 20% of all reported cases are in pregnant women. It is the fifth most common gynecological emergency which can include surgical intervention.
Ovarian torsion usually arises in only one ovary at a time. They can occur in either normal or enlarged ovaries and fallopian tubes, and occasionally they develop in both.

Causes and symptoms

There are a variety of conditions that can cause torsion of the ovary ranging from changes in normal ovaries to congenital and developmental abnormalities or even a disease that affects the tube or ovary. Normal ovaries that experience spasms or changes in the blood vessels in the mesosalpinx can become twisted. For example, if the veins in the mesosalpinx become congested, the ovaries will undergo torsion.
Developmental abnormalities of the fallopian tube such as extremely longer-than-normal tubes or a missing mesosalpinx will cause ovarian torsion. Diseases such as ovarian cysts or fibromas, tumor of the ovary or tubes, and trauma to either the ovaries or the tubes will also cause ovarian torsion.
The characteristic symptom of ovarian torsion is the sudden onset of extreme lower abdominal pain that radiates to the back, side and thigh. Nausea, vomiting, diarrhea, and constipation can accompany the pain. The patient may also experience tenderness in the lower abdominal area, a mild fever and tachycardia.

Diagnosis

The diagnosis of ovarian torsions usually occurs in an emergency room due to the suddenness of extreme pain. Emergency room physicians may consult with another physician specializing in obstetrics and gynecology. Since 20% of ovarian torsions occur in pregnant women, physicians will order a pregnancy test. Visualization with an ultrasound and CT scan (computed tomography) will help pinpoint the ovarian structures and allow physicians to diagnose. Diagnosis is often confirmed through laparoscopy.

Treatment

Ovarian torsions need to be repaired. This is done through surgery, and for less severe cases laparoscopic surgery is used. Medications such as NSAIDs are given to control pain.

Prognosis

If ovarian torsions are diagnosed and treated early, then the prognosis is favorable. However, if diagnosis is delayed, the torsions can worsen and cut off arterial blood flow into and venous blood flow out of the ovary. This results in necrosis (death) of the ovarian tissue. Delayed diagnosis can also result in problems when trying to conceive due to infertility.

Prevention

Currently, there are no known methods for prevention of ovarian torsion.

Key terms

Congenital — condition present at birth
Laparoscopy — endoscope used to observe structures in the abdomen
Mesosalpinx — a ligament connected to the fallopian tube
Ovary — female reproductive gland that contains the ova (eggs)
Tachycardia — rapidly beating heart
Torsion — the action of twisting
References in periodicals archive ?
1,2 In female patients, diagnosing AA may be more difficult due to the presence of a larger number of differential diagnoses, including pelvic inflammatory disease, ovarian torsion, ovarian cyst rupture, pregnancy complications, endometriosis, and ectopic pregnancy.
The most common symptoms are abdominal pain secondary to a ruptured ovarian cyst or ovarian torsion.
The risk of ovarian torsion rises by 5 fold during pregnancy.
Given the gravity of potential complications, such as bowel obstruction, ovarian torsion, hemorrhage and rupture, and consequently, peritonitis, it is important for the chiropractic community to familiarize themselves with the typical radiographic appearance and epidemiology of mature pelvic teratomas.
Initial blood work was drawn and the patient was sent for a pelvic ultrasound with differential considerations including pelvic inflammatory disease, ovarian torsion, and intrauterine or ectopic pregnancy.
A presumptive diagnosis of ovarian torsion was made based on the clinical findings and an ultrasonographic examination.
Objectives: Misdiagnosing ovarian torsion is now suggested as an important issue in clinical setting.
Except those that do: appendicitis tops the list, but also bowel obstructions, ovarian torsion ora handful of other things that really can't wait until the next day.
There was a high level of distinction as to who had ovarian torsion and who did not," Dr.
9-g/day groups included tachycardia in one woman, low blood sugar in one woman, severe ovarian torsion in one woman, and complaints of severe dyspepsia, severe gastritis, and severe chest pain in one woman.
Cases include ectopic pregnancy, septic abortion, hypertensive emergencies, cardiac failure, acute asthma attack, fetal distress, jaundice, obstructed labor, postpartum collapse, acute pelvic inflammatory disease, ovarian torsion, endotoxic shock, acute urinary retention, sexual assault, abnormal uterine bleeding, emergency contraception, gynecologic oncology emergencies, postexposure prophylaxis to HIV and hepatitis B, cardiopulmonary resuscitation, diabetic ketoacidosis, and medicolegal and ethical issues.
However, ovarian cysts can herald an underlying malignant process or, possibly, distract the emergency clinician from a more dangerous condition, such as ectopic pregnancy, ovarian torsion, or appendicitis.