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 ?
The patient underwent salpingo-oophorectomy due to a prediagnosis of ovarian torsion with a dermoid cyst.
Of these, laparotomy was performed in 5 women (2 for acute appendicitis, 2 for ovarian torsion, 1 for blunt trauma with splenic rupture) and laparoscopy was done in 3 women (2 for acute appendicitis, 1 for acute cholecystitis).
Among them, patients with certain benign conditions like autoimmune and hematologic conditions, the presence of bilateral ovarian tumors, severe or recurrent ovarian endometriosis and recurrent ovarian torsion may mostly benefit from the development of such strategies (8, 9).
Ovarian torsion is a gynaecologic emergency characterized by necrosis after ischemia; it is caused by partial or complete rotation of the ovary, twisting its supporting ligaments.
2- Surgery for ovarian torsion: Ovarian torsion is a rare complication of ovulation induction and leads to the loss of one or both ovaries if not diagnosed and treated surgically on time.
In four of the major surgery cases performed under GA uncomplicated laparoscopies were performed to remove the adnexal mass; in one case a laparoscopic salpingoophorectomy was performed as an emergency for a suspected ovarian torsion at 16/40 weeks.
Raja Cingapagu, pediatric surgeon at Danat Al Emarat Hospital, who performed the baby's surgery along with a surgical team of various specialties, said: "The baby was born in the 35th week of pregnancy, and the tests revealed that she suffered from ovarian torsion and bleeding due to large ovarian cysts in both ovaries.
Leiomyomatosis peritonealis disseminate complicated by sarcomatous transformation and ovarian torsion: presentation of two cases and review of the literature.
Ovarian torsion (OT) is defined as partial or complete torsion of the ovarian vascular pedicle producing cessation of circulation that is initially venous and lymphatic and consequently becomes arterial occlusion which may occur as a resultant of edema progression [1].
Fitzpatrick, "Recurrent Ovarian Torsion due to Paratubal Cysts in an Adolescent Female," Journal of Pediatric & Adolescent Gynecology, vol.
Torsion of the omentum presents with acute abdominal pain which is more localised in the right iliac fossa, thus mimicking acute appendicitis or acute cholecystitis, and in the female patient, it can mimic ovarian torsion. This nonspecific presentation makes preoperative diagnosis difficult.