2.14 Ovarian Torsion

Question 1

What is the likely size of an ovarian mass if it is to cause a torsion?

Answer 1

like >5cm

more likely when benign, more likely in pregnancy

Question 2

What do girls who have torsion before menarche likely have?

Answer 2

they will have longer INFUNDIBULOPELVIC LIGAMENTS that can twist more easily

Question 3

Presentation of ovarian torsion?

Answer 3

• sudden severe unilateral pelvic pain
• nausea and vomiting
• localised tendernes
• poss palpable mass
• can be milder and prolonged, twist and untwist

Question 4

How can you diagnose ovarian torsion?

Answer 4

pelvic US is initial, transvaginal is ideal:

• “whirlpool sign”
• free fluid in pelvis
• oedema of ovary
• doppler lack of blood flow

definitive diagnosis: laparoscopic surgery

Question 5

Management of ovarian torsion?

Answer 5

emergency
laparoscopic surgery to:
- untwist ovary and fix it in place (detorsion)
- remove ovary (oophrectomy)

(decision to save is based on visual inspection during surgery)

Question 6

Complications of torsion?

Answer 6

loss of function of sole remaining ovary would lead to infertility and menopause

necrotic and not removed: infected, abscess, sepsis; could rupture, peritonitis and adhesions