An update on the diagnosis and management of ovarian torsion 2012 TOG

Question 1

Features more likely to indicate ovarian torision

Answer 1

Unilateral lumber or abdo pain
Pain >8hrs
Vomiting
Absence abnormal discharge, PVB
Ovarian cyst >5cm

Question 2

Which types of ovarian pathology are less likely to tort?

Answer 2

Endometrioma and malignancy - adhesions

Question 3

What features may be seen on USS?

Answer 3

Ovarian enlargement and oedema
Peripheral arranged follicles
Whirlpool pedicles
Doppler - reduced blood flow late sign

Question 4

2nd line investigation after USS

Answer 4

MRI, maybe more useful in 2nd or 3rd trimesters

Question 5

How common is an ovarian cyst >25mm in pregnancy? how likely is it to tort? When is it most likely to tort?

Answer 5

5%
1-3% torsion rate
1st trimester

Question 6

How much does assisted reproduction increased the rate of ovarian torsion in pregnancy?

Answer 6

11 fold increase

Question 7

When should surgical de-torsion be consider over oophorectomy

Answer 7

Paeds causes
If there has been <48hours since pain.