Ovarian torsion Flashcards
What is ovarian torsion?
Where the ovary twists in relation to its surrounding tissue, fallopian tube and blood supply (adnexa)
What usually causes ovarian torsion?
Ovarian mass >5cm - cyst or tumour - usually benign tumour
When is ovarian torsion most likely to occur?
During pregnancy
Or before menarche
Why is ovarian torsion common before menarche?
Young girls have longer infundibulopelvic ligaments which can twist more easily
What does twisting of the adnexa and blood supply to the ovary cause?
Necrosis and loss of function
Describe the presentation of ovarian torsion?
Sudden onset severe unilateral pelvic pain
Often associated with nausea and vomiting
Pain is not always severe and may take a more mild prolonged course
Pain may be intermittent if the ovary twists and untwists
What is found on examination in ovarian torsion?
Localised tenderness
Palpable mass - absence of a mass does not exclude it
Describe the diagnosis of ovarian torsion
TV US
Diagnostic laparoscopy
What may be seen on US of the ovary in torsion?
Whirlpool sign
Free fluid in pelvis
Oedema
Describe the management of ovarian torsion
Emergency referral to gynae
Laparoscopic surgery:
- detorsion - untwist the ovary
- Oophorectomy - remove the ovary
Laparotomy if large ovarian cyst or suspicion of malignancy
How is the decision to save or remove the ovary made?
Based on visual inspection of the ovary
Describe the complications of ovarian torsion
Loss of function of that ovary - if this is the only ovary then loss of this can lead to infertility and menopause
Necrotic ovary - Infected if not removed, abscess and sepsis. May rupture causing peritonitis and adhesions
