Ovarian torsion

Question 1

What is ovarian torsion

Answer 1

Ovary twists in relation to surrounding connective tissue, fallopian tube or blood supply (the adnexa)

Question 2

Ovarian torsion causes

Answer 2

Usually due to an ovarian mass larger than 5cm e.g. cyst or tumour.
More likely to occur in benign tumour or during pregnancy
Can also occur in young girls before menarche when they have longer infundibulopelvic ligaments (suspensory) that can twist more easily

Question 3

Ovarian torsion presentation

Answer 3

Sudden onset severe unilateral pelvic pain. Pain is constant and gets progressively worse. Associated with nausea and vomiting.
Can also intermittent pain as ovary may twist and untwist.

Question 4

Ovarian torsion examination

Answer 4

Localised tenderness and may be a palpable mass in pelvis
Pelvic ultrasound (transvaginal ideal but can also do transabdominal) - whirlpool sign (twisted vascular pedicle of ovary), free fluid and oedema of ovary.
Doppler ultrasound - lack of blood flow
Definitive diagnosis made with laparoscopic surgery

Question 5

Ovarian torsion differentials

Answer 5

PID, Endometriosis (ovarian), PCOS, Ovarian cysts, Ovarian cancer, Ovarian tumour

Question 6

Ovarian torsion management

Answer 6

Emergency admission
Laparoscopic surgery to untwist ovary and fix in place (detorsion)
Laparoscopic surgery to remove ovary (oophorectomy)

Question 7

Ovarian torsion complications

Answer 7

Twisting of adnexa and blood supply can lead to ischaemia and potential necrosis if prolonged torsion.
Can cause infertility and lead to menopause
May become infected if necrotic ovary not removed. Abscess can form and may lead to sepsis.
May rupture and cause peritonitis and adhesions