Ovarian Torsion

Question 1

What are the risk factors for ovarian torsion?

Answer 1

• Ovarian cysts or tumours
  
  • Dermoid cysts are the most likely - endometriomas are least likely
  • >5 cm
• Long ovarian ligaments
• Pregnancy
• Tubal ligation

Question 2

What are the signs and symptoms of ovarian torsion?

Answer 2

• Severe right or left iliac fossa pain - unlikely to have shoulder-tip pain
  
  • Differentiate from ectopic
• Vomiting

Question 3

What are the appropriate investigations for suspected ovarian torsion?

Answer 3

• Pregnancy test
• FBC = may show high WCC
• Speculum (if PID is a differential)
• Bimanual examination = adnexal mass
• Urinalysis (rule out ureteric colic)
• USS with Dopplers
  
  • Doppler may give false -ve due to dual blood supply to the ovary (ovarian artery and uterine artery)
  • 25% of torsion occurs in children - do transabdominal rather than TVUSS
• Ovarian necrosis may cause lactic acidosis
• USS = ‘whirlpool’ sign

Question 4

What is the management of ovarian torsion?

Answer 4

• 1st line = laparoscopic detorsion ± cystectomy
• 2nd line = salpingo-oophorectomy
• If surgery is not prompt enough, removal of a necrotic ovary may be necessary