Ovarian Torsion

Question 1

Ovarian Torsion

Answer 1

Ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply

Question 2

Cause of ovarian torsion

Answer 2

Due to ovarian mass > 5cm such as a cyst or tumour

Question 3

Risk factors for ovarian torsion

Answer 3

Benign tumour

Pregnancy

Before menarche - longer infundibulopelvic ligaments

Question 4

Complications of ovarian torsion

Answer 4

Ovary necrosis

Fertility affected if both ovaries are damaged

Ovarian rupture - peritonitis and adhesions

Ovarian abscess

Question 5

Presentation of ovarian torsion

Answer 5

Sudden onset severe unilateral pelvic pain

The pain is constant, gets progressively worse

Associated with nausea and vomiting

The pain is not always severe, and ovarian torsion can take a milder and more prolonged course.

Occasionally, the ovary can twist and untwist intermittently, causing pain that comes and goes.

Question 6

Examination signs for ovarian torsion

Answer 6

Localised tenderness.

May be a palpable mass in the pelvis

Question 7

Investigations for ovarian torsion

Answer 7

Transvaginal USS - first line

Doppler studies - blood flow to ovaries

Definitive diagnosis - laparoscopic surgery

Question 8

Pelvic USS results for ovarian torsion

Answer 8

Whirlpool sign

Question 9

Management of ovarian torsion

Answer 9

Emergency admission to gynae

Laparoscopic surgery:
- Un-twist the ovary and fix it in place (detorsion)

• Remove the affected ovary (oophorectomy)