Ovarian Torsion

Question 1

What size/ type of ovarian mass does ovarian torsion generally occur with? When is it most likely to occur?

Answer 1

> 5cm

Benign tumours

More likely in pregnancy but can also happen to younger girls before menarche.

Question 2

Why can ovarian torsion happen before menarche?

Answer 2

When girls have longer infundibulopelvic ligaments that can twist more easily.

Question 3

How does ovarian torsion present?

Answer 3

Sudden onset severe unilateral pelvic pain.

Constant pain, gets progressively worse and is 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 4

What is the diagnosis of choice for ovarian torsion?

Answer 4

Pelvic ultrasound initially

Transvaginal is ideal but transabdominal can also be used.

Question 5

How may ovarian torsion look on pelvic ultrasound and doppler studies?

Answer 5

“Whirlpool sign” - free fluid in pelvis and oedema of the ovary.

Doppler may show lack of blood flow to ovary.

Question 6

How are the two management options for ovarian torsion?

Answer 6

1. Detorsion (un-twist ovary and fix it)

2. Oophorectomy

Question 7

What is the problem of not removing a necrotic ovary?

Answer 7

May become infected, develop an abscess and lead to sepsis. Additionally it may rupture, resulting in peritonitis and adhesions.