Ovarian Torsion Flashcards
What is ovarian torsion?
A gynaecological emergency where the ovary twists in relation to the fallopian tube, connective tissue and blood supply
What is the main cause of ovarian torsion?
A mass larger than 5cm (for example a cyst or tumour)
In which women does ovarian torsion occur in?
Mainly occurs in women of reproductive age
More common during pregnancy
Can occur in young girls before menarche
What is the pathophysiology of ovarian torsion?
Twisting of the adnexa (fallopian tube and ovary) leads to ischaemia. Necrosis can occur if the torsion is prolonged
What is the presentation of ovarian torsion?
Sudden onset severe unilateral pelvic pain
Nausea and vomiting
What are the risk factors for ovarian torsion?
Previous ovarian torsion
Pregnancy
Ovarian hyperstimulation
PCOS
Benign or malignant ovarian cysts
What are the differentials of ovarian torsion?
Ectopic pregnancy
Ruptured graafian follicle
Urolithiasis
PID
Appenditicitis
Functional ovarian cysts
Endometriosis
UTI
What is the first line investigation for ovarian torsion?
Transvaginal ultrasound
What signs may be seen on transvaginal ultrasound in someone with ovarian torsion?
Whirlpool sign
Free fluid in the pelvis
Oedema around the ovary
What is the definitive investigation for someone with ovarian torsion?
Laparascopic surgery
What other investigations are performed to help diagnose ovarian torsion?
Pregnancy test
Urinalysis
FBC
CRP
CT abdo/pelvis
What is the management of ovarian torsion?
Laparoscopic detorsion
Laparoscopic oophorectomy
What are the complications of ovarian torsion?
Rupture - peritonitis, adhesions
Infertility if only functioning ovary
Abscesses - sepsis
