ovarian torsion

Question 1

what is ovarian torsion

Answer 1

twisting of the ovary around the infundibulopelvic ligament (carries the ovarian artery) and utero ovarian ligament
almost always involving the fallopian tube

Question 2

which side does ovarian torsion usually occur on

Answer 2

2/3 of cases occur on the right
left-sided mobility is limited by the sigmoid
right-sided infundibulopelvic ligament is longer

Question 3

ovarian torsion in pregnancy

Answer 3

more common in pregnancy x5
due to enlarged corpus luteum cysts and increased laxity of supporting structures
greatest risk is in 1st trimester

Question 4

do normal ovaries tort

Answer 4

torsion of a normal ovary is rare

Question 5

risk factors for ovarian torsion

Answer 5

developmental anomalies: long tube, absent mesosalpinx
ovarian masses: tumours
pregnancy
ART - enlarged stimulated ovaries
previous pelvic surgery

Question 6

presentation ovarian torsion

Answer 6

acute onset pelvic pain with nausea and vomiting
- in patient with known adnexal mss
- usually unilateral lower abdominal pain
- worsens intermittently
my have history of recent physical activity or had recent increase in abdominal pressure
2/3 will have unilateral adnexal mass found on examination
necrosis may lead to pyrexia, tachycardia, hypotension
peritoneal signs

Question 7

diagnosis of ovarian torsion

Answer 7

clinical diagnosis based on history and examination
supporting tests:
bloods:
- HCG to rule out pregnancy
- FBC - may have elevated WCC (non specific), haemorrhage can led to anaemia
- UEC - may have hypo K from vomiting
imaging:
- USS may be performed to support diagnosis
- CT/MRI not helpful apart from showing enlarged ovary
diagnostic laparosocpy

Question 8

USS features of ovarian torsion

Answer 8

heterogeneously enlarged ovary - oedema, engorgement, haemorrhage
presence of peripheral follicles - oedema causes displacement (string of pearls)
midline ovary, anterior to uterus
free fluid in pouch of douglas
whirlpool sign - twisted pedicle
asymmetrical thickening of ovarian wall cysts

Question 9

doppler studies

Answer 9

commonly used but not always helpful
presence of blood flow does not rule out torsion
may be incomplete occlusion, intermittant torsion, collateral blood supply

Question 10

management of ovarian torsion

Answer 10

laparoscopic approach prefered
for premenopausal, viable, non-malignant ovary: aim to detort and preserve ovarian function
for irreversible ischaemia and necrosis: oopherectomy

Question 11

prevention of recurrence

Answer 11

suppression of ovarian cysts: COCP
oopheropexy
both of these are poorly evidenced

Question 12

ovarian torsion in a fetus

Answer 12

in utero torsion can occur
ovary may undergo necrosis and develop into calcified persistent mass or resorb