Ovarian Torsion

Question 1

Pathology of ovarian torsion

Answer 1

The ovary, and often the fallopian tube as well (adnexal torsion) become twisted around their vascular pedicle. Twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is compromised, leading to ischemia and infarction. An ovary with a mass or cyst is more prone to twisting by virtue of its asymmetry. It is most common in the reproductive years, but can occur at any age

Question 2

Symptoms

Answer 2

Sudden onset of unilateral lower abdominal pain
- Usually visceral pain first (vague)
- Nausea and vomiting
May describe history of intermittent pain (intermittent torsion)

Question 3

What history findings would be suspicious?

Answer 3

Prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy (ie, corpus luteum cyst) should increase your suspicion for torsion

Question 4

PE findings

Answer 4

lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Fever is uncommon, and usually low-grade if present.

Question 5

What is the most dangerous condition in the differential for torsion?

Answer 5

Ectopic pregnancy

Question 6

What is the best imaging?

Answer 6

Ultrasound

Question 7

Main Ultrasound findings

Answer 7

• The absence of blood flow within the ovary on Doppler exam is a useful finding in establishing the diagnosis. However, it is important to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion.

Question 8

Other useful US findings

Answer 8

Enlargement or edema of the ovary, an ovarian mass or cyst, and free pelvic fluid (indicating hemorrhage).

Question 9

Treatment

Answer 9

Surgery

• Best done if within 8 hours, but no clear consensus.
• Oophoropexy is still somewhat controversial. However, becoming more common as more surgeons are trying to save the ovaries.