Ovarian torsion

Question 1

What is the definition of ovarian torsion?

Answer 1

partial or complete torsion of the ovary on its supporting ligaments that may in turn compromise the blood supply

Question 2

What is adnexal torsion?

Answer 2

ovarian torsion when the fallopain tube is also involved

Question 3

What are 4 risk factors for ovarian torsion?

Answer 3

1. Ovarian mass: present in around 90% of cases of torsion (neoplasm, cyst)
2. Being of a reproductive age
3. Pregnancy
4. Ovarian hyperstimulation syndrome (fertility treatments)

Question 4

What are 5 key clinical features of ovarian torsion?

Answer 4

1. Sudden onset deep-seated colickly abdominal pain
2. Associated with vomiting and distress
3. Abdominal mass on palpation
4. Fever may be seen in a minority (possibly secondary to adnexal necrosis)
5. Vaginal examination may reveal adnexal tenderness

Question 5

What is the key investigation prior to surgery for ovarian torsion and what 2 things is it likely to show?

Answer 5

transvaginal doppler ultrasound

1. free fluid
2. whirlpool sign

Question 6

What is the management of ovarian torsion?

Answer 6

laparoscopy: usually both diagnostic and therapeutic

detorsion to preserve normal ovarian function and fertility

Question 7

What can cause a fever in ovarian torsion?

Answer 7

adnexal necrosis

Question 8

How is a definitive diagnosis of ovarian torsion made?

Answer 8

laparoscopy

Question 9

Overall what are 6 investigations to consider in suspected ovarian torsion, prior to laparoscopy?

Answer 9

1. FBC - leucocytosis
2. Pregnancy test
3. transvaginal USS with doppler flow
4. abdominal ultrasound - appropriate in children
5. urinalysis - likely to be negative in torsion
6. may consider cervical swab - if PID is likely differential