Ovarian torsion (Complete) Flashcards
Define ovarian torsion
Twisting of the ovary (and sometimes fallopian tube) leading to partial or complete blockagae of bloody supply
Ovarian torsion can occur at any age but is most common in which age groups?
20s and 30s
What are the main risk factors for ovarian torsion?
Ovarian cysts/masses
Reproductive age
Pregnancy (especislly first trimester)
PCOS
Fertility treatments
What are the main clinical features of ovarian torsion?
Demographic: Patient with history of risk factors (e.g. ovarian mass)
May have a history of recent strenous exercise or sudden increase in abdominal pressure
Symptoms:
Abdominal pain
- Sudden-onset
- Unilateral
- Occasional radiation to back, flank or groin
Nausea and vomitting
Diarrhoea
Low-grade fever
Signs:
Abdominal/pelvic tenderness
Palpable adnexal mass
What signs on abdominal examination can occur in patients with ovarian torison?
Abdominal/pelvic tenderness
Palpable adnexal mass (tends to be where tenderness occurs)
What differentials should be considered alongside ovaian torsion?
Ectopic pregnancy
Ruptured ovarian cyst
Pelvic inflammatory disease
Mittelschmerz caused by ruptured Graafian follicle
What investigations should be considered for patients with suspected ovarian torsion?
Bedside:
Abdominal and pelvic examination: May feel an adnexal mass
Pregnancy test: Rule out ectopic pregnancy
Urinalysis: Rule out UTI
Cervical swabs: Rule out PID
Basic obs: Check haemodynamic status
Bloods:
FBC: May show leukocytosis
CRP: May be raised
Group & Save: Prepare for surgery
Imaging:
Transvaginal USS: Check for Whirlpool sign or free fluid
Laparoscopy: Gold standard diagnostic test and can manage condition
What is the gold-standard diagnostic test for ovarian torsion?
Laparoscopy
Both diagnostic and curative
What findings on transvaginal USS are indicative of ovarian torsion?
Whirlpool sign
Free fluid
What investigations findings may be seen in patients with ovarian torsion?
Presence of palpable adenxal mass
Leukocytosis and raised CRP (in some cases)
Whirlpool sign or free fluid from Transvaginal USS
What is the management plan for patients with ovarian torsion?
Surgical:
Non-necrosed ovary: laprascopic surgical detorsion
Necrosed ovary: Salpingo-oophorectomy
Medicine:
Anti-emetics and analgesia (whilstawaiting surgery)
What is the best surgical option for patients with non-necorsed ovarian torsion?
Laprascopic surgical detrosion
What is the best surgical option for patients with necorsed ovarian torsion?
Salingo-oophorectomy
What complications can occur due to ovarian torsion?
Ovarian atrophy and necrosis
Peritonitis (if surgery is delayed)
How does ectopic pregancy differ to ovarian torsion?
History of sexual activity
May present with vaginal bleeding
Signs of haemodynamic instability (if ruptured)
Positive pregnancy test
Can be clinically indistinguishable so always important to do pregnancy test
How does ruptured ovarian cyst differ to ovarian torsion?
Sudden onset of sharp pelvic pain
Often following physical activity or sexual intercourse
How does PID differ to ovarian torsion?
High-grade fever
Bilateral lower abdominal pain versus unilateral
Vaginal discharge suggestive of STD
Cervical motion tenderness
How does Mittelschmerz due to ruptured graafian follicle differ to ovarian torsion?
Occurs mid-cycle
Typically mild and self-limitting
