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| | | {{Ovarian torsion}} |
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| | '''For patient information, click [[Ovarian torsion (patient information)|here]]''' |
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| {{SK}} Adnexal torsion | | {{SK}} Adnexal torsion |
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| ==Overview== | | ==[[Ovarian torsion overview|Overview]]== |
| Ovarian torsion refers to a twisting of the ovary. If the torsion involves the ovary and the oviduct it is called adnexal torsion. Ovarian torsion is in the differential diagnosis of unilateral abdominal pain in a woman. Approximately 60% of the time it occurs on the right side of the abdomen. | |
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| ==Epidemiology and Demographics==
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| Obviously ovarian torsion only occurs in women. Ovarian torsion is the fifth most common gynecologic emergency. 83% of cases occur in women of reproductive age, with a median age at presentation of 28 years.
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| ==Pathophysiology==
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| In general, ovarian torsion occurs in association with an enlarged ovary. Because ovarian enlargement plays a critical role, 50% to 60% of cases of ovarian torsion are due to either benign or malignant ovarian tumors, usually over 4 cm in size. An enlarged ovary that occurs in early pregnancy due to enlargement of the corpus lutiem can also predispose a woman to ovarian torsion. Likewise women undergoing fertility treatment who develop theca lutein cysts are at risk of ovarian torsion. Ovarian torsion can occur in children if a long fallopian tube is present.
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| ==Differential Diagnosis of Underlying Causes of Ovarian Torsion== | | ==[[Ovarian torsion historical perspective|Historical Perspective]]== |
| ===Gynecologic Disorders===
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| Infertility drugs
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| Long fallopian tube in children
| | ==[[Ovarian torsion pathophysiology|Pathophysiology]]== |
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| Benign and malignant [[ovarian tumor]]s
| | ==[[Ovarian torsion causes|Causes]]== |
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| [[Pregnancy]] | | ==[[Ovarian torsion differential diagnosis|Differentiating Ovarian Torsion from other Conditions]]== |
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| ==Differential Diagnosis of Disorders That Ovarian Torsion Should Be Distinguished from== | | ==[[Ovarian torsion epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Appendicitis]] | |
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| [[Ectopic pregnancy]] | | ==[[Ovarian torsion risk factors|Risk Factors]]== |
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| == Diagnosis== | | ==[[Ovarian torsion natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Abdominal ultrasound is helpful in establishing the diagnosis in patients with suspected torsion.
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| <div align="left">
| | ==Diagnosis== |
| <gallery heights="175" widths="175">
| | [[Ovarian torsion history and symptoms|History and Symptoms]] | [[Ovarian torsion physical examination|Physical Examination]] | [[Ovarian torsion laboratory findings|Laboratory Findings]] | [[Ovarian torsion CT|CT]] | [[Ovarian torsion MRI|MRI]] | [[Ovarian torsion ultrasound|Ultrasound]] | [[Ovarian torsion other imaging findings|Other Imaging Findings]] | [[Ovarian torsion other diagnostic studies|Other Diagnostic Studies]] |
| Image:Ovarian-torsion-001.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-002.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-003.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-004.jpg|Coronal T2 patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-005.jpg|Sag T2 patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-006.jpg|Axial T2 patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Ovarian-torsion-101.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-102.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-103.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-104.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Ovarian-torsion-105.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
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| </gallery>
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| </div>
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| ==Treatment== | | ==Treatment== |
| Associated symptoms of nausea and [[vomiting]] can be treated with antiemetics. Dehydration secondary to vomiting can be treated with intravenous fluids.
| | [[Ovarian torsion medical therapy|Medical Therapy]] | [[Ovarian torsion surgery|Surgery]] | [[Ovarian torsion primary prevention|Primary Prevention]] | [[Ovarian torsion secondary prevention|Secondary Prevention]] | [[Ovarian torsion cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ovarian torsion future or investigational therapies|Future or Investigational Therapies]] |
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| ===Early Conservative Management===
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| If there is no evidence of vascular compromise, or [[peritonitis]] then laparoscopy can be used to uncoil the torsed ovary.
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| ===Salpingo-oophorectomy===
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| If there is evidence of vascular compromise, or peritonitis, the salpingo-oophorectomy may be required. Unfortunately, the visual characteristics of the ovaries such as size, color, and edema may not accurately reflect the extent of injury. Therefore, most studies support a strategy of early conservative management, which is successful in 88% of cases.
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| ===Treatment to Reduce the Risk of Recurrent Torsion===
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| Among young women in whom there is a long ligament, laparoscopic triplication of the utero-ovarian ligament has been utilized to reduce the risk of recurrent torsion. Patients with [[polycystic ovarian disease]] are also at risk of recurrence.
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| | == Case Studies == |
| | [[Ovarian torsion case study one|Case #1]] |
| | ==Related Chapters== |
| | * [[Testicular torsion]] |
| | * [[Ovary]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| | [[Category:Disease]] |
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |