Ovarian torsion

Ovarian torsion Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Ovarian Torsion from other Conditions
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Ovarian torsion On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ovarian torsion All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ovarian torsion
CDC on Ovarian torsion
Ovarian torsion in the news
Blogs on Ovarian torsion
Directions to Hospitals Treating Ovarian torsion
Risk calculators and risk factors for Ovarian torsion

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Adnexal torsion

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.

Epidemiology and Demographics

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.

Pathophysiology

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.

Differential Diagnosis of Underlying Causes of Ovarian Torsion

Gynecologic Disorders

Infertility drugs

Long fallopian tube in children

Benign and malignant ovarian tumors

Pregnancy

Differential Diagnosis of Disorders That Ovarian Torsion Should Be Distinguished from

Appendicitis

Ectopic pregnancy

Diagnosis

Abdominal ultrasound is helpful in establishing the diagnosis in patients with suspected torsion.

• 
  CT patient#1 Image courtesy of RadsWiki and copylefted
• 
  CT patient#1 Image courtesy of RadsWiki and copylefted
• 
  CT patient#1 Image courtesy of RadsWiki and copylefted
• 
  Coronal T2 patient#1 Image courtesy of RadsWiki and copylefted
• 
  Sag T2 patient#1 Image courtesy of RadsWiki and copylefted
• 
  Axial T2 patient#1 Image courtesy of RadsWiki and copylefted

• 
  8 y/o female with right lower quadrant pain patient#2 Image courtesy of RadsWiki and copylefted
• 
  8 y/o female with right lower quadrant pain patient#2 Image courtesy of RadsWiki and copylefted
• 
  8 y/o female with right lower quadrant pain patient#2 Image courtesy of RadsWiki and copylefted
• 
  8 y/o female with right lower quadrant pain patient#2 Image courtesy of RadsWiki and copylefted
• 
  8 y/o female with right lower quadrant pain patient#2 Image courtesy of RadsWiki and copylefted

Treatment

Associated symptoms of nausea and vomiting can be treated with antiemetics. Dehydration secondary to vomiting can be treated with intravenous fluids.

Early Conservative Management

If there is no evidence of vascular compromise, or peritonitis then laparoscopy can be used to uncoil the torsed ovary.

Salpingo-oophorectomy

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.

Treatment to Reduce the Risk of Recurrent Torsion

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.

Template:WikiDoc Sources