What is Ovarian Torsion?

>> Tuesday, November 13, 2012

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Ovarian torsion is when the ovary and fallopian tube flip and twist over on themselves. Rotation of the ovary causes obstruction to venous and arterial flow. Ovarian torsion is usually associated with a cyst or benign type tumor on the ovary. These cysts or benign tumors cannot be larger than 5 cm, because, once they get larger than that, they would be stuck in one place in the pelvis, wedged next to the uterus and unable to move about.

The reason I mention this is to follow-up on our discussion on ovarian cysts and also because so many of you are worrying about this happening to you. I really want to let you know more about it, so no matter what you read on the internet, you can have some sound medical information.

Ovarian torsion is an uncommon cause of acute abdominal pain at any age, but it is a gynecologic emergency - diagnostic delay can result in loss of the ovary. The ovary, and often the fallopian tube as well (adnexal torsion) become twisted around themselves. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to the death of that ovary. The engorgement can be confusing and appear to be a cyst or tumor on ultrasound. An ovary with a mass or cyst is more prone to twisting by virtue of its asymmetry.

The classic presentation of adnexal torsion is sudden onset of one-sided lower abdominal pain which may actually radiate over to the other side and make it hard to actually know, without an ultrasound, which side is actually affected. It may even radiate to the groin or upper thighs and down legs.

There are other things that can cause severe pain and confuse the diagnosis, such as ovarian cysts, tubo-ovarian abscesses, ectopic pregnancy (a pregnancy test can easily rule this out), appendicitis, or kidney stones. The scariest condition in the differential diagnosis for adnexal torsion is an ectopic pregnancy. Any female of reproductive age presenting to the emergency department should have a pregnancy test. There are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion.

Some tests may be helpful in pointing you toward an alternative diagnosis. A urinalysis may reveal blood - consistent with kidney stones, or it may show bacteria - more consistent with a urinary tract infection. A fever or flu-like symptoms may mean there is a severe pelvic infection like PID and a tubo-ovarian abscess over torsion.

Even though there are fancier scans like CT scans and MRIs, ultrasound is the best way to detect ovarian torsion and determine if there is still good blood flow to the ovary. If the twisting is too tight, it can completely cut off blood flow to the ovary and the ovary will die. As the flow is stopped, the ovary swells and the blood can clot; this is intensely painful. This is why, even though not life threatening, it is still considered a medical emergency - we always want to save the ovary if possible. Keep in mind, a woman can reproduce and live a normal life, and go through menopause at the normal time (49-54 years) with just one ovary. So, if the ovary does die and has to be removed, all will still be okay.

The presence of blood flow on color Doppler imaging does not allow exclusion of torsion, but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of flow in the twisted vascular pedicle may indicate that the ovary has already died and needs to be removed.

Outpatient care has no role in the treatment of ovarian torsion. So you can't treat it with pain medications and waiting. Ovaries don't flip back on their own once they have twisted. The ovary must be untwisted surgically as soon as possible to restore blood flow. Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and operated on as soon as possible. Laparoscopic surgery can work, or the doctors may opt for an open procedure for confirmation of the diagnosis and treatment.

So, I hope this helps all of you with understanding this. The internet is so informative, but it is still important to know where and who the information is coming from.

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