Ovarian Torsion aka Adnexal Torsion

It is an uncommon cause of acute abdominal pain in females, but it is a ‘gynecologic emergency’- Ovarian Torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. This twisting can cut off blood flow to the ovary and fallopian tube. It is most common in the reproductive years, but can occur at any age – diagnostic delay can result in loss of the ovary.

How do I make the diagnosis?

If you have the history of sudden onset of unilateral pelvic pain, sometimes radiating to the groin, often associated with nausea and vomiting, do a pelvic exam. The remainder of findings on ultrasound and CT are nonspecific. Diagnosis of adnexal torsion is usually confirmed by color Doppler transvaginal ultrasonography. However, either ultrasound or CT may help you find other pathology to explain a patient’s pain.
The bottom line – there is no single finding that can definitively “rule in” or “rule out” ovarian torsion. If all your tests are negative, but you still suspect it, call your gynecologist to discuss your worries.

Treatment

Treatment of adnexal torsion is surgical. The ovary must be untwisted as soon as possible to restore blood flow. While there is no absolute cutoff to ensure viability, some studies have indicated that the best outcomes are achieved if the ovary is detorsed within 8 hours. If on surgical examination the ovarian tissue is obviously necrotic, it may be removed. An ovarian mass or cyst may be resected. Most surgeons will try to salvage any normal ovarian tissue in a premenopausal patient. Unlike orchiopexy for testicular torsion, oophoropexy is still somewhat controversial, although with the current trend toward ovarian salvage more clinicians have advocated this procedure.

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Pearls and Pitfalls

  • Pain may be reminiscent of a kidney stone: colicky, fairly sudden onset, radiation to the groin
  • Get an ultrasound to look for Doppler flow. Lack of flow is a helpful sign, but remember that a significant number of patients with torsion confirmed on laparoscopy had an ultrasound that showed intact blood flow.
  • Torsion does occur in infants, children, and postmenopausal women. Children have a higher incidence of torsion of a normal ovary than in the adult population.
  • “Time is ovary,” to borrow a phrase so Consult your gynecologist early.

Lifestyle

Ovarian Torsion is not related to lifestyle or anything women are physically doing.

Key points

  • Adnexal torsion, which is uncommon, is more likely to result from benign tumors than from malignant ones.
  • Torsion causes sudden, severe pelvic pain and sometimes nausea and vomiting; it may be preceded by days or occasionally weeks of intermittent, colicky pain, presumably resulting from intermittent torsion.
  • Suspect adnexal torsion based on symptoms, and confirm by Doppler transvaginal ultrasonography.
  • Immediately attempt to salvage the ovary and fallopian tube by untwisting them via laparoscopy or laparotomy; if nonviable or necrotic tissue or an ovarian cyst or mass is present, surgery (salpingo-oophorectomy, cystectomy) is required.

A piece of advice: Don’t be a hero, go to the doctor!

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