Ovarian torsion

Ovarian torsion (or adnexal torsion) is a twisting of the ovary (and/or fallopian tube) on its vascular and ligamentous supports, blocking adequate blood flow to the ovary.

Rapid diagnosis and emergency surgical intervention are necessary to preserve ovarian function.

Most often seen in women of reproductive age; can occur during pregnancy. Also seen in infants, children, adolescents, and postmenopausal women.

Commonly presents with sudden-onset, severe lower abdominal pain, often associated with nausea and vomiting. A palpable adnexal mass is often present. High clinical suspicion is necessary; the diagnosis can be challenging because clinical presentation is nonspecific, with no absolute clinical profile.

Transvaginal ultrasound may show an enlarged ovary; Doppler flow studies may show absence of blood flow.

Definitive diagnosis is surgical. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility.

Ovarian torsion is a twisting, or torsion, of the ovary around its ligamentous supports. The term adnexal torsion includes torsion of an ovary, but also includes torsion of the fallopian tube, paratubal cyst, or a combination of these conditions.[1]American College of Obstetricians and Gynecologists. Adnexal torsion in adolescents: ACOG committee opinion no, 783. Obstet Gynecol. 2019 Aug;134(2):e56-63. https://journals.lww.com/greenjournal/fulltext/2019/08000/adnexal_torsion_in_adolescents__acog_committee.45.aspx http://www.ncbi.nlm.nih.gov/pubmed/31348225?tool=bestpractice.com This may result in loss of blood supply to both the ovary and the fallopian tube. When diagnosed, this condition is considered a surgical emergency. Therefore, reaching a correct diagnosis as quickly as possible is critical to prevent adverse events that may result in the loss of the ovary, fallopian tube, or both.