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 intervention are necessary to preserve ovarian function.
Most often seen in women of reproductive age between 20 and 40 years; can occur during pregnancy. Also seen in infants, children, adolescents, and postmenopausal women.
Commonly presents with abdominal pain, nausea, vomiting, and an abdominal mass. High clinical suspicion is necessary. Clinical presentation is nonspecific, with no absolute clinical profile.
Transvaginal ultrasound with Doppler flow studies may show an enlarged ovary with absence of blood flow.
Definitive diagnosis is surgical. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility.
The twisting, or torsion, of the ovary around its ligamentous supports. 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.
History and exam
Key diagnostic factors
- abdominal pain
- nausea, vomiting, or diarrhea
- abdominal/pelvic tenderness
- palpable adnexal mass
Other diagnostic factors
- feeding intolerance, vomiting, abdominal distention, and fussiness (neonates)
- strenuous exercise
- peritoneal signs
- cervical motion tenderness
- ovarian neoplasm
- ovarian cyst
- paraovarian cyst
- infertility treatment
- strenuous exercise
- sudden increased abdominal pressure
1st investigations to order
- pregnancy test
- transvaginal ultrasound with Doppler flow
- abdominal ultrasound
- genetic probe or cervical culture
- surgical visualization
Investigations to consider
- CT abdomen/pelvis
- MRI abdomen/pelvis
Dr Sareena Singh, MD, FACOG
Department of Obstetrics and Gynecology
Northeast Ohio Medical University
Chief of Gynecologic Oncology
SS declares that she has no competing interests.
Dr Sareena Singh would like to gratefully acknowledge Dr Michael P. Hopkins, Dr Jay R. Patibandla, Dr John C. Nulsen, and Dr Vanessa N. Weitzman, the previous contributors to this topic.
MPH, JRP and JCN declare that they have no competing interests. VNW is an author of a reference cited in this topic.
Adam Magos, BSc, MB, BS, MD, FRCOG
University Department of Obstetrics and Gynaecology
Royal Free Hospital
AM declares that he has no competing interests.
Joseph Sanfilippo, MD, MBA
Department of Obstetrics
Gynecology and Reproductive Sciences
Division of Reproductive Endocrinology and Infertility
University of Pittsburgh
JS declares that he has no competing interests.
Howard Sharp, MD
Associate Professor and Chief
General Division of Obstetrics and Gynecology
University of Utah School of Medicine
Salt Lake City
HS has been reimbursed for attending and participating in conferences on pelvic varicosity pain syndrome by Cook Inc.
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