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.

Ovarian torsion is a surgical emergency. Rapid diagnosis and intervention are necessary to preserve ovarian function where this is clinically appropriate and it is important to maintain fertility.

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

Commonly presents with acute severe pelvic or abdominal pain, nausea, vomiting, and usually with a palpable abdominal mass. High clinical suspicion is necessary. Clinical presentation is often non-specific, with no absolute clinical profile.

Transvaginal ultrasound may show an enlarged ovary.

Definitive diagnosis is surgical. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility where this is clinically appropriate. Oophorectomy may be performed where this is preferable clinically and the patient does not wish to retain 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://www.doi.org/10.1097/AOG.0000000000003373 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 in order to prevent adverse events that may result in the loss of the ovary, fallopian tube, or both.