Ovarian Torsion
Definition
· Ovarian torsion is the partial or complete rotation of the ovary on its ligamentous supports, often leading to impedance of blood supply. Common gynaecological emergency. Fallopian tube often twists along with ovaries (this called adnexal torsion); isolated tube torsion is uncommon.
· Diagnosis is a clinical diagnosis; confirmed by surgical visualisation. Fair clinical confidence if (acute pelvic pain + adnexal mass + U/S consistent of torsion + exclude ectopic)
Epidemiology
- *Any age
- Usually dermoid (teratoma = mature = benign)
Risk factors
· Ovarian mass, esp if ≥5cm (90%) (and ∴ risk factors for ovarian cyst or neoplasm)
o Reproductive age
o Pregnancy (10-22% of torsion)
o Undergoing ovulation induction for infertility t/m
· In paediatrics may have no underlying lesion
Clinical features
Symptoms
- *Acute onset pelvic pain (90%): sudden, sharp/colicky/crampy, severe, radiates to back/flank/groin
o Pain gets better if left too long as ovaries die
- *Nausea & vomiting (47-70%)
- Adnexal mass (90%) –hx/recent diagnosis
- Fever (2-20%)
- Abnormal PV bleeding (4%)
- History of recent vigorous activity/sudden ↑ abdo pressure – may precipitate the torsion
- Pre-menopausal/post-menopausal; desire for pregnancy – affects surgical mx
Signs
- ± Low grade fever, slightly ↑ BP/HR
- Abdo:
o Peritonism signs (?adnexal necrosis)
o Pelvic or abdominal tenderness (60%) – localised or diffuse
o ± palpable pelvis mass
- VE:
o ± Adnexal mass
Ddx
Ectopic pregnancy, tubo-ovarian abscess, appendicitis, acute/chronic pain conditions
Investigations
- Bloods: β-HCG, FBC (Hb/WCC), UEC
o Β-HCG – rule out ectopic; ↑ risk in pregnancy for torsion; guide mx
- If adnexal mass + ?malignancy – tumour markers
- Pelvic ultrasound (1st line imaging)
o Look at blood flow to ovaries
- Definitive diagnosis by surgery visualisation based on clinical diagnosis
Management
- Admit into hospital
- Urgent referral to O&G
- Surgery – to diagnose and mx
o Detorison/ovarian conservation/salpingo-oophorectomy/ovarian cystectomy (depending on reproductive age, adnexal mass benign or malignant)
Source
A/Prof Amanda Dennis 2014
UpToDate 2014
· Ovarian torsion is the partial or complete rotation of the ovary on its ligamentous supports, often leading to impedance of blood supply. Common gynaecological emergency. Fallopian tube often twists along with ovaries (this called adnexal torsion); isolated tube torsion is uncommon.
· Diagnosis is a clinical diagnosis; confirmed by surgical visualisation. Fair clinical confidence if (acute pelvic pain + adnexal mass + U/S consistent of torsion + exclude ectopic)
Epidemiology
- *Any age
- Usually dermoid (teratoma = mature = benign)
Risk factors
· Ovarian mass, esp if ≥5cm (90%) (and ∴ risk factors for ovarian cyst or neoplasm)
o Reproductive age
o Pregnancy (10-22% of torsion)
o Undergoing ovulation induction for infertility t/m
· In paediatrics may have no underlying lesion
Clinical features
Symptoms
- *Acute onset pelvic pain (90%): sudden, sharp/colicky/crampy, severe, radiates to back/flank/groin
o Pain gets better if left too long as ovaries die
- *Nausea & vomiting (47-70%)
- Adnexal mass (90%) –hx/recent diagnosis
- Fever (2-20%)
- Abnormal PV bleeding (4%)
- History of recent vigorous activity/sudden ↑ abdo pressure – may precipitate the torsion
- Pre-menopausal/post-menopausal; desire for pregnancy – affects surgical mx
Signs
- ± Low grade fever, slightly ↑ BP/HR
- Abdo:
o Peritonism signs (?adnexal necrosis)
o Pelvic or abdominal tenderness (60%) – localised or diffuse
o ± palpable pelvis mass
- VE:
o ± Adnexal mass
Ddx
Ectopic pregnancy, tubo-ovarian abscess, appendicitis, acute/chronic pain conditions
Investigations
- Bloods: β-HCG, FBC (Hb/WCC), UEC
o Β-HCG – rule out ectopic; ↑ risk in pregnancy for torsion; guide mx
- If adnexal mass + ?malignancy – tumour markers
- Pelvic ultrasound (1st line imaging)
o Look at blood flow to ovaries
- Definitive diagnosis by surgery visualisation based on clinical diagnosis
Management
- Admit into hospital
- Urgent referral to O&G
- Surgery – to diagnose and mx
o Detorison/ovarian conservation/salpingo-oophorectomy/ovarian cystectomy (depending on reproductive age, adnexal mass benign or malignant)
Source
A/Prof Amanda Dennis 2014
UpToDate 2014