From the Guidelines
A woman with a partial hysterectomy can still experience ovarian torsion, as the procedure typically leaves one or both ovaries intact, making them susceptible to torsion. Ovarian torsion occurs when an ovary twists around its supporting ligaments, cutting off blood supply and potentially causing tissue death if not treated promptly 1. The diagnosis of ovarian torsion can be made using transvaginal ultrasound (TVUS), which has a sensitivity of 83.3% for ovarian torsion 1.
Key Points to Consider
- A partial hysterectomy removes the uterus but leaves one or both ovaries intact, which means these remaining ovaries remain susceptible to torsion.
- Women who have had a partial hysterectomy should be aware of symptoms such as sudden, severe pelvic pain, nausea, vomiting, and fever, which warrant immediate medical attention.
- The risk of ovarian torsion may actually be slightly higher after hysterectomy because the removal of the uterus can alter the normal anatomical support structures of the ovaries, potentially allowing more mobility that could lead to twisting.
- Treatment for ovarian torsion typically involves emergency surgery to untwist the ovary and restore blood flow, or to remove the ovary if tissue damage is severe.
- Regular gynecological check-ups remain important for women with retained ovaries after hysterectomy to monitor ovarian health.
Diagnostic Approach
- TVUS is the most useful imaging modality for initial assessment when an obstetrical or gynecological etiology is suspected 1.
- A combined transabdominal and transvaginal approach is typically used for pelvic US imaging, and both should be performed when possible 1.
- Signs of ovarian torsion on US have varying accuracy, including ovarian tissue edema, absence of intraovarian vascularity, absence of arterial flow, and absence or abnormal venous flow 1.
Importance of Prompt Medical Attention
- Women with symptoms of ovarian torsion should seek immediate medical attention to prevent tissue death and other complications.
- Prompt diagnosis and treatment can help preserve ovarian function and prevent long-term consequences 1.
From the Research
Ovarian Torsion after Hysterectomy
- Ovarian torsion is a surgical emergency that can occur after hysterectomy, although it is a rare event 2, 3.
- The condition refers to the partial or complete rotation of the ovary on its ligamentous support, often resulting in partial or complete obstruction of its blood supply 4, 5.
- Symptoms of ovarian torsion are nonspecific and can include acute onset of pelvic pain, nausea, and vomiting 4, 3.
Risk of Ovarian Torsion after Partial Hysterectomy
- While the provided studies do not specifically address the risk of ovarian torsion after partial hysterectomy, they do suggest that ovarian torsion can occur after hysterectomy, including laparoscopic hysterectomy 2, 3.
- The risk of adnexal torsion is estimated to occur between 1% and 8% in post-hysterectomy cases 2.
- Ovarian torsion can be a difficult condition to diagnose, and a low threshold to consider laparoscopy is essential for clinical acumen 2.
Diagnosis and Treatment
- Diagnosis of ovarian torsion is often challenging and requires a combination of clinical evaluation, imaging studies, and surgical exploration 4, 6.
- Treatment of ovarian torsion typically involves surgical detorsion, with or without oophoropexy, or oophorectomy 4, 6.
- Early diagnosis and treatment are crucial to preserve ovarian function and prevent severe morbidity 4, 6.