From the Guidelines
Untreated ovarian torsion for years would likely lead to severe complications, including permanent ovarian damage and tissue death, with initial symptoms of sudden, severe pelvic pain, nausea, vomiting, and sometimes fever, eventually resulting in decreased or absent pain as the nerves in the ovary die. The symptoms of untreated ovarian torsion for years can be understood by considering the natural progression of the condition. Initially, the torsion would cause severe pelvic pain, nausea, vomiting, and sometimes fever due to the compromised blood supply to the ovary 1.
As the condition progresses, the affected ovary would undergo necrosis (tissue death) due to the lack of blood supply. This would eventually result in decreased or absent pain as the nerves in the ovary die. Long-term consequences would include:
- Infertility issues if both ovaries are affected
- Hormonal imbalances leading to irregular menstruation or early menopause
- Chronic pelvic pain
- Potential development of peritonitis or sepsis if necrotic tissue causes infection
- The body may form adhesions around the damaged ovary, potentially causing bowel obstruction or chronic pain
- Untreated torsion could lead to autoimmune responses as the body reacts to the necrotic tissue
The diagnosis of ovarian torsion can be made using imaging modalities such as transvaginal ultrasound (TVUS) or computed tomography (CT) scan. TVUS has a sensitivity of 83.3% for ovarian torsion, while CT evaluation has a sensitivity of 74% to 95% and a specificity of 80% to 90% for the diagnosis of adnexal torsion 1.
Treatment typically requires surgical intervention, but after years of torsion, removal of the affected ovary (oophorectomy) would likely be necessary rather than salvage procedures that might be possible with early intervention. It is essential to prioritize prompt medical attention if symptoms of ovarian torsion are suspected to prevent long-term complications and improve outcomes 1.
From the Research
Symptoms of Untreated Ovarian Torsion
The symptoms of untreated ovarian torsion for years are not directly addressed in the provided studies. However, the studies do discuss the symptoms and consequences of ovarian torsion in general:
- Acute onset of pelvic pain is the most common symptom of ovarian torsion, followed by nausea and vomiting 2, 3, 4, 5.
- Abdominal or pelvic pain may not always be sudden in onset or severe, and nausea and vomiting occur in approximately 70% of cases 3.
- Ovarian torsion can cause ischemia, leading to severe morbidity and potential infertility if left untreated 2, 4, 5.
- The condition can affect females of all ages, including infants, reproductive-aged women, pregnant women, and postmenopausal women 2, 3, 4.
Consequences of Delayed Treatment
Delayed treatment of ovarian torsion can lead to:
- Ischemic changes of the adnexa, resulting in potential infertility 5.
- A lower gonadal salvage rate, with one study reporting a salvage rate of 14.4% for ovarian torsion compared to 30.3% for testicular torsion 6.
- Increased risk of ovarian necrosis, which can be distinguished using computed tomography findings, plasma d-dimer level, and the time from pain onset 5.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of ovarian torsion are crucial to preserve ovarian function and prevent severe morbidity:
- Surgery is the definitive treatment for ovarian torsion, and early intervention can improve outcomes 2, 3, 4, 5.
- A better understanding of ovarian torsion is critical for gynecologists to promote accuracy of diagnosis and select the optimal surgical procedure 5.
- Liberal use of diagnostic laparoscopy and more urgent intervention for suspected ovarian torsion should be considered, especially in girls with lower abdominal pain 6.