From the Guidelines
Abdominal heat is not a reliable or standard sign of ovarian torsion, and patients with suspected ovarian torsion should be evaluated based on symptoms such as sudden, severe pelvic or lower abdominal pain, nausea, vomiting, and fever. The diagnosis of ovarian torsion is primarily based on clinical presentation and imaging findings, particularly ultrasound with Doppler flow studies to assess blood flow to the ovary 1. According to a recent study published in the Journal of the American College of Radiology in 2024, transvaginal ultrasound (TVUS) demonstrated a sensitivity of 83.3% for ovarian torsion, and the absence of arterial flow had a sensitivity of 76% and specificity of 99% for diagnosing ovarian torsion 1. Key signs indicating torsion include a unilaterally enlarged ovary with central afollicular stroma and multiple uniform peripheral follicles, as well as the absence of intraovarian vascularity or abnormal venous flow 1. While abdominal heat might be present due to inflammation, it is not a specific or reliable indicator of ovarian torsion, and patients experiencing severe, sudden abdominal pain, especially with nausea or vomiting, should seek emergency medical care promptly. In the context of ovarian torsion, it is crucial to prioritize symptoms such as severe pelvic pain, nausea, and vomiting over non-specific signs like abdominal heat, as delayed treatment can lead to loss of the ovary due to compromised blood supply 1. The use of ultrasound, particularly TVUS, is critical in the diagnosis of ovarian torsion, and its findings should guide clinical decision-making rather than reliance on non-standard signs like abdominal heat 1.
From the Research
Ovarian Torsion Symptoms
- Abdominal pain is a common symptom of ovarian torsion, with most patients presenting with acute onset of pelvic pain 2, 3, 4.
- Nausea and vomiting are also frequent symptoms, occurring in 70-90% of patients 5, 2, 4.
- The pain is often localized to the right lower quadrant, but can be diffuse or nonspecific 5, 3.
- There is no direct evidence to suggest that a patient feeling hot in her abdomen is a specific sign of ovarian torsion, but abdominal pain and discomfort are common presentations 5, 2, 3, 4.
Diagnosis and Management
- Pelvic ultrasonography is a useful diagnostic tool for ovarian torsion, and can provide information on ovarian cysts and adnexal masses 5, 2, 3, 4.
- A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion 3.
- Surgical detorsion is the mainstay of treatment for ovarian torsion, and should be performed as soon as possible to preserve ovarian function 5, 2, 3, 4.
- Ovarian conservation is recommended, even in cases where the tissue appears necrotic, as intraoperative visual diagnosis of ovarian death is highly inaccurate 3.
Clinical Presentation
- Ovarian torsion can occur in females of all ages, including reproductive-aged women, premenarchal females, pregnant women, and postmenopausal women 2, 4, 6.
- The clinical presentation of ovarian torsion can be diverse and nonspecific, making diagnosis challenging 5, 2, 3, 4.
- A high index of clinical suspicion is necessary to diagnose ovarian torsion, especially in patients with risk factors such as ovarian masses or cysts 5, 2, 3, 4.