Can a 62-year-old experience an ovarian torsion?

Ovarian Torsion in a 62-Year-Old Patient

Yes, ovarian torsion can occur in a 62-year-old patient, though it is less common in postmenopausal women compared to those of reproductive age. Prompt recognition and surgical intervention are essential to prevent ovarian necrosis and other complications.

Epidemiology and Risk Factors in Older Women

Ovarian torsion in postmenopausal women has distinct characteristics:

• While ovarian torsion occurs in approximately 2-15% of patients with adnexal masses requiring surgery 1, it is considered rare in postmenopausal women 2
• The primary risk factor in postmenopausal women is the presence of an ovarian mass or cyst 2
• Ovarian neoplasms account for approximately 8% of acute pelvic pain cases in postmenopausal women 2

Clinical Presentation

The presentation of ovarian torsion in older women may include:

• Acute onset of pelvic pain (most common symptom)
• Nausea and vomiting
• Symptoms may be nonspecific, leading to diagnostic challenges and delays

Diagnostic Approach

Imaging

1. Transvaginal and Transabdominal Ultrasound:

   • First-line imaging for suspected gynecological causes of pelvic pain 2
   • Ultrasound findings suggestive of torsion include:
     • Unilaterally enlarged ovary (>4 cm or volume >20 cm³)
     • Central afollicular stroma with peripheral follicles (in up to 74% of cases)
     • Abnormal Doppler flow patterns:
       • Absence of venous flow (100% sensitivity, 97% specificity)
       • Absence of arterial flow (76% sensitivity, 99% specificity)
       • Absence of intraovarian vascularity (52% sensitivity, 91% specificity)
       • Ovarian tissue edema (21% sensitivity, 100% specificity) 2

2. CT Abdomen and Pelvis with IV Contrast:

   • Equally appropriate as initial imaging in postmenopausal women with acute pelvic pain 2
   • Findings suggestive of torsion include:
     • Enlarged, featureless, and hypoenhancing ovary
     • Swirling of vascular pedicle
     • Abnormal craniocaudal orientation of ovary
     • Uterine deviation to the affected side 2

Important Diagnostic Considerations

• Up to 5% of torsed ovaries may be normal in size 2
• Diagnostic accuracy of ultrasound for adnexal torsion: 79% sensitivity, 76% specificity 2
• CT evaluation has 74-95% sensitivity and 80-90% specificity for adnexal torsion 2

Management

Surgical intervention is the mainstay of treatment for ovarian torsion:

• Laparoscopic approach is preferred when feasible
• Options include:
  • Detorsion (preferred in reproductive-age women)
  • Oophorectomy (may be more appropriate in postmenopausal women, especially with suspicious masses)

Pitfalls and Caveats

1. Diagnostic Delays: Symptoms may be nonspecific and can be mistaken for other conditions, leading to delayed diagnosis and potential ovarian necrosis 3

2. Normal Doppler Findings: The presence of normal blood flow on Doppler does not exclude torsion, as torsion can be intermittent or partial

3. Age Bias: There may be a lower clinical suspicion for ovarian torsion in postmenopausal women, potentially delaying diagnosis

4. Mimics: Other conditions can present similarly to ovarian torsion, including:

   • Appendicitis
   • Diverticulitis
   • Ureteral stones
   • Degenerating fibroids

Conclusion

While ovarian torsion is less common in postmenopausal women, it should remain in the differential diagnosis for acute pelvic pain in a 62-year-old woman, especially if an ovarian mass is present. Early imaging with ultrasound or CT is crucial, and surgical intervention should not be delayed if clinical suspicion is high, even with equivocal imaging findings.