Ovarian Torsion and Ligament Involvement
Yes, ovarian torsion directly affects the supporting ligaments, particularly involving rotation of the ovary around its vascular pedicle and supporting ligaments, which can lead to compromised blood flow and potential tissue damage. 1, 2
Anatomical Basis of Ovarian Torsion
- Ovarian torsion occurs when the ovary rotates around its supporting ligaments, specifically the infundibulopelvic ligament and utero-ovarian ligament, causing vascular compromise 2
- The rotation of these ligaments is the fundamental mechanism of torsion, as the ovary twists along with its vascular pedicle, leading to obstruction of blood flow 3
- The ovaries receive dual blood supply from both the ovarian artery and uterine artery, which explains why some cases of torsion may still show arterial flow on imaging 2
Diagnostic Findings Related to Ligament Involvement
- The "whirlpool sign" on ultrasound, which represents the twisted vascular pedicle and supporting ligaments, is a key diagnostic finding in ovarian torsion 4, 1
- This whirlpool sign can be located either lateral or medial to the affected ovary, with the location potentially related to the size of the ovarian mass 4
- A retrospective study found that 90% of patients with the whirlpool sign on ultrasound had confirmed adnexal torsion on laparoscopy 4
Ligament Abnormalities Contributing to Torsion
- Abnormally long supporting ligaments can predispose patients to recurrent ovarian torsion 5
- One case report identified a 3-cm utero-ovarian ligament (longer than normal) as the underlying cause of intermittent torsion 5
- Anatomical variations in the broad ligament can also be associated with conditions that may mimic or complicate ovarian torsion 6
Surgical Management Targeting Ligaments
- Surgical management of recurrent ovarian torsion often involves procedures that specifically address the ligaments 7, 5
- Oophoropexy (fixation of the ovary) to the round ligament has been reported as an effective technique for preventing recurrent torsion 7
- Laparoscopic plication (shortening) of the utero-ovarian ligament can be performed to prevent recurrent torsion by reducing the mobility of the ovary 5
- In cases of broad ligament defects associated with torsion, surgical closure of these defects may be necessary 6
Clinical Implications
- Understanding the involvement of ligaments in ovarian torsion is crucial for both diagnosis and management 1, 2
- The presence of abnormal ligament length or mobility should be assessed during surgical management of torsion, especially in cases of recurrence 5
- Preservation of ovarian function, particularly in young patients, remains the primary goal of management, with ligament-focused surgical techniques offering promising outcomes 7, 3