Can ovarian torsion pain resolve completely and what are the implications?

Ovarian Torsion Pain Resolution and Clinical Implications

Ovarian torsion pain can temporarily resolve or fluctuate in intensity, but complete resolution without intervention is rare and should raise concern for intermittent torsion or progression to tissue necrosis, requiring immediate surgical evaluation. 1

Pain Characteristics in Ovarian Torsion

• Ovarian torsion typically presents as severe, constant pain that may fluctuate in intensity but rarely completely resolves without surgical intervention 1
• If pain completely resolves, it may indicate intermittent or partial torsion, where the ovary twists and then untwists spontaneously 2
• Pain that comes and goes in a cyclical pattern suggests intermittent torsion, which can still lead to permanent ovarian damage if not addressed 2

Clinical Implications of Pain Resolution

• Complete pain resolution does not rule out ongoing torsion, as torsion can be intermittent or partial 2
• Patients may experience symptoms for several hours or days before seeking medical attention, making the duration of symptoms a poor predictor of ovarian salvageability 2
• Pain resolution may create false reassurance, delaying diagnosis and potentially leading to ovarian necrosis and loss 3

Diagnostic Considerations

• Ultrasound is the first-line imaging modality for suspected ovarian torsion, with key findings including:

  • Unilaterally enlarged ovary (>4 cm or volume >20 cm³) 1
  • Peripheral follicles (found in up to 74% of cases) 1
  • Abnormal or absent venous flow (100% sensitivity, 97% specificity) 1
  • Whirlpool sign (90% sensitivity) representing the twisted vascular pedicle 1

• Normal arterial blood flow on ultrasound does not rule out ovarian torsion, as torsion can be intermittent or partial, and venous flow abnormalities are more sensitive 1, 2

Management Implications

• Even with temporary pain resolution, surgical evaluation should not be delayed if ovarian torsion is suspected 2
• Surgery remains the standard method for definitive diagnosis and treatment, even after several hours of symptoms 2
• Delaying surgery may lead to serious infection and compromise both ovarian viability and fertility 4
• Laparoscopic detorsion is the preferred approach when possible, as it can preserve ovarian function 3

Special Considerations

• Ovarian torsion can occur at any age, including in postmenopausal women, where it is often associated with ovarian masses and carries a higher risk of malignancy 5
• Pregnancy, especially following fertility treatments like IVF that cause ovarian hyperstimulation, increases the risk of ovarian torsion 4
• In pregnant patients with suspected torsion, prompt intervention is crucial to protect both the ovary and preserve the pregnancy 6
• A high index of suspicion must be maintained for pregnant patients with adnexal masses and acute lower abdominal pain, as 38% to 60% of pregnant patients with torsion have normal Doppler flow on ultrasound 6

Common Pitfalls

• Misinterpreting pain resolution as resolution of the underlying condition 2
• Relying solely on arterial Doppler flow to rule out torsion 1, 2
• Delaying surgical intervention due to temporary symptom improvement 4
• Failing to consider ovarian torsion in patients outside reproductive age 5