Does shifting posture exacerbate ovarian torsion?

Shifting Posture and Ovarian Torsion Severity

Shifting posture does not directly affect the severity of established ovarian torsion, but movement may exacerbate pain in cases of intermittent or partial torsion. 1

Pathophysiology and Clinical Presentation

• Ovarian torsion involves complete or partial rotation of the ovary along its supporting ligaments, leading to obstruction of vascular flow 2
• Pain in ovarian torsion is typically severe and constant, though it may fluctuate in intensity but rarely resolves completely without intervention 1
• Nausea and vomiting occur in approximately 70% of cases, accompanying the abdominal or pelvic pain 2

Types of Ovarian Torsion and Relationship to Movement

• Acute ovarian torsion involves arterial obstruction leading to ovarian ischemia and potential necrosis 3
• Partial or intermittent torsion involves venous and lymphatic obstruction followed by ovarian swelling 3
• In intermittent torsion cases, positional changes may temporarily alter symptoms as the ovary rotates and unrotates, potentially causing fluctuating pain patterns 1

Diagnostic Considerations

• Ultrasound is the first-line imaging modality for suspected ovarian torsion 1

• Key ultrasound findings include:

  • 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" representing the twisted vascular pedicle (90% sensitivity) 1

• CT findings may include:

  • Asymmetrically enlarged ovary with or without an underlying mass 4
  • Twisted pedicle (better visualized with multiplanar reformations) 4
  • Subacute ovarian hematoma, abnormal/absent ovarian enhancement 4
  • Deviation of the uterus to the side of the twist 4

Important Clinical Pitfalls

• Normal arterial blood flow on ultrasound does not rule out ovarian torsion, as torsion can be intermittent or partial 1
• Venous flow abnormalities are more sensitive indicators of torsion than arterial flow changes 1
• The diagnosis of ovarian torsion can be challenging as patients often present with non-specific symptoms 5
• Clinicians should maintain a low threshold for investigating ovarian torsion in patients with lower abdominal pain, especially those with risk factors such as ovarian masses or fertility treatment 5

Management Approach

• Prompt surgical intervention with laparoscopic detorsion is the mainstay of treatment to preserve ovarian function 6, 3
• Conservative surgical management (detorsion rather than oophorectomy) is recommended to preserve fertility and hormonal function, especially in young women 3
• Oophoropexy (fixation of the ovary) may be performed to prevent recurrence 3