From the Guidelines
Ovarian torsion is a medical emergency that presents with sudden, severe, unilateral lower abdominal or pelvic pain, and prompt intervention is crucial to preserve ovarian function. The symptoms of ovarian torsion can be constant or intermittent, developing over minutes to hours, and may be accompanied by nausea, vomiting, and sometimes fever 1. Some patients may experience abnormal vaginal bleeding, and on physical examination, there is typically tenderness over the affected side, with a possible palpable pelvic mass. Ovarian torsion occurs when an ovary twists on its vascular pedicle, cutting off blood supply, and risk factors include ovarian cysts or masses, pregnancy, and prior pelvic surgery.
The diagnosis of ovarian torsion typically involves ultrasound with Doppler flow studies to assess blood flow to the ovary, with a sensitivity of 79% and a specificity of 76% for adnexal torsion 1. However, normal blood flow does not exclude torsion, and other signs such as ovarian tissue edema, absence of intraovarian vascularity, and absence of arterial flow can indicate torsion. A unilaterally enlarged ovary with central afollicular stroma and multiple uniform peripheral follicles can also be a sign of torsion, found in up to 74% of cases 1.
Ultrasound with Doppler flow studies is the recommended initial imaging modality for suspected ovarian torsion, as it has a high sensitivity and specificity for diagnosing adnexal torsion and can help identify other potential causes of pelvic pain 1. CT abdomen and pelvis with IV contrast may be considered if a life-threatening diagnosis is suspected or if ultrasound and MRI are inconclusive, but it is not the initial imaging modality of choice for clinically suspected gynecological etiology of pelvic pain 1.
Treatment of ovarian torsion is surgical, usually performed laparoscopically, to untwist the ovary and assess its viability. Prompt intervention is essential to preserve ovarian function and prevent complications such as ovarian necrosis and loss of the ovary. If you experience sudden, severe pelvic pain, especially with nausea and vomiting, seek emergency medical care immediately, as prompt intervention offers the best chance of preserving ovarian function 1.
From the Research
Ovarian Torsion Symptoms
- The most common symptom of ovarian torsion is abdominal or pelvic pain, which can be sudden in onset or severe, but not always 2, 3, 4.
- Nausea and vomiting are also common symptoms, occurring in 70% of cases 2 and 90% of cases 4.
- Other symptoms may include lower urinary tract symptoms, fever, and elevated white blood count 5.
- The symptoms of ovarian torsion can be non-specific and may mimic other disorders, making diagnosis challenging 6.
Clinical Presentation
- Ovarian torsion can affect females of all ages, including reproductive-aged women, premenarchal females, pregnant women, and postmenopausal women 2, 3.
- The majority of patients present with abdominal pain, nausea, and vomiting, and may require opioids for pain management 4.
- A total of 95% of patients may present within 24 hours of symptom onset, with most localizing to the right lower quadrant 4.
Diagnosis and Treatment
- Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot exclude the diagnosis 2.
- Computed tomography with intravenous contrast can also assist with diagnosis 2.
- Surgery is the definitive treatment for ovarian torsion, and may still be effective after several hours of symptoms 6.
- Laparoscopy is recommended for ovarian conservation, as it has a shorter hospital stay, fewer postoperative complications, and ovarian preservation compared to laparotomy 5.