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Ovarian torsion

Definition
  • Ovarian torsion refers to the partial or complete rotation of the ovary on its ligamentous supports, leading to a compromise in its blood supply. It is a gynaecological emergency.
Epidemiology
  • Most commonly occurs in reproductive-aged women but can happen at any age.
  • Accounts for about 3% of gynaecologic emergencies.

Aetiology

  • Often associated with ovarian cysts or masses, which can act as a fulcrum for rotation.
  • Can also occur in normal ovaries, especially in premenarchal and postmenopausal women.

Pathophysiology

  • The torsion leads to venous, lymphatic, and eventually arterial occlusion.
  • This results in ovarian oedema, haemorrhage, and necrosis if not promptly treated.

Clinical Features

  • Sudden onset of severe, unilateral pelvic pain.
  • Nausea and vomiting are common.
  • Fever and leucocytosis may be present in later stages.
  • Physical examination may reveal unilateral adnexal tenderness and a palpable mass.

Diagnosis

  • Primarily clinical, but ultrasound with Doppler is the imaging modality of choice.
  • Ultrasound findings may include an enlarged ovary, free pelvic fluid, and absent or reduced ovarian blood flow.
  • Differential diagnosis includes ectopic pregnancy, appendicitis, and pelvic inflammatory disease.

Management

  • Immediate surgical intervention is typically necessary.
  • Laparoscopy is preferred for detorsion and assessment of ovarian viability.
  • If the ovary is necrotic, oophorectomy may be necessary.
  • Postoperative follow-up is important to manage any complications and to monitor for recurrence.

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