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.

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

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.