Ovarian torsion

Question 1

Define ovarian torsion.

Answer 1

Ovarian torsion is a twisting, or torsion, of the ovary around its ligamentous supports.

Question 2

What is the aetiology of ovarian torsion? What are risk factors of ovarian torsion?

Answer 2

Underlying anatomical abnormalities account for the highest percentage of patients with ovarian torsion. Just over half (56%) of patients in a large series of adnexal torsion had an ovarian mass, mostly with benign histology, including dermoid cysts and para-ovarian cysts. The likelihood of a malignancy is greater in post-menopausal women.

Question 3

Summarise the epidemiology of ovarian torsion.

Answer 3

Ovarian torsion is thought to account for approximately 3% of all gynaecological surgical emergencies.

Question 4

What are the signs and symptoms of ovarian torsion?

Answer 4

Pelvic or abdominal pain

Nausea, vomiting, or diarrhoea

Abdominal/pelvic tenderness

Palpable adnexal mass

Question 5

What investigations should be performed for ovarian torsion?

Answer 5

Pregnancy test

Urinalysis

FBC

Group and save

Sickle cell test

Transvaginal ultrasound

Abdominal or transrectal ultrasound

Doppler flow

PCR, nucleic acid amplification test, or cervical culture

Surgical visualisation

Question 6

What is the management for ovarian torsion?

Answer 6

Surgical detorsion or salpingo-oophorectomy

Question 7

What are complications associated with ovarian torsion? What is the prognosis for ovarian torsion?

Answer 7

Ovarian atrophy

Peritonitis

Excellent prognosis and retention of ovarian function is expected with timely surgical intervention.