Ovarian Torsion

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Ovarian Torsion

Definition

Ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. This results in extreme lower abdominal pain.

Description

Ovarian torsion occurs infrequently only in females. In can occur in women of all ages, but most women that experience this are younger. Approximately 70-75% of cases occur in women under 30 years old. About 20% of all reported cases are in pregnant women. It is the fifth most common gynecological emergency which can include surgical intervention.

Ovarian torsion usually arises in only one ovary at a time. They can occur in either normal or enlarged ovaries and fallopian tubes, and occasionally they develop in both.

Causes and symptoms

There are a variety of conditions that can cause torsion of the ovary ranging from changes in normal ovaries to congenital and developmental abnormalities or even a disease that affects the tube or ovary. Normal ovaries that experience spasms or changes in the blood vessels in the mesosalpinx can become twisted. For example, if the veins in the mesosalpinx become congested, the ovaries will undergo torsion.

Developmental abnormalities of the fallopian tube such as extremely longer-than-normal tubes or a missing mesosalpinx will cause ovarian torsion. Diseases such as ovarian cysts or fibromas, tumor of the ovary or tubes, and trauma to either the ovaries or the tubes will also cause ovarian torsion.

The characteristic symptom of ovarian torsion is the sudden onset of extreme lower abdominal pain that radiates to the back, side and thigh. Nausea, vomiting, diarrhea, and constipation can accompany the pain. The patient may also experience tenderness in the lower abdominal area, a mild fever and tachycardia.

Diagnosis

The diagnosis of ovarian torsions usually occurs in an emergency room due to the suddenness of extreme pain. Emergency room physicians may consult with another physician specializing in obstetrics and gynecology. Since 20% of ovarian torsions occur in pregnant women, physicians will order a pregnancy test. Visualization with an ultrasound and CT scan (computed tomography) will help pinpoint the ovarian structures and allow physicians to diagnose. Diagnosis is often confirmed through laparoscopy.

Treatment

Ovarian torsions need to be repaired. This is done through surgery, and for less severe cases laparoscopic surgery is used. Medications such as NSAIDs are given to control pain.

Prognosis

If ovarian torsions are diagnosed and treated early, then the prognosis is favorable. However, if diagnosis is delayed, the torsions can worsen and cut off arterial blood flow into and venous blood flow out of the ovary. This results in necrosis (death) of the ovarian tissue. Delayed diagnosis can also result in problems when trying to conceive due to infertility.