Ovarian Torsion

Caused by twisting of the ovary and sometimes fallopian tube around the vascular pedicle. This leads to venous and lymphatic obstruction, then arterial compromise → ischemia. It is most often caused by an ovarian cyst or mass (especially >5 cm)

Epidemiology

• Mostly affects reproductive-age women
• Also can occur in children and postmenopausal women but less common

Clinical Presentation

• Sudden onset of severe, unilateral lower abdominal/pelvic pain
• Nausea and vomiting common
• May have adnexal mass or tenderness on pelvic exam
• Intermittent torsion can cause episodic pain

Diagnosis

• Pelvic ultrasound with Doppler flow:
  • Enlarged ovary (>4 cm)
  • Decreased or absent venous and arterial blood flow (arterial flow can sometimes be present early)
  • Ovarian edema, free pelvic fluid
• Definitive diagnosis: surgical exploration (laparoscopy)

Management

• Emergency surgery (laparoscopy) to untwist ovary and preserve ovarian function
• If ovary appears necrotic but salvageable → detorsion and observe
• If nonviable → oophorectomy
• Remove any underlying cyst/mass

• Sudden, severe unilateral pelvic pain + adnexal mass + nausea/vomiting → think ovarian torsion
• Doppler ultrasound can sometimes show preserved arterial flow despite torsion (don’t exclude diagnosis if arterial flow present)
• Prompt surgical intervention needed to prevent necrosis and infertility