Ovarian Torsion

Introduction

• Description: Ovarian torsion involves the twisting of a part or all of the adnexa on its mesentery, resulting in tissue ischemia and frank infarction. This usually involves the ovary but may also include the fallopian tube.

• Prevalence: Uncommon; 2%–3% of gynecologic operative emergencies; fifth most common gynecologic emergency; 5/100,000 in ages 1–20 years. Slightly more common on the right side (64%).

• Predominant Age: Mid- to late-20s.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Spontaneous twisting of the ovary on its mesentery, generally associated with ovarian enlargement (50%–60% have an ovarian tumor [benign teratoma] or functional cyst).

• Risk Factors: Torsion of the adnexa is usually associated with the presence of an ovarian, tubal, or paratubal mass (generally >5 cm). Risk of torsion is higher during pregnancy or after ovulation induction.

Signs and Symptoms

• Pain (90%; generally abrupt, intense, and unilateral. The pain of adnexal torsion generally comes and goes with a periodicity that varies from hours to days or longer; this is in contrast to the variable pain caused by obstruction of the bowel, ureter, or common bile duct, which is more regular and frequent.)

• Unilateral palpable (tender) mass (90% of patients)

• Nausea and vomiting (60%–70%)

• Fever (up to 20%)

Diagnostic Approach