Ovarian/Tubal Torsion

Synonyms/Description

Adnexal torsion

Etiology

Torsion is defined as the twisting by at least one complete turn of the adnexa, ovary, or (rarely) the tube only around the infundibulo-pelvic and tubo-ovarian ligament, resulting in ischemia. It occurs more frequently on the right side (70%), perhaps because of a longer tubo-ovarian ligament on the right. Approximately 15% of ovarian torsions occur in children. An increase in weight of the adnexa is the primary risk factor for torsion, particularly with dermoid cysts and other mobile ovarian masses. Ovarian cancer or endometriomas seldom cause torsion because of lack of mobility of these lesions. The incidence of ovarian torsion increases during pregnancy, and ovarian stimulation is an additional risk factor.

Up to 26% of cases of torsion occur in patients who have an apparently normal adnexa; therefore a leading ovarian mass is not always present.

Paratubal cysts weighing down the tube can cause isolated torsion of the tube, although this is rare compared with ovarian torsion. Occasionally a torsed fallopian tube is associated with a hydrosalpinx.