Diagnosis
Ovarian torsion
Twisting of the ovary on its vascular pedicle.
Etiology
Causes
Functional cysts: Follicular cyst and corpus luteum cyst
Dermoid cyst: Embryonal stem cells
Cystadenomas: ovarian tissue
Endometriomas: result of endometriosis
Cancer: Anatomic changes affecting the weight and the size of the ovary
Pathophysiology [wqi]
The ovary has dual blood supply from the ovarian arteries and uterine arteries
Twisting of the vascular pedicle:
Venous congestion
Edema
Compromised arterial blood supply
Resulting in tissue necrosis:
Pain (possibly peritonitis)
Hemorrhage
Risk factors [wqi]
Increased length of the ovarian ligaments
Ovarian mass that is >5 cm in diameter
Enlarged ovaries
Tumors
Enlarged corpus luteum in pregnancy
Complications [wqi]
Loss of ovary --> infertility
Complications from the surgery itself:
Infection
Venous thromboembolism
Adhesions
Epidemiology
Incidence per 100.000 [nb4][b3k][p9z][v4g][bsv]
Symptoms & findings
Symptoms
Fever, Nausea, Tachycardia, Vomiting
Clinical findings
Elevated CRP, Elevated D-dimer, Leukocytosis
Anamneses
None listed.
Localized findings
Approach
Blood test: hCG, complete blood cell count, electrolytes, AFP, CA125, LD, CEA, estradiol, testosterone
Urine: hCG
Blood gas
Abdominal x-ray
Pelvic ultrasonography
Transvaginal ultrasound
CT abdomen
MRI
Diagnostic laparoscopy
Treatment
Laparoscopic detorsion and oophoropexy [v4g][wqi]
Oophorectomy
Cyst: cystectomy, unroofing, aspiration
Differential diagnoses
Acute mesenteric ischemia, Appendicitis, Diverticulitis, Endometriosis, Gastroenteritis, Gastrointestinal obstruction, Gastrointestinal perforation, Infectious colitis, Ischemic colitis, Ovarian abscess, Ovarian cancer, Pelvic inflammatory disease, Perforated ulcer, Pyelonephritis, Ruptured ectopic pregnancy, Ruptured ovarian cyst, Urinary tract infection, Urolithiasis
References
[1] Baron SL, Mathai JK. Ovarian Torsion. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560675/
[2] Guthrie BD, Adler MD, Powell EC. Incidence and trends of pediatric ovarian torsion hospitalizations in the United States, 2000–2006. Pediatrics. 2010;125:532–38.
[3] Yuk JS, Kim LY, Shin JY, Choi DY, Kim TY, Lee JH. A national population-based study of the incidence of adnexal torsion in the Republic of Korea. Int J Gynaecol Obstet. 2015 May;129(2):169-70.
[4] Karaman E, Beger B, Çetin O, Melek M, Karaman Y. Ovarian Torsion in the Normal Ovary: A Diagnostic Challenge in Postmenarchal Adolescent Girls in the Emergency Department. Med Sci Monit. 2017 Mar 15;23:1312-1316.
[5] Bolli P, Schädelin S, Holland-Cunz S, Zimmermann P. Ovarian torsion in children: Development of a predictive score. Medicine (Baltimore). 2017 Oct;96(43):e8299.
[6] Robertson JJ, Long B, Koyfman A. Myths in the Evaluation and Management of Ovarian Torsion. J Emerg Med. 2017 Apr;52(4):449-456.
[7] http://emedicine.medscape.com/article/2026938 (2014-01-02); [Medscape]