Ovarian torsion

Last updated: January 17, 2023

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Ovarian torsion is the twisting of an ovary around the adnexal ligaments. It most commonly occurs in women of childbearing age. Risk factors include ovarian enlargement (e.g., ovarian cysts, tumors, or hyperstimulation syndrome), laxity of pelvic ligaments, a history of pelvic inflammatory disease, and previous pelvic surgery. Torsion can lead to venous congestion and edema, which cuts off the blood supply to the ovary. Patients present with sudden onset unilateral lower abdominal or pelvic pain, and there may be a palpable adnexal mass and adnexal tenderness. In partial ovarian torsion, the pain may be intermittent or resolve spontaneously. Diagnosis is made using pelvic ultrasound. Torsion is a surgical emergency and exploratory laparoscopy is indicated in all patients with suspected ovarian torsion. Delays in treatment may result in ovarian necrosis and infertility.

  • Partial or complete twisting of the ovary and the fallopian tube around their supporting ligaments
  • Also known as adnexal torsion or tubo-ovarian torsion

  • Most common during reproductive years but can occur at any age [6]
  • Sudden-onset unilateral lower abdominal and/or pelvic pain
  • Nausea and vomiting
  • Adnexal mass may be palpable
  • Adnexal tenderness
  • In partial ovarian torsion, abdominal pain may be intermittent or resolve spontaneously.

Pain due to ovarian torsion may resolve intermittently as a result of spontaneous detorsion.

Laboratory studies

A positive pregnancy test does not rule out torsion; an enlarged corpus luteum is a risk factor for torsion during pregnancy. [7]

Imaging [1][8]

Consult gynecology immediately if ovarian torsion is clinically suspected, even if ultrasound findings are normal. [6]

Ovarian torsion is a frequently missed diagnosis; a delay in treatment may affect fertility and pose a medicolegal risk. [6]

The differential diagnoses listed here are not exhaustive.

Surgery with adnexal detorsion and preservation of ovaries is the mainstay of treatment.

Diagnostic laparoscopy should be performed if there is strong clinical suspicion for ovarian torsion despite inconclusive imaging findings.

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  2. Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol. 2010; 202 (6): p.536.e1-536.e6. doi: 10.1016/j.ajog.2009.11.028 . | Open in Read by QxMD
  3. Committee on Adolescent Health Care. Adnexal Torsion in Adolescents, ACOG Committee Opinion No. 783. Obstet Gynecol. 2019; 134 (2): p.e56-e63. doi: 10.1097/aog.0000000000003373 . | Open in Read by QxMD
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  6. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  7. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy D, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th edition. McGraw Hill Professional ; 2019
  8. Bhosale PR et al.. ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group. Ultrasound Q. 2016; 32 (2): p.108-115. doi: 10.1097/ruq.0000000000000200 . | Open in Read by QxMD
  9. Wattar B, Rimmer M, Rogozinska E, et al.. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta‐analysis. BJOG. 2020; 128 (1): p.37-44. doi: 10.1111/1471-0528.16371 . | Open in Read by QxMD
  10. Peña JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril. 2000; 73 (5): p.1047-1050. doi: 10.1016/s0015-0282(00)00487-8 . | Open in Read by QxMD
  11. Ashwal E et al.. Characteristics and Management of Ovarian Torsion in Premenarchal Compared With Postmenarchal Patients. Obstet Gynecol. 2015; 126 (3): p.514-520. doi: 10.1097/aog.0000000000000995 . | Open in Read by QxMD
  12. R Eskander, M Berman, L Keder. Practice Bulletin No. 174. Obstet Gynecol. 2016; 128 (5): p.e210-e226. doi: 10.1097/aog.0000000000001768 . | Open in Read by QxMD
  13. Hartley J, Akhtar M, Edi-Osagie E. Oophoropexy for Recurrent Ovarian Torsion. Case Rep Obstet Gynecol. 2018; 2018 : p.1-4. doi: 10.1155/2018/8784958 . | Open in Read by QxMD

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