When the ovary twists itself or on the fallopian tube, this is known as ovarian torsion or adnexal torsion. It’s serious, but typically not life-threatening, a medical emergency that requires swift diagnosis and treatment. Torsion of the ovary and /or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow in the blood vessels, depriving the ovary of life-sustaining blood and oxygen.
Ovarian torsion can cause severe pain and other symptoms because the ovary is not receiving enough blood supply. If the blood restriction continues for too long, it can lead to tissue death.
Ovarian torsion is a rare condition, occurring in only about 6 per 100,000 women. It is slightly more common in young women. Ovarian torsion usually affects only one ovary. Doctors may also call this condition adnexal torsion. Most ovarian torsion occurs in women in the reproductive age group, and it is less common in premenarchal girls and postmenopausal women.
Ovarian torsion accounts for about 3% of gynecologic emergencies. The incidence of ovarian torsion among women of all ages is 5.9 per 100,000 women, and the incidence among women of reproductive age is 9.9 per 100,000 women. In 70% of cases, it is diagnosed in women between 20 and 39 years of age.
Ovarian Torsion Symptoms
The surest sign of ovarian torsion is a sudden onset of severe, lower abdominal pain or pelvic pain, usually striking during exercise or other vigorous movements. Although some women report mild pain, the pain is usually severe and worsens over a period of a few hours. The pain is usually isolated to the affected ovary but can radiate through the pelvis, back, and/or thigh. In addition, many studies have shown a right-sided predominance of ovarian torsion, with a right side–to–left side predominance ratio of 3:2.
Approximately 25% of patients experience bilateral lower quadrant pain described as sharp and stabbing or, less frequently, crampy. Nausea and vomiting occur in approximately 70% of patients.
Risk Factors for Ovarian Torsion
Women with enlarged ovaries and elongated fallopian tubes are at an increased risk for ovarian torsion. Such conditions can result from:
- Ovarian cysts and tumors
- Previous pelvic surgeries, especially tubal ligations
- Congenital malformations – typically found in young children diagnosed with ovarian torsion
Another cause is an ovarian ligament, connecting the ovary to the uterus, that may be longer than usual. A longer ovarian ligament makes ovarian torsion more likely. Torsion can also occur in normal ovaries.
Development of an ovarian mass (adnexal mass) is related to the development of torsion. In a women’s reproductive years, regular growth of large corpus luteum cysts is a risk factor for rotation. The mass effect of ovarian tumors is also known as a common cause of torsion.
Ovary torsion usually occurs with torsion of the fallopian tube as well on their shared vascular pedicle around the broad ligament, although in rare cases the ovary rotates around the mesovarium or the fallopian tube rotates around the mesosalpinx. In 80%, torsion happens unilaterally, with slight predominance on the right.
The risk is greater in pregnant women and those suffering menopause.
Diagnosis of Ovarian Torsion
If ovarian torsion is diagnosed and treated quickly, the chances of a successful recovery are quite high. However, most occurrences are diagnosed too late, and the ovary has already sustained too much damage.
Often if the signs point to ovarian torsion, doctors will recommend surgery before a certain diagnosis is made. This is because the process of diagnosis may take too long, prolonging the time the ovary is cut off from its blood supply.
Doppler sonography is the method of choice for the evaluation of ovary or adnexal torsion because it can show morphologic and physiologic changes in the ovary and can help in determining whether blood flow is impaired.
A patient with a medical history and physical examination findings suggestive of ovarian torsion, gynecologic consultation, and subsequent laparoscopy are critical. To diagnose ovarian torsion, a doctor may use the following tests:
- A transvaginal ultrasound, which involves inserting a small ultrasound probe into the vagina.
- An abdominal ultrasound, which uses an ultrasound probe on the outside of the abdomen.
- Other imaging tests, such as computed tomography (CT scan) or magnetic resonance imaging (MRI scan).
- A complete blood count test, or CBC, which can measure the number of white blood cells in the body.
However, a confirmation of the ovarian torsion without performing surgery to see the ovary is very uncommon.
Ovarian Torsion Treatments
There are two primary treatments for ovarian torsion.
A laparoscopy is a conservative surgical procedure which can correct an ovarian torsion if an early diagnosis is made. The surgeon will make one or more small incisions in the abdomen, and insert a laparoscope – a small, thin, flexible instrument with a lighted tip – into the surgical site to guide the correction procedure to the hemorrhagic torsed ovary.
Surgical removal of the ovary
In most cases of ovarian torsion, the ovary cannot be salvaged. In these cases, the ovary and usually the fallopian tube must be surgically removed in a procedure called a salpingo-oophorectomy.
Complications of Ovarian Torsion
The most dangerous risk of ovarian torsion is the cut off of the arterial flow to the ovary. If the ovarian torsion is not treated quickly, there is a high likelihood that the ovary will have been starved of blood for too long and will have succumbed to necrosis. This usually means that the dead or dying ovary will need to be surgically removed from the body.
Fortunately, the condition is not life-threatening and research indicates that the loss of an ovary does not typically impact fertility in a significant way.