Ovarian Torsion
Related Subjects:
|Ectopic Pregnancy
| Ovarian Torsion
| Ruptured Ovarian Cyst
| Septic Abortion /Miscarriage
| Pelvic Abscess
| Acute Uterine Haemorrhage
| Pelvic Inflammatory Disease
⚠️ Ovarian torsion is a gynaecological emergency caused by rotation of the ovary (± fallopian tube) around its ligamentous supports, leading to compromised blood flow. Prompt diagnosis and intervention are essential to preserve ovarian function and fertility.
📋 Clinical Presentation
- Sudden-onset, severe unilateral lower abdominal/pelvic pain, often colicky or intermittent early on.
- 🤢 Associated nausea and vomiting.
- May occur in context of pre-existing ovarian cysts, dermoid cysts, or ovarian masses; adnexal mass may be palpable.
- Fever is usually absent unless secondary necrosis or infection occurs.
- Symptoms may mimic appendicitis, ectopic pregnancy, or ruptured cyst, so high clinical suspicion is necessary.
🔬 Investigations
- Transvaginal ultrasound with Doppler → reduced or absent ovarian blood flow; note that normal flow does not exclude torsion due to dual blood supply.
- Pelvic US for adnexal mass, cyst size, and free fluid.
- CT or MRI only if ultrasound is inconclusive or other pathology suspected.
- Pregnancy test to exclude ectopic pregnancy.
⚙️ Management
- Emergency surgical intervention:
- Urgent laparoscopy is preferred to detorse the ovary and assess viability; fertility preservation is key.
- Oophorectomy if ovary is necrotic or non-viable.
- Oophoropexy (ovarian fixation) may be considered to reduce recurrence, particularly in recurrent torsion or paediatric/adolescent cases.
- Supportive care:
- Analgesia (opioids or NSAIDs as required).
- IV fluids if vomiting or haemodynamic compromise.
- Monitor vitals and post-operative recovery.
- Follow-up:
- Post-operative ultrasound to assess ovarian perfusion and function.
- Counselling regarding recurrence risk and fertility considerations.
📚 References
