ACR Codes: 8.3
Ovarian torsion is the 5th most common gynecologic surgical emergency, but overall a relatively uncommon event. It can occur in an otherwise normal ovary, but most agree to an increased risk if there is pathologic enlargement of the ovary. It can occur at any age, but is more common in younger, reproductive age females. Torsion (or twisting about the ovarian pedicle) leads to compromise of the blood supply with resulting tissue anoxia and eventually necrosis.
The classic history is sudden onset of unilateral abdominal pain with a tender adnexal mass. Additional symptoms may include nausea and vomiting, and physical exam may reveal decreased bowel sound, fever and tachycardia.
It is essential to evaluate for other acute causes of pelvic pain, particulary the need to check a bHCG and to evalutate for ectopic pregnancy. Otherwise the differential considerations include ruptured ovarian cyst, tubo-ovarian abscess and endometriosis. In addition, torsion of tubal masses (hydro- or pyosalpinx) and peduclulated uterine leiomyomas may also case acute pelvic pain. Non-gynecologic considerations include appendicitis, ureteral calculi and diverticulitis.
Treatment is surgical (laparoscopy). The ovary is un-torsed, and evaluated for potential viability and return of appropriate blood flow based on visual evaluation by the Gyn surgeon. It is also evaluated for ovarian masses, with biopsy, ovarian sparing cystectomy or oophorectomy performed as appropriated for the suspected underlying pathology.
Reference(s): Tintinalli J, et al: Emergency Medicine: A comprehensive study guide. New York, McGraw Hill, 1996.
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