ovarian torsion In female anatomy, it occurs when the ovaries and fallopian tubes, which connect the ovaries to the uterus, twist around supporting tissues and blood vessels. This twist cuts off the blood supply to the organ.
Ovarian torsion is an emergency and must be diagnosed and intervened promptly to save the ovaries and corresponding reproductive organs. It can occur in people of all ages, but is more prominent in teens and young women of reproductive age.
This article discusses the signs, causes, and treatment of ovarian torsion.
Types of ovarian torsion
Partial ovarian torsion occurs when the ovaries and fallopian tubes are only partially twisted to cut off the blood supply.
Often, symptoms associated with partial ovarian torsion are less severe than complete ovarian torsion. Ovaries and fallopian tubes sometimes twist occasionally over days or months, causing repeated abdominal pain and partial torsion.
Complete ovarian torsion is when the ovaries and fallopian tubes are completely twisted to cut off the blood supply to the tissues.
ovarian torsion symptoms
The most common symptom of ovarian torsion is acute lower abdominal pain, followed by nausea and vomiting. Often, the pain comes and goes, and it is thought that the ovaries may twist and unravel during this time. Full torsion is associated with significant pain.
right and left
The ovary on the right side of the body is more prone to twisting than the ovary on the left because the gut on the left helps to keep the left ovary in a stable position.
More than 80% of people with ovarian torsion have a large ovarian cyst (a fluid-filled sac in or on the ovary) or lump. The larger the ovarian cyst or mass, the greater the chance of torsion. This can happen with any size lump, but healthcare providers are most concerned with lumps larger than 5 centimeters.
Benign (noncancerous) tumors are more likely to develop ovarian torsion than ovarian malignant tumors (cancerous tumors).
When a mature egg is released from the ovary ovulationSome people develop multiple ovarian follicular cyst. These cysts also increase the risk of ovarian torsion.
People at risk for an enlarged cyst or mass include:
- Taking hormones to induce ovulation
- undergo in vitro fertilization and development hyperstimulation syndrome
- have polycystic ovary syndrome (PCOS)
- who is pregnant
- Past history of ovarian torsion
Adolescent ovarian torsion
Almost half of adolescent girls with ovarian torsion have normal ovaries without cysts or lumps.
Healthcare providers must be on high alert for ovarian torsion for early detection. Before testing, they could only rely on a person’s medical history, physical exam, and risk factors for ovarian torsion. There are no specific blood tests that can indicate ovarian torsion.
Pelvic ultrasound is the best imaging test for the diagnosis of ovarian torsion. If pelvic ultrasound does not clearly show ovarian torsion, but healthcare providers remain concerned, magnetic resonance imaging (MRI) or computed tomography (CT) imaging of the abdomen and pelvis may help confirm the diagnosis.
However, MRI is expensive and takes a long time to obtain, and CT imaging can be missed. Evaluation of ovarian torsion is generally not recommended.
Direct visualization of the process Laparoscopic surgerywhich requires making a small incision in the abdomen and feeding in a slender tool with a tiny camera, is the best way to diagnose ovarian torsion when the provider is highly suspicious of the condition.
The goal of ovarian torsion treatment is to unravel the tissue and blood vessels so that enough blood can flow back to the ovary. This requires surgery. Options include laparoscopic or open surgery.
The laparoscopic approach is less invasive than open surgery and is a more popular option. However, if ovarian or fallopian tube cancer is suspected, gynecologist Might want to do an open program.
The new recommendations advise gynecologists to do everything they can to protect ovarian function and future fertility. This means they unravel the tissue and try to keep the ovary in place rather than remove it. Ovarian tissue is good at restoring function after ischemia.
The only way to know if the ovary is healthy enough to stay in the body is to observe it. Sometimes, even if the tissue turns black or blue, it can recover.
The amount of time since the onset of symptoms is not always a reliable indicator of whether the tissue has died. Studies have shown that ovarian function can return several days after symptoms appear. However, sometimes, too long, a healthcare provider needs to remove the ovaries.
Experts recommend preventing recurrent ovarian torsion if a large cyst or mass is found during surgery. Sometimes a gynecologist can remove the cystic fluid after unraveling the tissue to make it smaller. But even this approach doesn’t prevent ovarian torsion from happening again.
Surgical treatment of pregnant women and adolescents
The management of ovarian torsion in pregnant women is the same as in non-pregnant women. Laparoscopic surgery can be safely used to treat ovarian torsion during pregnancy.
Experts recommend that teens should not have torsional ovaries removed during surgical treatment unless the ovarian tissue is completely disintegrated.
If a person with ovarian torsion does not seek medical care, the ovary becomes ischemia and necrosis, which means the tissue dies due to lack of blood flow. Although rare, when this happens, the area can bleed or become infected, and the infection can spread to other parts of the abdomen.
In recent years, gynecologists have turned to unraveling tissue and blood vessels to save the ovaries, rather than removing them. Previously, there was concern that the act of unraveling could cause the blood clot to spread to the lungs. However, this procedure rarely results in blood clots.
People with ovarian torsion can still get pregnant afterwards. The ovaries that are left in place have an excellent ability to return to normal function. Still, if one ovary needs to be removed, a person has a second, functioning ovary.
Ovarian torsion is an emergency in which the ovaries and fallopian tubes wrap around the surrounding tissue, cutting off the blood supply. It requires rapid diagnosis and intervention to save the ovaries and reproductive areas. People with large ovarian cysts or lumps are most at risk of torsion. Gynecologists aim to unravel the tissue and preserve the ovaries to prevent infectious complications and infertility.
Ovarian torsion is painful and scary. If you have severe lower abdominal pain and are of reproductive age, you may have ovarian torsion. Your odds are higher if you are known to have ovarian cysts or lumps. Instead of waiting to see your primary care provider, go to the hospital for emergency care.