Ovarian Torsion - Symptoms, Causes, Diagnosis, Treatment, and Complications

Introduction

Ovarian torsion, otherwise called adnexal torsion, is a condition where the ovary twists around the ligaments that support it. The fallopian tube also gets twisted in some cases. The twisted fallopian tubes are a painful condition, which can eventually cut off the blood supply to the ovaries and other affected organs. The medical emergency in which an individual might lose the twisted ovary. It usually affects only one ovary. It is commonly seen in women who have larger or multiple cysts in their ovaries. An ovarian cyst causes the ovary to enlarge, which makes it more likely to get twisted. Medications like oral contraceptive pills might help reduce the size of the cyst in some patients and lower the risk of ovarian torsion.

What Is Ovarian Torsion?

Ovarian torsion is a condition when the ovary or fallopian tube twists around the ligaments and cuts off the blood supply leading to ovary loss.

What Are the Causes of Ovarian Torsion?

Although the exact reason for the ovary to get twisted is not known, some of the factors or conditions that are commonly associated with ovarian torsion are:

• Ovarian Cysts or Growth - Ovarian cysts or any other growth adds extra weight to the ovary. This displaces the ovary, which starts to twist and rotate around the supporting tissues.

• Longer Ovarian Ligament - When the ligament that connects the ovary to the uterus is longer than usual, it makes ovarian torsion more likely.

• Assisted Reproductive Technologies (ART) - Taking medicines to induce ovulation can also increase the risk.

• Ovarian Hyperstimulation Syndrome (OHSS) - The condition occurs in females who take medications to stimulate eggs.

• Pregnancy - Some pregnant women develop corpus luteum cysts during the first trimester. This can cause the ovary to twist. The hormone levels are high during pregnancy, which relaxes the tissues in the body. This also relaxes the ligaments around the ovaries and makes them more prone to twisting.

What Are the Symptoms of Ovarian Torsion?

The symptoms commonly seen are as follows:

• Sudden lower abdominal pain.

• The pain will be severe and on the side of the affected ovary.

• Fever.

• Abnormal bleeding.

• Dizziness.

• Weight gain.

• Frequent urination.

• Pelvic pain.

• Severe abdominal cramps.

• Vomiting.

• Nausea.

• Pain during sex.

• Back pain.

An individual might experience these symptoms suddenly or it might come and go for many weeks. If an individual has severe abdominal pain and finds it difficult to lie down, then consult the doctor immediately.

What Are the Risk Factors of Ovarian Torsion?

The risk factors of ovarian torsion are as follows:

1. Polycystic ovarian syndrome (PCOS).

2. Women between 20 to 40 years of age.

3. Tubal ligation.

4. Pregnancy.

5. Infertility treatment using hormones.

How Is Ovarian Torsion Diagnosed?

If an individual has severe one-sided abdominal pain with vomiting, they should get immediate medical help. This condition needs to be treated immediately, or else an individual might lose that ovary. Many other conditions also result in similar symptoms, so the doctor rules out those conditions also before making a diagnosis.

The doctor will take a complete history of the symptoms and will perform a pelvic exam. The doctor might try to locate the areas that are tender to touch. An individual might have to get a transabdominal or transvaginal ultrasound, CT scan, or MRI to see the blood flow to the ovary and fallopian tube.

Ovarian torsion results in enlargement of the ovary, edema, hemorrhage, free pelvic fluid, and a twisted and enlarged tubular structure.

The ultrasonographic features are:

• Enlarged ovary.

• The follicles are peripherally displaced and central stromal tissue.

• The ovary is displaced to the midline.

• Free pelvic fluid is seen in more than 80 % of cases.

• Ovarian cyst or any lesion is commonly seen which is the cause.

The Doppler ultrasound findings are:

• There is an absence or little venous blood flow in the ovaries.

• Arterial flow is absent.

• Whirlpool sign (the pedicle of the ovary appears twisted).

What Is the Differential Diagnosis of Ovarian Torsion?

The doctor will suggest the patient get blood, urine, and other tests to rule out conditions like:

1. Urinary tract infection (UTI).

2. Kidney stones.

3. Gallstones.

4. Gastroenteritis (stomach flu).

5. Ovarian abscess.

6. Appendicitis.

7. Ectopic pregnancy.

What Are the Treatment Options for Ovarian Torsion?

The treatment options for twisted ovary or ovarian torsion are as follows:

Surgery:

Surgery is done to untwist the ovary and fallopian tube. The surgical procedures include:

1) Laparoscopy - This procedure is done under general anesthesia. Here, the doctor will make a small incision through which specialized lighted instruments are inserted. These instruments are used to view the internal organs. Then, another incision is made to access the ovary, and a blunt tool is used to untwist it.

2) Laparotomy - Here, the surgeon makes a larger cut on the lower part of the stomach to reach the twisted ovary. The surgeon then untwists it manually.

If the ovary, fallopian tube, or surrounding tissues are dead due to prolonged loss of blood flow, then the affected part is removed.

• Oophorectomy - The surgical removal of the ovary is called oophorectomy. It is done if the tissues in the ovary are dead.

• Salpingo-Oophorectomy - It is the surgical removal of the ovary and fallopian tube of the affected side. This procedure is also done to prevent recurrence in postmenopausal women.

Most patients recover within a week following surgical treatment.

Medicines:

To help the patient with ovarian torsion pain, the doctor will prescribe painkillers like Acetaminophen, Ibuprofen, and Naproxen. For severe pain, the patient will need opioids like Oxycodone. To reduce the risk of recurrence, the doctor might put the patient on high-dose birth control pills.

What Are the Complications of Ovarian Torsion?

If detected and treated early, ovarian torsion does not cause permanent damage. But if the blood supply to the organs is cut off for a long time, then it can result in irreversible tissue changes in the involved ovary. The condition is treated by removing the affected ovary and fallopian tube.

If an individual has a fever, redness in the incision sites, smelly discharge, and severe pelvic pain after getting surgery, they should seek immediate help as these are signs of an infection.

If treatment is done promptly, then ovarian torsion does not cause permanent damage or does not impact the ability to conceive. Consult a gynecologist online to know more.

Conclusion

Ovarian torsion is a condition when the ovary twirl over the ligaments leading to cuts off the blood flow. The hormonal imbalance leads the ovary to twist. The symptoms include fever, back pain, lower abdominal pain, pain during sex, and severe abdominal cramps. The condition can be treated by surgery and medications. A regular gynecological examination helps in identifying different abnormalities that may increase the chances of ovarian torsion.