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 supports it. The fallopian tube also gets twisted in some cases. It is a painful condition, which can eventually cut off the blood supply to the ovaries and other affected organs. It is a medical emergency, and if left untreated, you might lose the twisted ovary. It usually affects only one ovary.

The exact cause of this condition is not known, but it is commonly seen in women who have larger or multiple cysts in their ovaries. 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 Symptoms Does Ovarian Torsion Cause?

The symptoms commonly seen are:

• 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.

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• Nausea.

• Pain during sex.

You might experience these symptoms suddenly or it might come and go for many weeks. If you have severe abdominal pain and you find it difficult to lie down, then consult your doctor immediately. Other conditions that can cause similar symptoms are kidney stones, gallstones, appendicitis, stomach flu, urinary tract infection (UTI), etc.

What Causes 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 cyst 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) - It is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in very rare cases.

• 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.

Risk Factors:

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

Your doctor will take a complete history of your symptoms, and will perform a pelvic exam. He or she might try to locate the areas that are tender to touch. You might have to get a transabdominal and/or transvaginal ultrasound, CT scan, or MRI to see the blood flow to your 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 absent or little venous blood flow in the ovaries.

• Arterial flow is absent.

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

Differential Diagnoses:

The doctor will suggest you 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?

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 incision in the lower abdomen 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 you with the pain, your doctor will prescribe painkillers like Acetaminophen, Ibuprofen, and Naproxen. For severe pain, you will need opioids like Oxycodone.

To reduce the risk of recurrence, the doctor might put you 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 long, then it can result in irreversible tissue changes in the involved ovary. And the only way to treat it is by removing the affected ovary and fallopian tube.

If you have a fever, redness in the incision sites, smelly discharge, and severe pelvic pain after getting surgery, then get 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