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Oophoropexy: A Treatment Option For Ovarian Torsion

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Ovarian torsion is the twisting of ovaries or fallopian tubes over the tissue that supports them. Oophoropexy is explained below as a treatment option for it.

Medically reviewed by

Dr. Richa Agarwal

Published At May 26, 2023
Reviewed AtJanuary 10, 2024

Introduction

Adnexal torsion (TA) also known as ovarian torsion involves the torsion of all adnexal components (fallopian tubes and ovaries), resulting in impaired blood flow. TA has a reported prevalence of 2.7 % and an incidence of 4.9 out of 100,000 women. Adnexal torsion in children is a rare event, and preventing adnexal torsion in children remains controversial. The mean age of the patients was five and a half years (range: two months to ten years). However, many studies show benefits in preventing ovarian torsion and conclude that longer ovarian cords might correlate with the development of ovarian torsion. In addition, in situations where the ovarian ligaments are congenitally long, patients have recurrent torsion.

What Is Ovarian Torsion?

Ovarian torsion also referred to as adnexal torsion or torsion, implies the twisting of the ovary and the part of the fallopian tube. It can be intermittent or persistent and leads to venous, arterial, and lymphatic stasis. Gynecologic surgical intervention is necessary to stop ovarian necrosis in this situation. Age distribution for ovarian torsion in epidemiology is bimodal, particularly in young and older women after menopause. Approximately 20 % of cases occur during pregnancy. An ovary with prolonged infarction may have a more complex presentation with cystic or hemorrhagic degeneration peripherally displaced follicles with central stoma follicular ring sign. Affected ovaries are displaced toward the midline, and a twisted pedicle can be identified in the adnexa, most commonly in front of the uterus. The uterus shifted to the affected side with minimal accumulation of free liquid fat in the adnexa. Spontaneous torsion has also been reported. The clinical presentation includes pain in the pelvic area, vomiting, and belly mass.

What Is the Risk Factor of Ovarian Torsion?

Ovarian torsion is seen in women during their reproductive years, but it occasionally occurs in prepubescent girls. The risk factors that can increase the risk of getting ovarian torsion are listed below:

1. Cyst: A cyst on the ovary is the biggest risk factor for ovarian torsion as it can cause the ovary to become unbalanced and push it to turn on itself. The ovary is attached to the uterus and the walls of the pelvis the same as the ball on a string. And if one puts a cyst on it, it makes it uneven by weighing it down and becomes more likely to wrench on itself.

2. Pregnancy: When a female ovulates, an egg is discharged from the follicle. It then closes itself off and forms the corpus luteum (a hormone-secreting system). If one does not get pregnant, the corpus luteum smashes down and is reabsorbed by the body. If one becomes pregnant, the corpus luteum fills with blood or liquid and becomes a cyst. This type of cyst is typical and occurs mostly in early pregnancy. It often vanishes on its own, but it can induce ovarian torsion.

3. Hormonal Medicines: Consuming the hormones pills that trigger ovulation (for infertility) can promote the ovaries to form cysts, increasing the likelihood of ovarian torsion.

What Are the Investigations for the Diagnosis of Adnexal Torsion?

The ovarian torsion also known as adnexal torsion is diagnosed with the help of the following investigations:

  1. CT Scan (Computed Tomography):The appearance of a twisted ovarian peduncle on CT is of ovarian torsion. Non-contrast CT suggests hemorrhagic necrosis. A lack of contrast can be observed. Hemorrhagic necrosis is a sign of non-viability.

  2. Doppler Test: Doppler flow is highly specific for torsion, but normal flow does not completely rule out torsion.

  3. Complete Blood Picture: Blood tests to learn more about the type of cyst.

  4. Aspiration: Cyst aspiration with torsion.

The expert may wait one to two months to notice if the cyst persists. Then, the expert inspected again after one or two menstrual cycles. Finally, an ultrasound can test the cyst's location and extent. If necessary, surgery can be performed if the cyst is very large.

What Is the Treatment For Ovarian Torsion?

Immediate surgery is required to stop ovarian necrosis. Most ovaries are irreparable. An abscess or peritonitis may develop if the necrotic ovary is not removed. It may also get infected. Mortality from ovarian torsion is rare. Diagnosis should be considered in the case of an enlarged edematous ovary, with or without a fallopian tube. Emergency surgery is required when a cyst has ruptured and is bleeding into the abdomen or there is ovarian torsion. Some of the treatment procedures are:

  • Cystectomy: The cyst is eliminated without putting off the ovary. Cystectomy can be performed through laparoscopy or a larger abdominal incision (laparotomy).

  • Ovariectomy: The whole ovary, including the cyst, is removed.

  • Salpingo-Oophorectomy: The procedure involves the fallopian tube, ovary, and cyst being eliminated.

Oophoropexy Procedure:

Always look laparoscopically for an ovarian mass, causing the torsion surgeon to make a small incision in the abdomen. With a lighted camera, the surgeon can see the cyst. A laparoscopy occurs when the ultrasound shows a cyst unlikely to go away or resolve independently. The ovarian cyst is removed and sent for analysis. Laparoscopy is also done when providers have concerns about ovarian torsion or bleeding from the cyst. Both situations can be medical emergencies. The main primary complication is that ruptured ovarian cysts can cause fluid to leak from the cyst or bleed into the abdomen.

What Caution Should One Follow to Prevent Ovary Torsion?

  • One should avoid strenuous activity diagnosed with a large cyst until it shrinks and disappears, as extreme activity can cause ovarian torsion.

  • Birth control pills (BC) can be prescribed to stop ovulation. By stopping ovulation, one can save new cysts from forming. However, taking birth control pills will not help a cyst that is already there to go away.

Can a Woman Become Pregnant When Affected With Torsion?

Women can still become pregnant if at least one ovary is present and vital or functional. Consult the doctor in cases related to:

  • Conceiving after the operation.

  • Fever over 101° Farenheit.

  • Redness at the surgical site.

  • A drain exits the surgical site.

  • Heavy vaginal bleeding.

Conclusion

The results of several studies show that the two main risk factors for adnexal torsion were ovarian pathology and the stretching and hypermobility of the ovarian ligament. Therefore, reducing pathologic indications and performing unabsorbable sutures and multipoint fixation to restore normal functionality and structure.

Frequently Asked Questions

1.

What Does an Oophoropexy to the Round Ligament Mean?

Oophoropexy to the round ligament is often performed to secure the ovaries in their proper place within the pelvis. Attaching the ovaries to a round ligament prevents them from shifting or twisting abnormally, which can cause pain and other complications.

2.

What Is the Suture Material Used for Oophoropexy?

Doctors typically use special threads made of materials like absorbable sutures that dissolve over time or non-absorbable sutures that need to be removed later to perform Oophoropexy and secure the ovaries in place.

3.

What Do Adnexal Torsion and Ovarian Torsion Mean?

Adnexal torsion and ovarian torsion both refer to a condition where the ovary and sometimes the fallopian tube twist, leading to reduced blood flow, severe pain, and potentially serious complications.

4.

How Is Adnexal Torsion Treated?

The treatment for adnexal torsion usually involves surgery to untwist the affected ovary and fallopian tube and in some cases, the removal of the twisted ovary if it is severely damaged. Swift medical intervention is crucial to prevent complications and preserve reproductive health.

5.

Is Surgery Necessary for Ovarian Torsion?

Yes, surgery is often necessary for ovarian torsion. Prompt medical intervention is crucial to untwist the affected ovary and restore blood flow, which helps prevent tissue damage and preserve ovarian function. In some cases, the twisted ovary might need to be removed if it is severely damaged.

6.

What Are the Radiology Findings of Ovarian Torsion?

Radiology findings in ovarian torsion may show an enlarged ovary due to swelling, reduced or absent blood flow to the affected ovary, and the presence of free fluid in the pelvis. These findings are important for diagnosing ovarian torsion and determining the appropriate course of treatment.

7.

What Are the CT and MR Imaging Features of Adnexal Torsion?

CT and MR imaging features of adnexal torsion may include a twisted appearance of the affected ovary and fallopian tube, signs of reduced blood flow to the adnexal structures, and the presence of fluid around the twisted area. These imaging techniques help doctors diagnose adnexal torsion and plan appropriate treatment.

8.

What Is the Best Way to Diagnose Ovarian Torsion?

Ultrasound is often considered the best diagnostic tool for ovarian torsion, as it can detect changes in the ovary's size, shape, and blood flow, helping doctors confirm the diagnosis quickly and accurately.

9.

What Are the Ultrasound Findings in Ovarian Torsion?

The most common ultrasound finding in ovarian torsion is the whirlpool sign, which shows the twisted appearance of the ovarian blood vessels and the surrounding structures. This sign, along with the absence of blood flow or reduced blood flow to the ovary, helps doctors diagnose ovarian torsion accurately.

10.

What Does Adnexal Mass Show?

An adnexal mass indicates an abnormal growth or lump in the tissues near the uterus, often found in the ovaries or fallopian tubes. It requires further evaluation to determine its nature, which can range from benign cysts to more severe conditions like ovarian tumors.

11.

Can Ovarian Torsion Heal Itself?

Ovarian torsion usually requires medical intervention and cannot heal itself. Swift treatment, often involving surgery to untwist the affected ovary, is necessary to prevent complications and preserve ovarian function.

12.

What Are the Complications of Adnexal Torsion?

Complications of adnexal torsion can include reduced blood flow to the ovary and fallopian tube, leading to tissue damage, infertility, or in severe cases, the loss of the affected ovary. Prompt medical attention is crucial to minimize these complications and preserve reproductive health.

13.

What Occurs if Ovarian Torsion Is Left Untreated?

If ovarian torsion is not treated promptly, it can lead to the loss of the affected ovary due to lack of blood flow, causing tissue damage. It can result in severe pain, infection, and complications that may affect fertility. Proper medical intervention is needed to prevent these outcomes.

14.

What Is the Most Accurate Method to Diagnose Ovarian Torsion?

The most reliable way to diagnose ovarian torsion is through a combination of clinical evaluation, which includes assessing symptoms and physical examination, and imaging studies, especially ultrasound. Ultrasound can help visualize the blood flow to the ovaries and assess the condition accurately.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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