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Q. Can untreated ovarian torsion result in necrosis and internal bleeding?

Answered by
Dr. Sravanthi Nuthalapati
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 19, 2020 and last reviewed on: Apr 29, 2021

Hello doctor,

My wife was admitted to the emergency because of left side abdominal or flank pain. Found out she has a mass on her ovary that caused torsion on her left ovary. About less than a month ago, she had a mild heart attack and had two stents put in. They do not want to do surgery because of the high risk of death. They told her the options of risk or to lose the ovary. She went with losing an ovary, but the pain is excruciating even with pain medicines. I am concerned even if we wait for the ovary to become necrotic, she does not risk internal bleeding. Are there any other alternatives you may know of?

#

Hello,

Welcome to icliniq.com.

I totally understand your concern and distress. This situation of your wife is indeed very tricky and complicated too. I see you have not mentioned the age of your wife. If mentioned, it would be really helpful for me to gauge few things. As your doctors have said, I absolutely agree with that, and she had a heart attack with two stents insitu. She was definitely a very high-risk case for surgery and anesthesia. Chances were there that due to the anesthetic medications and fluctuations of vitals because of the drugs or even during the surgical procedure, your wife's life could have been in danger. It was a situation like high chances of the patient's possibility of dying on the operating table. But by giving conservative management by observation, we are expecting things to resolve on their own. I am taking a chance as you said there could be a possibility of necrosis of the torsed ovary and which can lead to internal bleeding, although chances are less as when the ovary gets torsion chances are that the blood would get clotted in the vessels supplying it because of being stagnant there. But however, the risk of infection of the necrosed ovary is high. But this can be treated with intravenous IV antibiotics. The aim is to surpass surgical management for your wife and take a chance for a conservative approach so that her life can be protected as there are high chances of death of taken for surgery which no one can guarantee if she will come out of the surgery safely with such a comorbid heart condition. Please share the scan reports of the ovarian cyst if possible. A follow-up scan might give an idea about the situation of the ovary if the previous ultrasound diagnosed with torsion ovary had been quite some days back.

Thank you doctor,

The age of my wife is 44 years. Kindly help us.

#

Hello,

Welcome back to icliniq.com.

Sure, I am there to help you.

Thank you doctor,

After the torsion, do you know how long it normally takes for an ovary to become necrotic?

#

Hello,

Welcome back to icliniq.com.

It may take up to one to two days for the tissue to become non-viable. But after the to get completely necrosed and digested and cleared by the body may take time. We are just expecting that to happen. If complications like infections happen, her life is again in danger. All in all, the situation is tricky with high risk.

Thank you doctor,

Wow, that is scary, and does the pain subside after the blood supply is cut from the ovary?

#

Hello,

Welcome back to icliniq.com.

Sometimes the torsions do undergo untwisting and may again recur, causing the pain to come and go. Many times only partial torsion or chronic torsion may happen. So it totally depends on what happens with the ovarian cyst. What was the size of the cyst, by the way?


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