eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Ovarian Torsion: Follow-up

Author: Erik D Schraga, MD, Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates
Coauthor(s): Michelle Blanda, MD,, Chair, Department of Emergency Medicine, Summa Health System Akron City/St. Thomas Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
Contributor Information and Disclosures

Updated: Feb 18, 2010

Follow-up

Further Outpatient Care

Outpatient care has no role in the treatment of ovarian torsion. Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and either operated on or observed by a gynecologist.

Complications

  • Infection
  • Peritonitis
  • Sepsis
  • Adhesions
  • Chronic pain
  • Infertility (rare)

Prognosis

  • The prognosis of ovarian torsion is excellent with early diagnosis and appropriate treatment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider adnexal torsion in the differential diagnosis is not uncommon given its relative infrequency. Consideration is particularly imperative in a patient with known risk factors for the disease, such as ovarian mass, prior pelvic surgery, or pregnancy.
  • Normal Doppler imaging must not be used as basis for exclusion of the diagnosis.
  • In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy is critical regardless of normal laboratory and radiologic studies.

Special Concerns

  • Pregnancy
    • Approximately 1 in 1800 pregnancies is complicated by adnexal torsion, typically between the sixth and fourteenth weeks of gestation. This increased frequency is likely due to greater laxity of the tissues adjoining the ovaries and oviducts during pregnancy as well as enlargement of the ovary in early pregnancy secondary to the corpus luteum cyst.
    • Detorsion of the adnexa during pregnancy has not been found to compromise to fetal well-being. However, if the corpus luteum cyst is removed during salpingo-oophorectomy, supplemental progesterone is indicated.
  • Postmenopausal women
    • As with other causes of abdominal pain, patients of advanced age are increasingly prone to unusual presentations of ovarian torsion.
    • Adnexal torsion is not limited to women of reproductive age.7 Ovarian tumors of both benign and malignant nature are common in postmenopausal women and may result in torsion.
  • Children and adolescents: Greater than 50% of patients with torsion in this age group have normal-sized ovaries. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought.
 


More on Ovarian Torsion

Overview: Ovarian Torsion
Differential Diagnoses & Workup: Ovarian Torsion
Treatment & Medication: Ovarian Torsion
Follow-up: Ovarian Torsion
References
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References

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Further Reading

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Keywords

adnexal torsion, ovarian torsion treatment, ovarian torsion symptoms, ovarian torsion diagnosis, acute pelvic pain, abdominal pain, ovarian torsion, lower abdominal pain in women, enlarged ovary, ovarian tumor, dermoid tumor, ovarian cyst

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Contributor Information and Disclosures

Author

Erik D Schraga, MD, Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates
Disclosure: Nothing to disclose.

Coauthor(s)

Michelle Blanda, MD,, Chair, Department of Emergency Medicine, Summa Health System Akron City/St. Thomas Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
Michelle Blanda, MD, is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerome FX Naradzay, MD, FACEP, Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina
Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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