Approach Considerations

In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy are critical, regardless of whether laboratory and radiologic studies yield normal results.

Approximately 1 in 1800 pregnancies are complicated by adnexal torsion, typically between the sixth and fourteenth weeks of gestation. This increased frequency in pregnant women is likely due to greater laxity of the tissues adjoining the ovaries and oviducts during pregnancy, as well as to 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 fetal well-being. However, if the corpus luteum cyst is removed during salpingo-oophorectomy, supplemental progesterone is indicated. Management of ovarian torsion is dependent on various factors. Oophorectomy can have significant implications for fertility and general health, thus requiring careful consideration.^[44]

Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and either operated on or observed by a gynecologist. Laparoscopy can be used for both confirmation of the diagnosis and treatment. A retrospective analysis revealed that single-incision laparoscopic surgery appears to be as feasible, effective, and safe as conventional laparoscopy for treatment of patients with ovarian torsion.^[45]

Ovarian torsion is a gynecologic emergency that may lead to ovarian necrosis, infection, and peritonitis. Early recognition is essential in preserving the ovary, particularly for patients with future fertility aspirations. Currently, no consensus has been reached regarding the time period of ovarian viability after onset of symptoms. Awareness of this condition among community members and healthcare professionals is crucial. Routine investigations should not delay management, as positive Doppler flow on ultrasonography does not exclude a diagnosis of ovarian torsion.^[46]

Guidelines

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Media Gallery

Video depicts 2 findings: (1) enlarged hypovascular left ovary and (2) flow in healthy right ovary. Small amount of intraperitoneal fluid surrounds left ovary.

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Author

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

Arthur C Fleischer, MD Professor, Chief of Ultrasound Imaging, Cornelius Vanderbilt Chair, Departments of Radiology and Obstetrics and Gynecology, Vanderbilt University Medical Center

Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Society of Radiologists in Ultrasound

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Acknowledgements

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