Ovarian torsion (adnexal torsion) is a medical emergency. It occurs when the ovary or ligaments that support the ovaries and fallopian tubes twist, cutting off the blood supply to your ovary, fallopian tube, or both.e60dc2a1-f33c-4a05-9b50-8e3e8e59762918fdf932-d3f3-42c2-afbf-decd1b9f298a Ovarian torsion, in itself, is not life-threatening. It can only be treated with surgery, and treatment should be prompt to prevent complications, such as the loss of an ovary or fallopian tube.e60dc2a1-f33c-4a05-9b50-8e3e8e597629046248a8-19bc-44cc-863e-bd30b48f7b81
Types Types of Ovarian Torsion
Ovarian torsion can be of two main types:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c1e0003d-0aea-4a54-baa4-31e9653dc45d Adnexal torsion: This is the most common type of torsion (twisting of an organ or body part). Here, both the ovary and the fallopian tube twist on their ligaments. The terms ovarian torsion and adnexal torsion are often used interchangeably. Isolated torsion: Only one organ — either the ovary or the fallopian tube, but not both — twists. Isolated torsion can affect the ovary or the fallopian tube.
Signs and Symptoms of Ovarian Torsion Symptoms Most commonly, someone with ovarian torsion will experience:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ae7c5297-e343-40a6-8872-c80e417c5ce5 Pain or tenderness in the lower part of the stomach or the pelvic area Nausea Vomiting A mass in the pelvic area Less common symptoms may include: Fever Vaginal bleeding Vaginal discharge
Causes and Risk Factors of Ovarian Torsion Causes The most common cause of ovarian torsion is having a mass on your ovary that is 5 centimeters (cm) or larger. This is because the weight that a larger mass puts on the ovary and surrounding ligaments increases the risk that the ovary will twist on itself. These ovarian masses can be cysts or (usually noncancerous) tumors.e60dc2a1-f33c-4a05-9b50-8e3e8e59762932246c9a-3c54-4a25-9f1e-204a58dc1a9d Other factors that raise the risk of ovarian torsion include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762927f74181-a56d-40c8-a9dd-3db324736e44 Being a woman of reproductive age Going through fertility treatment Being pregnant
How Is Ovarian Torsion Diagnosed? Diagnosis To diagnose ovarian torsion, your gynecologist will likely perform a variety of tests, including the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629d12abb05-bc37-42ed-a98d-ed426d16ecba Pelvic Exam Your doctor will check for any masses, discharge, tenderness, or other symptoms in your pelvic area. Ultrasound Your gynecologist will likely carry out both a pelvic and transvaginal ultrasound . An ultrasound helps detect ovarian torsion in approximately 84 percent of cases. Surgery The only way to definitively diagnose ovarian torsion is through surgery. This is because an ovary may be torsed (twisted) at one point in time, but not at the time of the ultrasound. Alternatively, the ovary may not have complete blood flow cut off, due to their dual blood supply source. Blood Tests Your doctor will also likely order some bloodwork as part of your consultation, such as a complete blood count, a complete metabolic panel, and a serum hCG, which measures levels of your hCG hormone and determines if you’re pregnant Imaging Tests An MRI or CT scan are not usually done for ovarian torsion, but your doctor may recommend them to rule out other abdominal issues, such as appendicitis , ruptured ovarian cyst, ectopic pregnancy (pregnancy outside of the uterus), kidney infection (pyelonephritis), diverticulitis , and pelvic inflammatory disease (PID) — all of which have some symptoms in common with ovarian torsion.
Treatment and Medication Options for Ovarian Torsion Treatment The only way to treat ovarian torsion is through surgery. The surgery is called “detorsion,” or untwisting of the ovary, and it’s usually done by a gynecologist.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6a0a36a-d566-47a6-bb39-597df4dcdd73 Detorsion Surgery The types of surgery that doctors usually perform for ovarian torsion are:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ef048228-2573-436c-9b26-657cea322e6a Laparoscopy In laparoscopy , the surgeon makes a few small incisions and uses a thin tube with a camera on it to visualize the area of concern, perform the untwisting, and, if necessary, remove the cyst or mass that caused the torsion. This is a minimally invasive procedure and the most common way to treat ovarian torsion. You can usually go home the same day after a laparoscopy. Open Surgery Your surgeon will make a larger incision in your stomach to perform the necessary procedures. This surgery usually requires an overnight stay in the hospital.
Medication Options Ovarian torsion cannot be treated with medication. But depending on your unique circumstances, your doctor may prescribe medication if you’re in severe pain from the torsion or after surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0c2721f-a3f1-42be-8247-e7648cda13a2 Possible medications include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0c2721f-a3f1-42be-8247-e7648cda13a2 Pain relievers, such as acetaminophen (Tylenol), or NSAIDs , such as ibuprofen (Motrin, Advil), to relieve pain before or after surgery Narcotics such as codeine or morphine , if you’re in severe pain Laxatives to counter the side effects of narcotic drugs, such as constipation
Prevention of Ovarian Torsion Prevention If you know you have some risk factors for torsion, such as a history of hormonal or fertility treatments, keep your regular scans and appointments to make sure your ovaries don’t have enlarged follicles or cysts, which can raise the risk of torsion.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295323fb77-5d25-4e31-aa8f-1bf3ce46dd77 Once ovarian torsion has been surgically treated, it doesn’t usually come back.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293d627028-a6d0-45cd-9809-9acd3047b7c7 But to prevent the torsion from returning in some patients, such as postmenopausal women or people who have had a cancerous tumor in their ovary, doctors may recommend removing the affected ovary and fallopian tube (a procedure called salpingo-oophorectomy).e60dc2a1-f33c-4a05-9b50-8e3e8e597629fc3c4fb8-d6f8-4794-ab07-9d054836d462
Ovarian Torsion Outlook Prognosis and Outlook The best results from surgery are seen in people who’ve seen a medical professional as quickly as possible after developing symptoms. Most women (over 90 percent) recover fully with surgery, especially if the condition is diagnosed promptly.e60dc2a1-f33c-4a05-9b50-8e3e8e59762926313f1c-953a-4f51-a247-752e2000fa2f Surgeons are also able to salvage the ovary or fallopian tube affected in the vast majority of cases, especially with quick and timely intervention.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291021391b-a8e3-486a-b454-ea3d1fb520b2 Once it’s been surgically treated, ovarian torsion doesn’t usually happen again.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291021391b-a8e3-486a-b454-ea3d1fb520b2
Complications of Ovarian Torsion Complications If treatment is delayed, possible complications from ovarian torsion include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762997bae95b-6fda-41a2-ae6f-6eb9a9ee0138 Hemorrhage (excessive bleeding) Peritonitis (inflammation or infection of the abdominal cavity)e60dc2a1-f33c-4a05-9b50-8e3e8e597629b62ef848-e972-4adc-aa7e-07abd895b4f9 Losing the ovary The need to surgically remove both the fallopian tube and the ovary Impaired fertility or infertility Scar tissue in the pelvic area (called adhesions), which may affect fertility Atrophied ovaries (when ovaries become smaller and reduce in weight), which may affect fertility It’s important to remember that the vast majority of people affected recover fully with treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629574597fa-9c88-45c7-9e48-84f63cdf0828
Research and Statistics: Who Has Ovarian Torsion? Research and Statistics Ovarian torsion can affect any person with ovaries, but it occurs most often in women of reproductive age. It can also happen in children and teens, with about 20 percent of cases occurring in girls before they’ve had their first menstruation.e60dc2a1-f33c-4a05-9b50-8e3e8e59762968251bdc-5c63-4252-a93e-6cb7b1b971ed
Conditions Related to Ovarian Torsion Related Conditions Conditions related to ovarian torsion include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629fdca3c7e-0818-4ab9-8ff3-5d86cab9b504e60dc2a1-f33c-4a05-9b50-8e3e8e59762970d73b62-4cd4-4aac-9c95-06f414d2b5d4 Ovarian cysts Ovarian cancer Ovarian necrosis Benign teratoma (a type of noncancerous tumor)
The Takeaway Ovarian torsion is a twisting of the ovary, the fallopian tube, or both. It is a medical emergency that can only be treated with surgery. If left untreated, ovarian torsion can lead to complications such as infertility or loss of the ovary. Surgery is usually done laparoscopically and is therefore minimally invasive, and you typically go home the same day. The vast majority of people recover fully from ovarian torsion, especially if they receive treatment promptly.
Resources We Trust Cleveland Clinic: Ovary PainAmerican Pediatric Surgical Association: Ovarian TorsionNationwide Children’s Hospital: Ovarian Torsion: What Parents Need to KnowSaint Luke’s Health System Kansas City: Understanding Laparoscopic Surgery for Ovarian TorsionNHS Leeds Teaching Hospitals: Laparoscopic Ovarian Cystectomy (Keyhole Surgery to Remove an Ovarian Cyst)
