When an ovary twists itself around the ligaments and tissues that hold it in its place, this is known as ovarian torsion or adnexal torsion. Sometimes, this involves structures other than ovaries like fallopian tubes and arteries, cutting off the blood supply to the ovary and causing severe discomfort and pain. This is a rare but emergency situation that requires prompt treatment.
- Risk factors
- Ovarian torsion after hysterectomy
- Ovarian torsion and assisted reproduction
- When to consult a doctor?
Symptoms of ovarian torsion
Ovarian torsion is a rare condition that causes severe pain and other symptoms like:
- Nausea and vomiting
- Severe tenderness and pain in pelvis
- Occasional cramps that last for several days and sometimes weeks as the ovary might keep on twisting and untwisting itself
- Pain on one side or both sides of pelvis radiating to your lower back or legs
- Abnormal vaginal bleeding
- Adnexal mass or pelvic mass
Causes of ovarian torsion
Adnexal or ovarian torsion occurs when the ovary twists itself around its supporting ligament called round ligament, causing the blockage in blood supply to the organ. This is a rare condition but some of the possible causes are given below:
- A longer round ligament than usual which is often found in premature girls
- The presence of a cyst on the ovary such as in polycystic ovarian syndrome can give it extra weight, displacing it and twisting it around the ligaments.
- Sometimes higher levels of hormones during pregnancy can also relax these ligaments, making them prone to twists, thus ovarian torsion during pregnancy is very common.
Some females are more likely to get ovarian torsion than others, some of these risk factors are:
- Women between the age of 25 to 45
- Those on any sort of fertility treatment
- Presence of any sort of mass, like a benign tumor, on the ovary
- Females who have had an adnexal surgery
- Laparoscopic hysterectomy
Complications of ovarian torsion
Adnexal torsion or ovarian torsion is an emergency condition that can cause several complications, the longer it takes to receive treatment. Some of these are:
- Ovarian necrosis
- In the case of oophorectomy, fertility is slightly compromised
- Stromal edema
- Infarction of other structures
- Infection, if it is left untreated for days
- Ovarian abscess or peritonitis
Ovarian torsion after hysterectomy
Approximately 8% of adnexal torsions are reported in females who underwent a laparoscopic hysterectomy. As the ovaries are much more mobile after laparoscopic surgery and very often oophoropexy is done to limit its movement and avoid any sort of twisting
Ovarian torsion and assisted reproduction
Females who are on any sort of assisted reproductive treatment are at higher risk of experiencing ovarian torsion due to increased levels of hormones. These hormones cause the ovaries to develop cysts and sometimes even enlarging the ovaries in size, displacing them and resulting in twists.
Management of ovarian torsion
Torsion results in blockage of blood supply to the organ and results in the death of the ovary thus should be diagnosed and treated as soon as possible.
Diagnosis of a torsed ovary is a little difficult as the presenting symptoms can be indicative of so many other possible conditions. However, upon presentation, the doctor will take a complete medical history looking for any sort of recent adnexal or ovarian masses followed by a physical examination. This is confirmed by a few tests after confirming the visual signs of ovarian torsion:
- A blood complete picture to look for infection
- Serum HCG to rule out pregnancy
- Ultrasound pelvis and abdomen to look for an abnormal mass
- A Doppler ultrasound to assess the blood flow to the ovary, size, and density of the ovarian mass
- An MRI can Demonstrate the components of the mass
- CT scan to rule out diverticulitis, appendicitis, and other similar conditions
- Definite diagnosis and reversal of torsion by direct visualization through a surgical procedure is recommended
Surgical treatment is the first-line treatment for ovarian torsion. However, medical treatment is also employed during follow-up visits and sometimes to reduce the severity of symptoms before carrying out the surgical procedure.
- The surgical approach is the only option to treat a torsion.
- Laparotomy or laparoscopy should be done as early as possible to reverse the torsion and preserve the function of the viable ovary
- In case of total occlusion of the artery and venous and lymphatic congestion, ovarian mass can become necrotic and should be removed to avoid the spread of infection. Oophorectomy and salpingo-oophorectomy and two procedures that can be done, depending upon the viability of organs
- Ovarian cystectomy is done to remove any sort of benign ovarian mass
- Post-surgical follow-ups include ultrasound to look for any signs of reversal
- Over-the-counter pain relievers like acetaminophen and naproxen are given to help relieve the pain before and after the surgery
- In case of severe pain, opioid analgesics are also recommended
- High-dose contraceptives are given up as follow up medication to decrease the chances of recurrence
When to consult a doctor?
If you experience cramping in your lower abdomen or pelvis that comes and goes, associated with some nausea and vomiting you should consult your doctor. The presence of fever signals an infection due to stasis of blood and should be seriously addressed.
What does ovarian torsion feel like?
Sudden onset of severe pain in pelvis accompanied by nausea and vomiting which is often preceded by fever if left untreated.
Why does ovarian torsion pain come and go?
The cramping often comes and goes because the ovary keeps on twisting and twisting repeatedly.
Is ovarian torsion life-threatening?
No, in case of delayed diagnosis this can affect fertility but if left untreated for weeks this can increased morbidity. Infection can spread to the whole body resulting in a state of toxicity that may become life-threatening.
Can ovarian torsion fix itself?
Yes, in intermittent torsion a torsed ovary can twist itself back into the place and resolve itself without any sort of treatment.