Ovarian torsion is a rare but serious condition that demands prompt medical attention. The twisting of an ovary, along with the fallopian tube, restricts the blood supply and can result in severe damage if not treated quickly.

In this comprehensive guide, we’ll walk through the symptoms, causes, diagnosis, and emergency treatment options for ovarian torsion, along with insights into ovarian torsion surgery. If you or someone you know may be at risk, understanding these details could make all the difference in seeking timely care.

Symptoms of Ovarian Torsion

The symptoms of ovarian torsion can vary but typically begin with acute, sudden abdominal pain. Early recognition of these symptoms is crucial for a positive outcome.

Common symptoms include:

• Sharp, severe pelvic or abdominal pain: Often localised to one side of the abdomen, the pain can vary from mild to excruciating and may increase in intensity over time.
• Nausea and vomiting: Many patients report feeling nauseous or experiencing vomiting alongside pain.
• Low-grade fever: While not as common, some patients develop a low fever as a reaction to the torsion.
• Irregular or absent periods: In certain cases, ovarian torsion may disrupt menstrual cycles.
• Radiating pain: Pain can sometimes radiate to the lower back or thigh, adding to the discomfort.
• Frequent urination or bowel discomfort: The proximity of the ovaries to other organs may lead to bladder and bowel irritation.

The pain often worsens during physical activity or sudden movements, as these may aggravate the twisted ovary.

Causes of Ovarian Torsion

Ovarian torsion is more common in women of reproductive age but can occur at any age. Understanding the primary causes of ovarian torsion can help in identifying high-risk individuals.

Common causes of ovarian torsion include:

• Ovarian cysts: Cysts can add weight or change the shape of the ovary, increasing the likelihood of twisting.
• Hormonal stimulation: Fertility treatments, such as those using hormone injections to stimulate ovulation, can result in larger-than-normal ovaries, which increases the risk.
• Pregnancy: Pregnant women are at higher risk due to hormonal changes and enlargement of the ovaries.
• Ovarian enlargement: Conditions such as polycystic ovarian syndrome (PCOS) can lead to enlarged ovaries, raising torsion risk.
• Previous surgeries: Surgical history in the pelvic area can sometimes increase the risk of torsion.
• Anatomical abnormalities: Certain structural issues, such as longer fallopian tubes, can make the ovaries more prone to twisting.

Diagnosis of Ovarian Torsion

Diagnosing ovarian torsion is challenging due to its similarity to other causes of acute abdominal pain, such as appendicitis, kidney stones, or a ruptured ovarian cyst. An accurate diagnosis is crucial because ovarian torsion requires prompt treatment to prevent permanent damage to the ovary. Below is a detailed overview of diagnostic methods for ovarian torsion:

Patient History and Symptom Evaluation

The physician will take a detailed history, including any prior episodes of abdominal pain, history of ovarian cysts, or recent fertility treatments, as these factors increase torsion risk. Symptoms such as sudden, sharp pelvic pain, nausea, vomiting, and fever provide initial indicators. Pain typically worsens with movement and may be localised to one side of the abdomen.

Physical Examination

The physician examines for areas of tenderness, especially one-sided pain in the lower abdomen. A pelvic exam may reveal a tender, enlarged ovary or mass, though it’s often challenging to detect.

Imaging Techniques

Imaging is essential to confirm ovarian torsion, as physical exams alone are often inconclusive.

• Pelvic Ultrasound (Transvaginal or Transabdominal):
  • The most commonly used imaging test, a transvaginal ultrasound allows detailed views of the ovary and surrounding structures.
  • An enlarged or displaced ovary is often visible, as torsion can cause swelling due to restricted blood flow.
  • An ultrasound can help identify cysts or masses that may be causing torsion.
• Doppler Ultrasound:
  • A Doppler ultrasound can assess blood flow to the ovary.
  • Doppler imaging helps determine if the blood supply to the ovary is compromised, which is a strong indicator of torsion. However, normal blood flow does not completely rule out torsion, as intermittent blood flow can sometimes be present.
• CT scan or MRI (in Some Cases):
  • If an ultrasound is inconclusive or if a more detailed image is needed, a CT scan or MRI may be used.
  • MRIs, in particular, can provide detailed soft tissue images to confirm the presence of ovarian torsion, ovarian cysts, or other abnormalities.
  • CT scans and MRIs can help rule out appendicitis, bowel obstruction, or other conditions with similar symptoms.

Laboratory Tests

Although there aren’t specific laboratory tests for diagnosing ovarian torsion, they may aid in ruling out other conditions.

• Blood work can reveal elevated white blood cell counts, indicating an inflammatory or infectious process, although it is not specific to torsion.
• A urine test can help rule out urinary tract infections or kidney stones, which may present with similar symptoms.
• In reproductive-age women, a pregnancy test is essential, as an ectopic pregnancy could cause similar symptoms and require different treatment.

Laparoscopy (Definitive Diagnosis)

In cases where imaging and tests remain inconclusive, or if torsion is strongly suspected, a diagnostic laparoscopy may be performed.

• Laparoscopy is a minimally invasive surgery that involves inserting a thin, lighted camera into the abdomen, allowing the physician to directly visualize the ovary and confirm torsion.
• If torsion is confirmed during laparoscopy, the surgeon can proceed to untwist the ovary (detorsion) and, if necessary, remove any cysts or masses.

Challenges in Diagnosis

Ovarian torsion diagnosis can be challenging for several reasons:

• Blood flow can fluctuate, which may show normal blood flow during imaging, leading to missed diagnoses.
• Torsion symptoms overlap with other gynaecological and gastrointestinal conditions, complicating the clinical picture.
• The ovary can lose function within hours if torsion persists, so rapid diagnosis and treatment are crucial to preserving ovarian function.

Emergency Treatment of Ovarian Torsion

Once ovarian torsion is suspected, emergency treatment is necessary to prevent permanent damage. The goal is to restore blood flow to the ovary and relieve the twisting. Here’s a look at the standard emergency response protocol:

• Hospital Admission: The patient is typically admitted to the emergency room, where medical professionals assess the symptoms and begin preparing for possible surgery.
• Stabilisation and Pain Management: Pain control is essential, as ovarian torsion is extremely painful. Initial treatments may involve intravenous (IV) pain relief.
• Pre-operative Evaluation: After a confirmed diagnosis, the patient is prepared for surgery to untwist the ovary and prevent further complications.

Ovarian Torsion Surgery

Surgical intervention is often the only definitive way to treat ovarian torsion. Ovarian torsion surgery, also known as laparoscopic detorsion, focuses on untwisting the ovary to restore blood flow and prevent tissue death.

Two primary methods are used in ovarian torsion surgery:

• Laparoscopy (Minimally Invasive): Most cases are treated with laparoscopy, a minimally invasive surgery that uses a thin, flexible tube with a camera to view the ovary. Through small incisions, the surgeon untwists the ovary and, if necessary, removes any cyst or tissue obstructing blood flow.
• Laparotomy (Open Surgery): In more complicated cases, or if there is a large ovarian mass or significant inflammation, a laparotomy (open abdominal surgery) may be performed. This involves a larger incision, allowing direct access to the ovary.

If the ovary shows signs of irreversible damage, the surgeon may perform an oophorectomy, the surgical removal of the affected ovary, to prevent complications. This decision is made only when there is no chance of salvaging the ovary due to tissue death.

Recovery and Post-Surgery Care

Recovery time for ovarian torsion surgery depends on the severity of the condition and the type of surgery performed. Here’s what to expect in the post-surgery phase:

• Hospital Stay: After a laparoscopic procedure, patients typically stay in the hospital for a day or two. Open surgery may require a longer hospital stay.
• Pain Management: Post-operative pain is common and can be managed with prescribed pain relievers.
• Activity Restrictions: Patients are usually advised to avoid heavy lifting and strenuous activity for several weeks to ensure proper healing.
• Follow-up Appointments: Regular follow-up appointments with the healthcare provider are necessary to monitor recovery and prevent complications.
• Fertility Considerations: Ovarian torsion surgery may affect fertility depending on the extent of damage. If the ovary is preserved, fertility can often be maintained.

Most patients experience a full recovery with timely treatment. However, if one ovary is removed, the remaining ovary usually compensates in hormone production and ovulation, though fertility can still be impacted.

Preventative Tips and Risk Management

Preventing ovarian torsion may not always be possible, especially in individuals with underlying health conditions or anatomical predispositions. However, certain measures can help lower the risk:

Awareness of Risk Factors

Regular monitoring and management of ovarian cysts or tumours through ultrasound can help identify any changes that may increase the risk of torsion. Women with PCOS should be aware of their condition and consult with healthcare providers to manage symptoms and reduce complications. If undergoing fertility treatments or hormone therapies, discuss with your doctor the potential for ovarian enlargement and the associated risk of torsion.

Regular Medical Check-Ups

Regular pelvic exams and consultations with a gynaecologist can help detect abnormalities early. Women with known ovarian issues should schedule more frequent check-ups. If you have a history of ovarian cysts or other relevant conditions, follow your doctor’s recommendations for regular ultrasounds to monitor the size and condition of the ovaries.

Early Intervention

Educate yourself about the symptoms of ovarian torsion (e.g., sudden severe pelvic pain, nausea, and vomiting) to seek immediate medical attention if they occur. Addressing ovarian cysts through medical management or surgical options can reduce the risk of torsion. If a cyst is identified as particularly large or symptomatic, discuss treatment options with your healthcare provider.

Lifestyle Modifications

While exercise is essential for overall health, high-impact sports or activities that involve rapid movements or twisting motions may increase the risk of torsion, especially in women with enlarged ovaries. Engaging in exercises that strengthen core muscles may help improve stability and reduce the risk of torsion during physical activity.

Education and Communication

Share information about ovarian torsion symptoms with family members and friends, so they can recognise warning signs and encourage you to seek medical attention if needed. Maintain open communication with your gynaecologist or healthcare team about any changes in your menstrual cycle, pelvic pain, or concerns related to ovarian health.

A Final Word

Ovarian torsion is a medical emergency that requires immediate attention to prevent long-term complications. Recognising the symptoms, understanding the causes, and knowing the options for ovarian torsion treatment can empower individuals to take quick action in potentially life-altering situations. Laparoscopic detorsion and other ovarian torsion surgery options allow doctors to untwist the ovary and, in many cases, preserve fertility and ovarian function.

For those with a high risk of ovarian torsion, regular checkups and early intervention are crucial. By staying informed and proactive, you can better navigate the complexities of ovarian health and take steps to protect your well-being.

Sources:

• https://www.healthline.com/health/womens-health/ovarian-torsion
• https://www.webmd.com/women/what-to-know-ovarian-torsion
• https://my.clevelandclinic.org/health/diseases/ovarian-torsion
• https://www.verywellhealth.com/ovarian-torsion
• https://www.healthgrades.com/right-care/womens-health/ovarian-torsion