Editing Ovarian torsion


Complete/partial rotation of ovary on ligamentous supports, resulting in issues with blood supply - can lead to ischaemia

* Typically rotates around both suspensory ligament of ovary and utero-ovarian ligament
* Fallopian tube twists along with ovary - referred to as adnexal torsion

== Aetiologies ==
{| class="wikitable"
|'''Fetus/neonate'''
|-
|Ovarian cysts
|-
|'''Premenarchal girls'''
|-
|Ovarian cysts and neoplasms
|-
|Elongated utero-ovarian ligament
|-
|'''Premenopausal women'''
|-
|Ovarian cysts and neoplasms (includes ovarian hyperstimulation syndrome)
|-
|Pregnancy
|-
|'''Postmenopausal women'''
|-
|Ovarian cysts and neoplasms
|}

* 86-95% of patients with torsion have an ovarian mass
** Commonly functional cyst/corpus luteum, or benign neoplasm
* Most likely when ovary >5cm diameter
* More likely with benign lesions
* Most occur in women of reproductive age
* Increased risk during pregnancy (corpus luteum)
* Increased risk with ovulation induction (hyperstimulation syndrome)
* However can occur AT ALL AGES

== Presentation ==

* Acute onset pelvic pain
* Nausea +/- vomiting
* Commonly inciting event (vigorous activity/increased abdo pressure)
* Adnexal mass
* Fever and PV bleeding are uncommon

== Natural history ==

* No specific time duration predictive of ovarian necrosis, however in one case series, mean time from symptom onset to successful salvage was 87 hours, so it's probably not that urgent. (see UTD)
* Intermittent torsion is not a/w necrosis
* If peritonitis is present, probably more urgent to get to theatre, raises concern for necrosis

== Investigation ==

* USS - sensitivity 46-75%, but quite specific
** Rounded, enlarged, heterogenous appearance (oedema/engorgement/haemorrhage)
** Ovary may be located anterior to uterus rather than normal location lateral or posterior
** Multiple small follicles may be present
** Normal doppler flow does not exclude torsion (can be seen in up to 57% of patients with torsion) but if no flow if present, highly sensitive for torsion
* Hcg, fbe, uec
* Inflammatory markers generally normal

== Intra-op findings ==

* Gross visual inspection
** dark, enlarged ovary - likely vascular and lymphatic congestion - likely viable
** Necrosis - loss of normal antomical structure, gelatinous, poorly-defined structure

[[Category:O+G]]