Surgical exploration is a necessary firstline management tool among patients with hemodynamic instability or evidence of an acute abdomen that suggests possible ovarian torsion or cyst rupturehemorrhage, with intravenous fluid resuscitation. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas. Jaspan, do facoog chairman the department of obstetrics and gynecology the einstein health care network, philadelphia, pa. Ovarian torsion figures 1267 and 1268 should be strongly considered in any patient with acute onset of lower abdominal pain, particularly when it is severe and accompanied by other signs and symptoms, such as diaphoresis or vomiting. A health problem that involves ovarian cysts is polycystic ovary syndrome pcos. Flow does not exclude ovarian torsion, but can indicate ovarian viability. Antenatally detected ovarian cystsa therapeutic dilemma. Within the cyst was a daughter cyst, without significant bloodflow fig. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. Clinical characteristics of ovarian torsion and highrisk factor.
A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy ie, corpus luteum cyst should increase your suspicion for torsion. The incidence of ovarian torsion ranges from 2% to 5% in patients who have surgical treatment for adnexal masses. It is basically a sac inside the ovary filled with fluids. Ovarian torsion refers to the complete or partial rotation of the ovary vascular pedicle, which in turn impedes the ovarian blood supply. Management of suspected ovarian masses in premenopausal women this is the first edition of this guideline. One ovary is located on each side of the uterus in the abdomen picture 1. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. The size of the mass is positively correlated with the risk of ovarian torsion. Borderline endometrioid cystic fibroma of the ovary. Symptoms typically include pelvic pain on one side. Introduction torsion of the ovary, tube or both is responsible for between. Pearls and pitfalls in diagnosis of ovarian torsion.
Objectives after participating in this conference, you should have an increased knowledge of, and be more competent to. Ovarian torsion ot is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Ovarian torsion adnexal torsion diagnosis and treatment. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. It is held in place by strong tissue or skin called a ligament. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. You may not be aware that you have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form. This patient has previously presented twice with right sided ovarian torsion with the background of polycystic ovaries in the last two consecutive years. Ovarian cyst and torsion an ovarian cyst oh vair ee uh n sist is a fluid filled sac in or on the surface of an ovary. Most ovarian cysts are small and dont cause any problems. Ovarian torsion definition of ovarian torsion by medical. However, a nonspecific clinical presentation in conjunction with a highly variable imaging appearance makes the diagnosis of ovarian torsion challenging. Torsion of ovarian masses is quite common and isolated torsion of the. Ovarian torsion ucsf emergency medicine ultrasound.
Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. Ovarian torsion almost always associated with a cyst. Emergency management and conservative surgery of ovarian torsion in children. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. Ovarian cysts are the most frequent type of neonatal abdominal tumours with an estimated incidence of more than 30%. Fever is uncommon, and usually lowgrade if present. Pelvic ultrasonography can provide information on ovarian cysts. Pdf adnexal torsion accounts for 3% of all gynaecologic emergencies. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. Given the history of intermittent abdominal pain and the imaging.
Thus, it warrants immediate attention and decision to intervene is taken when there is. Pdf adnexal torsionsymptoms, diagnosis and management. In contrast to adnexal torsion in adults, adnexal torsion in pediatric and adolescent females involves an ovary without an associated mass or cyst. In contrast to adnexal torsion in adults, adnexal torsion in pediatric and adolescent females involves an ovary without an associated mass or cyst in as many as 46. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on ct or mri. Ovarian torsion society for academic emergency medicine. The most common adnexal mass associated with ovarian torsion is an ovarian dermoid cyst. Physical examination may reveal lower abdominal tenderness. Ovarian torsion is more commonly seen in cysts that are 5 cm or greater. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ.
Defined as the abnormal twisting of the involved ovary on its ligamentous support. This may result in loss of blood supply to both the ovary and the fallopian tube. This may result in vomiting or feeling faint most ovarian cysts are related to ovulation, being. Ovarian tumour or cyst can be easily removed till 28 wks of gestation thereafter it is not readily accessible and may precipitate preterm labour. Ovarian torsion is frequently associated with an ipsilateral ovarian mass 50 to 81%, which may act as fulcrum to potentiate torsion of adnexa due to increased ovarian volume or.
Ovarian torsion is a common urgent gynecologic condition seen in women of all ages and typically presents. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign. Clinical symptoms have not shown to be reliable in the prediction of ovarian malignancy, although increased. Ovarian cyst with torsion presenting as a wandering mass in a newborn.
Always consider torsion when evaluating a female patient with abdominal pain, back pain, or flank pain. Torsion commonly associated with ovarian cysts, which can act as a catalyst to the torsion process. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. Draining the cyst without removing the cyst wall should be avoided because this may increase the incidence of recurrence. Casecontrol study comparing the sensitivity and specificity of. Ovarian cysts polycystic ovary syndrome medlineplus. While us is a great first initial test for the evaluation of both ovarian torsion, do not be reassured by normal dopplers. The median ages of group 1 and 2 were and 14 years. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable. Complications may include infection, bleeding, or infertility risk factors include ovarian cysts, ovarian. The larger the cyst, the more likely that ovarian torsion will occur. Abdominal pain, ovarian cyst, ovarian torsion, pelvic pain. Ovarian cyst which ruptures, or undergoes torsion or if it shows evidence of malignancy, requires immediate surgery, irrespective of the period of gestation.
Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Pearls and pitfalls in diagnosis of ovarian torsion rsna. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release. Ovarian torsion is another rare complication of ovarian cysts. Description ovarian torsion occurs infrequently only in females.
Request pdf torsion of paraovarian cyst torsion of uterine adnexa is an important cause of acute abdominal pain. In can occur in women of all ages, but most women that experience this are younger. This twisting can cut off blood flow to the ovary and fallopian tube. When there are symptoms, you might have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. Spectrum of imaging findings1 the accurate diagnosis of ovarian torsion is imperative, as loss of the ovary can have longterm consequences in terms of fertility. The most important risk factor for ovarian torsion is ovarian mass. Ovarian torsion and necrosis are followed by intracystic hemorrhage. An ovarian cyst is a fluidfilled sac within the ovary. Ultrasound is the preferred diagnostic test, but as we. The fallopian tube often twists along with the ovary. Torsion of malignant ovarian masses in this population is rare.
Imaging features of ovarian torsion on ct and mri are then pre sented with illustrative case examples. The follicular ovarian cyst is the most common kind of ovarian cyst. Women with pcos can have high levels of male hormones. While classically the pain is sudden in onset, this is not always the case. Ovarian cysts can be physiologic or malignant and are known to occur in children of all ages.
Clinical data of 95 patients with ovarian torsion were analyzed, of which. It consists of spectrum of pathologies including ovarian torsion. Laparoscopic surgery with detorsion is the preferred treatment to preserve normal ovarian function and fertility. A 31yearold nulliparous patient presents with a threeday history of right sided colicky abdominal pain and associated nausea. Ovarian torsion should be suspected for patients who present with a sudden onset of severe abdominal pain, fever, nausea, and vomiting 10. A missed diagnosis of ovarian torsion in a patient with. The clinical presentation of adnexal torsion, like other pathologies, is with acute onset of pelvic pain but can be nonspecific, frequently presenting diagnostic. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. Ovarian cysts are common in women with regular periods. Ovarian torsion is commonly seen in women of reproductive age but can occur in other age groups as well. The presence of an internal daughter cyst was confirmed fig. If a cyst bursts or causes bleeding, you should get medical help right away.
The twisting, or torsion, of the ovary around its ligamentous supports. Management of suspected ovarian masses in premenopausal. Eight girls group 1 had ovarian torsion in a normal ovary, and twentyone girls group 2 had ovarian torsion including a mass or cyst. Due to previous history, there was a high index of clinical suspicion that this may be a. If torsion is concurrent with an ovarian cyst, cystectomy is appropriate. Sonographic diagnosis of ovarian torsion ucsf emergency. This is when a large cyst causes an ovary to twist or move from its original position. Purpose and scope this guideline has been produced to provide information, based on clinical evidence, to assist clinicians with the initial assessment and appropriate management of suspected ovarian masses in the premenopausal woman. Ultrasonography us is the primary imaging modality for. An update on the diagnosis and management of ovarian torsion.
Ovarian torsion can be suggested when ultrasound examination detects changes in the size and characteristic of cysts, resulting in the reclassification of simple cysts as complex cysts. Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2011. Commonly physiologic due to maternal hormones and resolve spontaneously. Uptodate, electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine, allergy and immunology, cardiovascular medicine, emergency medicine, endocrinology and diabetes, family medicine, gastroenterology and hepatology, hematology, infectious diseases, nephrology and. Understanding the imaging appearance of ovarian torsion will. Diagnosis of ovarian torsion with color doppler sonography. In fact, most women make at least one follicle or corpus luteum cyst every month. Ovarian torsion symptoms, diagnosis and treatment bmj. B infertility as with endometriotic cyst, polycystic ovarian syndrome. Ovarian cysts treatment algorithm bmj best practice. Ovarian torsion rarely presents with classic symptoms.
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