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Emergency: requires immediate attention
Ovarian torsion
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Emergency: requires immediate attention

Ovarian torsion

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Contributors: Mitchell Linder MD
Other Resources UpToDate PubMed

Synopsis

Ovarian torsion is an acute condition that can be a true gynecologic emergency. It occurs when an ovary twists on the adjacent infundibulopelvic ligament, causing disruption of blood supply to the ovary and in effect creating a tourniquet. Torsion accounts for 2.7% of all gynecologic emergencies. It is more common in women 20-30 years of age, but it can occur at any age from early childhood (rare) to after menopause. Ovarian torsion more commonly occurs on the right side.

Patients present in various manners, making this a challenge to diagnose in an emergency setting. The most classic presentation is a sudden onset of sharp / stabbing pain in either the right or left lower quadrant that only lasts a few seconds to a few minutes and then resolves to a dull ache, only to recur at various intervals with sharp / stabbing pains for a short amount of time. This presentation is associated more with partial or intermittent torsion. Patients also commonly present with a gradual onset of more colicky, unimpressive-type pain. Often patients will also complain of nausea / vomiting when pain occurs.  

Abdominal exam may reveal positive rebound and guarding or may be more benign if the ovary is not acutely torsed at time of exam.

Risk factors include ovarian cyst with size greater than 4-6 cm or with solid components, history of prior torsion, pregnancy, and history of pelvic surgery. Patients may not have had a history of ovarian cysts prior.

Codes

ICD10CM:
N83.519 – Torsion of ovary and ovarian pedicle, unspecified side

SNOMEDCT:
13595002 – Torsion of ovary

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Ectopic pregnancy – persistent pain, positive blood human chorionic gonadotropin (hCG) test, missed menses, other pregnancy-related symptoms (nausea, breast tenderness, fatigue)
  • Appendicitis – pain usually not intermittent, other pertinent clinical history
  • Ruptured ovarian cyst – usually pain is progressively worse over time, not intermittent; pain relieved with meds
  • Bowel issues – suspected based on clinical history
  • Kidney stone – pain usually not intermittent, blood on urine dip
  • Pelvic inflammatory disease – will often have pain with intercourse, vaginal discharge, other complaints

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 04/11/2017
Last Updated: 05/30/2017
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Emergency: requires immediate attention
Ovarian torsion
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Ovarian torsion (Adult Presentation) : Nausea, Vomiting, Leukocytosis, Pelvic pain, Unilateral, Pelvic mass, Low grade fever
Imaging Studies image of Ovarian torsion
Ultrasound image demonstrates enlarged, heterogeneous left ovary with peripheralized follicles and absence of flow. Findings consistent with clinical diagnosis of ovarian torsion.
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