ovarian torsion

(adnexal torsion)

A condition in which an ovary becomes twisted around the tissues that support it (ovarian ligament and suspensory ligament of ovary). Sometimes, the fallopian tube may also become twisted.
It mainly occurs on one side and only once.

This can cut off blood supply to these organs. Prolonged reduction in blood flow can lead to necrosis.
The longer the condition goes untreated, the more likely to experience complications.
It is a medical emergency. If not treated quickly, it can result in loss of an ovary.

With prompt treatment, it does not compromise the ability to conceive.
Having a single ovary typically does not directly affect the chances of conceiving. However, underlying causes such as endometriosis and ovarian cysts can.

(Symptoms)
• severe, sudden pain in the lower abdomen (pelvic region)
• cramping
• nausea, vomiting

(Causes)
• Sudden increase in ovarian volume due to cysts or masses.
• Excessive mobilization due to a long mesosalpinx.

(Risk factors)
• ovarian cysts: Fluid-filled sacs or pockets in an ovary or on its surface.
• polycystic ovarian syndrome: A condition in which ovaries produce an abnormal amount of androgens. Numerous small fluid-filled sacs form in the ovaries.
• long ovarian ligament, which is the fibrous stalk that connects the ovary to the uterus
• tubal ligation: Getting fallopian tubes tied off for sterilization. It prevents an egg from traveling from an ovary through the fallopian tube to the uterus. It is a surgical procedure to prevent pregnancy.
• pregnancy
• hormonal treatments (e.g. infertility), which can stimulate the ovary

(Diagnosis)
• medical history, pelvic exam (physical exam)
• transvaginal ultrasound, Doppler ultrasound: To view the ovary, fallopian tube, and blood flow. The most frequent sonographic signs were ovarian edema, abnormal ovarian blood flow, relative enlargement of the affected ovary, and the presence of free fluid around the ovary or in the Douglas pouch.
- • whirlpool sign: The most definitive sign when present in the twisted vascular pedicle of the ovary. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary. It can also indicate midgut volvulus.
• laparoscopy: A minimally invasive procedure for direct visual assessment.
• blood and urine tests: To rule out other potential diseases (e.g. urinary tract infection, ovarian abscess, ectopic pregnancy, appendicitis)

(Prevention)
To help reduce the size of the cysts.
• high-dose birth control pills
• other forms of hormonal birth control
• oophoropexy: Plication of uteroovarian ligaments, a surgery to prevent recurrence.

(Treatment)
• surgery: Untwists the ovary, and fallopian tube if necessary. Occasionally, removes the affected ovary (oophorectomy) or both ovary and fallopian tubes (salpingo-oophorectomy).
(Surgical procedures)
- • laparoscopy (keyhole surgery, minimally invasive surgery)
- • laparotomy (open surgery)
• drugs: Pain relievers including opioids.
- • over-the-counter pain relievers: acetaminophen, ibuprofen, naproxen
- • opioid: oxycodone