Everything about Ovarian Torsion: Symptoms, Causes, Diagnosis, Treatment

Ovarian torsion is an uncommon medical condition characterized by the twisting of the ovary around its supporting structures. This twisting can obstruct blood flow, resulting in intense pain in the lower abdomen. Prompt medical attention is essential to prevent potential complications.

Ovarian torsion is a partial or complete rotation of the adnexal supporting organ with ischemia. It is considered a rare but emergency condition in females. Early diagnosis and surgery are crucial to protect ovarian and tubal function and prevent severe morbidity¹.

Transvaginal ultrasound may reveal the ovary condition, fallopian tubes, and blood flow.

Surgery is required to treat ovarian torsion sometimes and removal of the affected ovary is crucial¹.

This article will lead you to the dynamics of this rare and impactful medical event, shedding light on its underlying causes, symptoms, diagnosis, and treatment options. It will provide you with a deeper understanding of ovarian torsion’s significance in your health, management strategies, and the importance of timely intervention.

What is ovarian torsion?

Ovarian torsion is an uncommon yet serious medical condition in girls, especially in your younger age daughter2.

This medical emergency occurs when a mass or cyst in your ovary rotates the UO ligament (uterosacral ligament) and infundibulopelvic ligament¹.

How common is ovarian torsion?

A study revealed that ovarian torsion occurs in around 2%–15% of females who have surgical treatment of adnexal masses¹.

This gynecological emergency can affect females of all ages, resulting in ischemic alterations in the ovary. Ovary torsion more commonly involves both the fallopian tube and ovary and there are some cases of isolated torsion involving either one¹.

Keep reading and stay connected with us, as we will explore the potential symptoms of this rare medical condition. 

What are the symptoms of ovarian torsion?

A female can experience the following symptoms if she has ovarian torsion including:

• Cramping
• Abrupt onset of lower intermittent abdominal pain³
• Vomiting
• Nausea
• Low-grade fever¹

In some cases, tenderness, cramping, and pain in the lower abdomen may come and go for some weeks. This can happen if the ovary is trying to twist back into the correct position.

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What causes ovarian torsion?

Ovarian torsion can occur when the ovary is not fixed, causing it to become unstable due to an ovarian mass or cyst that makes it irregular.

You may also be more prone to develop ovarian torsion if you have:

• PCO (polycystic ovary syndrome)
• Had a tubal ligation
• Have a long ovarian ligament (fibrous stalk that connects the ovary to the uterus)
• Are pregnant
• Are undergoing hormonal treatment, typically for infertility, which can stimulate the ovary

Even though, ovarian torsion can occur at any age, most probably during your reproductive years (between your first menstrual cycle and menopause).

Diagnosis:

How ovarian torsion is diagnosed?

Immediately schedule a meeting with your healthcare provider or gynecologist, if you are facing the symptoms of ovarian torsion mentioned above. This is crucial as the longer the situation goes untreated, the more prone you will suffer the complications.

Your gynecologist will follow the assessment such as

1. Physical examination: examine your pelvic area to locate any pain and tenderness1.

2. Medical history: check your previous medical history related to this condition. 

3. Transvaginal ultrasound: this plays a key role in viewing your fallopian tube, ovary, and blood flow¹.

Laboratory Tests:

Your gynecologist will order you following laboratory tests include¹:

• White blood cell count
• A hematocrite
• Serum human chronic gonadotropin
• Electrotype panel

Your gynecologist will use urine and blood tests to rule out other potential diagnosis, include:

• Ovarian abscess
• Urinary tract infection
• Ectopic pregnancy
• Appendicitis

These are all preliminary diagnoses, your gynecologist will perform, but a definite diagnosis is typically made during corrective surgery¹.

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Treatment options:

How is ovarian torsion treated?

Your gynecologist will perform surgery to untwist your ovary, and, if they feel necessary fix the fallopian tube to be fixed. As normal medical practice, they prescribe certain medications to reduce your risk of recurrence. In most cases, they feel necessary to remove the affected ovary^1,2.

How does surgical procedure perform?

Your surgeon will perform one of two surgical procedures to unwind your ovary:

1. Laparotomy:

Your surgeon will create a larger incision in your lower abdomen to reach in and unwind the ovary manually.

Laparoscopy is typically performed under general anesthesia.

Furthermore, your gynecologist will order you to stay at the hospital overnight.

2. Laparoscopy:

In this surgical procedure, your gynecologist will insert a slender lighted, tool into a small incision in your lower abdomen. In this way, they will be able to view your internal organs. They will also make another incision to allow access to the affected ovary. Once the ovary is contacted, they will use a blunt probe or another or maybe another instrument to untwist it.

This procedure needs general anesthesia and is generally done on an outpatient basis.

Your gynecologist may suggest this surgery if you are pregnant.

If an extended time has passed and prolonged loss of blood flow has led the surrounding tissues to die, your surgeon will remove it through one of the following procedures.

1. Salpingo-oophorectomy:

If the fallopian tube and ovarian tissues are no longer functioning properly, your gynecologist may perform a laparoscopic procedure to remove them.

This procedure is often done to prevent recurrence in postmenopausal women.

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2. Oophorectomy:

If your, ovarian tissue is no longer able to work, your gynecologist will use this laparoscopic procedure to remove the affected ovary.

What are the risks of these surgical procedures?

As every surgery, has its risks, these procedures also included:

• Infections
• Complications from anesthesia
• Blood clotting

Medication:

Your gynecologist may suggest over-the-counter painkillers to aid in easing your symptoms during the recovery period, including:

• Naproxen (Aleve)
• Ibuprofen (Advil)
• Acetaminophen (Tylenol)

What to do if my pain is severe?

If your pain is more severe, your gynecologist may suggest opioids, including:

• Oxycodone (OxyContin)
• Oxycodone with acetaminophen (Percocet)

How to reduce the risks of ovarian torsion recurrence with medications?

Your gynecologist may prescribe high-dose birth control pills or other types of hormonal birth control to lessen the risk of recurrence of ovarian torsion.  

What are the complications?

When ovarian torsion occurs, blood flow to the ovary, and perhaps to your fallopian tube, is reduced. The longer it takes to get a diagnosis and treatment, the greater the risk to your ovarian tissue, as prolonged reduction in blood flow may lead to tissue death (necrosis). In this condition, your gynecologist has no other option but to remove the ovary and any other affected tissue.

Prevention:

How can I prevent ovarian torsion complications?

The only way to prevent the complications associated with ovarian torsion is to get prompt medical attention for your symptoms.  

Can I get pregnant if I lose my ovary due to ovarian torsion?

Even if your ovary is lost from necrosis, you can still get pregnant. Ovarian torsion doesn’t prevent you from having a baby.

Conclusion:

Ovarian torsion necessitates immediate medical attention, typically through surgery. Delayed diagnosis and treatment heighten the risk of complications, potentially requiring further surgical interventions. Following untwisting or removal of the ovary, hormonal birth control may be recommended to prevent recurrence. Ovarian torsion does not affect fertility.

While the frequency of ovarian torsion occurrences remains uncertain, it is generally considered rare among medical professionals. Females with ovarian cysts, which can lead to ovarian swelling, may have a higher likelihood of experiencing torsion. Utilizing hormonal birth control or other medications may help mitigate cyst size and thus reduce the risk of torsion.