Ovarian torsion can occur at any age with the greatest incidence in women 2030 years of age. Concern for acute ovarian torsion warrants immediate surgery in order to salvage ovarian tissue. A, there is a heterogeneous structure within the right lower quadrant that measures 6. 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 the egg and continues to grow, then it forms a cyst. In most series, the right ovary is reported to undergo torsion more often than the left 7, 8, 14, 17. When fallopian tube also twists with the ovary it is known as adnexal torsion. Apr 02, 2020 an ovarian cyst that underwent torsion twisting of the vascular pedicle.
Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle causing obstruction to venous outflow and arterial inflow. The spectrum of reported sonographic findings of ovarian or adnexal torsion has varied in. For benign ovarian cysts that require surgical man agement, laparoscopy has recently been accepted as the. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. May 07, 20 prognosis with early diagnosis and appropriate treatment,the prognosis of ovarian torsion is excellentespecially intervention with in the first 8 hrs. Dec 31, 2009 in this case we report a 23 yearold primigravida with 30 weeks presenting with torsion of the ovarian cyst. Jun 10, 2003 an ovarian cyst is a globular sac filled with fluid or semisolid material that develops in, or on, an ovary. Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor. This is a casereport study for evaluation a couple with male factor infertility, who was a good.
Ovarian torsion, also sometimes termed adnexal torsion or tubo ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. Adnexal torsion, laparoscopic vs open surgery, adnexal detorsion introduction. Dec 05, 2014 adnexal torsion is one of the few gynaecological surgical emergencies. Ovarian torsion is a common gynecological condition significantly. It can be intermittent or sustained and results in venous, arte. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. Diagnostic features on ct and mri with pathologic correlation shauna duigenan1 esther oliva2 susanna i.
Ovarian cysts can be physiologic or malignant and are known to occur in children of all ages. An update on the diagnosis and management of ovarian torsion. Sonographic diagnosis of ovarian torsion accuracy and predictive factors varian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2. The follicular ovarian cyst is the most common kind of ovarian cyst. Pearls and pitfalls in diagnosis of ovarian torsion radiographics. Abdominal pain, ovarian cyst, ovarian torsion, pelvic pain. Aetiology the ovaries, located on each side of a womans uterus and each measuring about 2. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the emergency department ed such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as. This ultrasound case shows many of the typical features of an ovarian torsion. Pdf adnexal torsion accounts for 3% of all gynaecologic emergencies. It is a dreaded complication of ovarian tumors either in pregnant or nonpregnant state. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. Massive edema or hemorrhage within the ovary without any underlying pathologic manifestations was seen in 6 patients 40%.
In most cases, the ovarian mass or cyst is a benign tumorous growth rather than a malignant one. She presented to the antenatal clinic with acute pain abdomen. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. You may also be more likely to develop ovarian torsion. You need to go in and be evaluated immediately, especially if you have a known ovarian cyst, jones told healthline. Jul 19, 2019 the most important risk factor for ovarian torsion is ovarian mass. Abnormal us findingsenlarged ovary absent or decreased arterial or venous. Sonographic diagnosis of ovarian torsion ucsf emergency. Pain and nausea are the most common symptoms of ovarian torsion. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow.
Ovarian torsionpathophysiologycausessignssymptomstests. Ovarian torsion or mass are two important considerations given this appearance. Five year retrospective case series of adnexal torsion. Studies have shown the low accuracy of clinical evaluation for diagnosing ovarian torsion ovarian torsion. In a normal menstrual cycle, the egg grows inside a tiny sac called a follicle. The clinical presentation of adnexal torsion, like other pathologies, is with acute onset of pelvic pain but can be nonspecific, frequently presenting diagnostic. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. We hereby report a case of huge cyst in a 15year old girl having severe abdominal pain which was diagnosed as torsion in ovarian dermoid cyst. Ovarian torsion society for academic emergency medicine. In 70% of cases, it is diagnosed in women between 20 and 39 years of age. Pearls and pitfalls in diagnosis of ovarian torsion. It consists of spectrum of pathologies including ovarian torsion.
Ovarian cysts and torsion in assisted reproduction and pregnancy an ovarian cyst 25 mm simple or complex cyst can be found in up to 5% of pregnancies,19 with a % torsion rate. Report of a case with simultaneous ovarian cyst torsion. Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of the ovary and tube, tumors, cysts etc. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy. Torsion is also one of the causes of emergency obstetric surgery, and the prevalence is 2. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign. Ovarian torsion ucsf emergency medicine ultrasound. Corpus luteum cysts also have the potential to rupture, causing sudden, sharp pain and some internal bleeding. This causes the fol licle to continue growing into a cyst. The most common precipitating factor for ovarian torsion is the presence of an ovarian cyst or mass which rotates the ovary around the infundibulopelvic and utero ovarian ligaments. How common is torsion in patients with ovarian cysts and what. Ovarian torsion is the fifth most common gynecological emergency condition and for that, delayed diagnosis is not uncommon leading to disastrous results as ovarian infarction and necrosis. Clinical characteristics of ovarian torsion and highrisk factor.
Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Pdf adnexal torsionsymptoms, diagnosis and management. The ovary, and often the fallopian tube as well adnexal torsion become twisted around their vascular pedicle. The presence of an internal daughter cyst was confirmed fig. Ovarian torsion represents a true surgical emergency. Benign cystic teratoma dermoid cyst is the most common ovarian tumor in women in the second and third decade of life 9 and as a rule is benign. This painful condition cuts off blood supply to these organs. Defined as the abnormal twisting of the involved ovary on its ligamentous support. The size of the mass is positively correlated with the risk of ovarian torsion. Benign ovarian cysts in reproductiveage women undergoing. Report of a case with simultaneous ovarian cyst torsion and. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable. The ovary is distended with absent doppler flow and some adjacent free fluid. When the egg matures, the follicle breaks open to release the egg.
It may be complicated by torsion, rupture, chemical peritonitis and malignant change but. Aug 16, 2016 within the cyst was a daughter cyst, without significant bloodflow fig. In can occur in women of all ages, but most women that experience this are younger. Follicle cysts form when the follicle doesnt break open to release the egg. The ovary also contains a 4 cm dermoid cyst with an echogenic rokitansky nodule dermoid. The incidence of ovarian torsion among women of all ages is 5.
It is basically a sac inside the ovary filled with fluids. This twisting can cut off blood flow to the ovary and fallopian tube. Casecontrol study comparing the sensitivity and specificity of. Eight girls group 1 had ovarian torsion in a normal ovary, and twentyone girls group 2 had ovarian torsion including a mass or cyst. Gpnotebook stores small data files on your computer called cookies so that we can recognise you and provide you with the best service. Adnexal torsion is reported to be the fifth most common gynecologic emergency condition encountered with a prevalence of 2.
Sometimes, the fallopian tube may also become twisted. Corpus luteum cysts may also cause the ovary to twist around the ovarian ligament. Ovarian torsion adnexal torsion occurs when an ovary becomes twisted around the tissues that support it. The larger the mass, the more likely ovarian torsion will occur.
Torsion commonly associated with ovarian cysts, which can act as a catalyst to the torsion process. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ. Pelvic ultrasonography can provide information on ovarian cysts. Ovarian torsion accounts for about 3% of gynecologic emergencies. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. Ovarian torsion definition of ovarian torsion by medical. Ovarian torsion is an uncommon cause of acute abdominal pain in females, but it is a gynecologic emergency diagnostic delay can result in loss of the ovary. The patient presented with a short history of severe lower abdominal pain.
The larger the cyst, the more likely that ovarian torsion will occur. This condition is called ovarian torsion, and can cut off the blood flow to the ovary. Nov 10, 2017 torsion can occur if the ovary is unstable. Ovarian cysts and ovarian cancer what are ovarian cysts. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard.
Jun 05, 2018 ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery andor vein. However, ectopic pregnancy occurs only at reproductive age. Description ovarian torsion occurs infrequently only in females. The primary risk factor for ovarian torsion is an ovarian mass approach to the patient with an adnexal mass view in chinese a woman with an adnexal mass may be associated with adnexal torsion, rupture of an ovarian cyst, or a ruptured ectopic pregnancy. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. Ovarian torsion almost always associated with a cyst. Commonly physiologic due to maternal hormones and resolve spontaneously. We present super infection of an ovarian dermoid cyst with actinomyces in an infertile patient. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. Ovarian torsion adnexal torsion diagnosis and treatment. Ovarian salvage rate is below 1o% in adult due todelay in diagnosis. Borderline endometrioid cystic fibroma of the ovary.