Understanding Ovarian Torsion

Ovarian torsion is one of the most common gynaecologic surgical emergencies. It occurs when the ovary twists on its ligamentous supports, resulting in blood obstruction.

This condition can affect females of any age, but it is most prevalent in women of reproductive age. When the fallopian tube twists along with the ovary, it is known as adnexal torsion.

Risk factors for ovarian torsion

The risk factors for ovarian torsion include having an ovarian mass of 5 cm in diameter or larger. However, torsion can occur in ovaries of any size. The risk of torsion typically increases with the size of the ovary.

Ovulation inducement for infertility treatment can result in large ovarian follicular cysts and, in some cases, massive ovarian enlargement due to hyperstimulation. 

Women with a history of ovarian torsion are also at higher risk.

Symptoms of ovarian torsion

Symptoms of ovarian torsion may include sudden onset, moderate to severe pelvic pain that may be sharp, dull, stabbing, crampy or colicky in nature, nausea with or without vomiting, and fever.

Diagnosis of ovarian torsion

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Tests that are used to diagnose ovarian torsion include imaging studies like transvaginal and pelvic ultrasound with Doppler and blood tests.

Definitive diagnosis is established by directly observing a rotated ovary during surgery. Typically, a laparoscopic approach is used.

Treatment options for ovarian torsion

Ovarian torsion, if left untreated, can result in the loss of blood supply to the affected ovary and fallopian tube. This lack of blood flow can lead to tissue damage, infarction (tissue death), and loss of function in these organs.

For premenopausal patients with a non-malignant (non-cancerous) twisted ovary, it is usually recommended to attempt to untwist the ovary and preserve it(detorsion and ovarian conservation) rather than removing it (salpingo-oophorectomy). If there is a benign cyst on the ovary, the surgeon may remove the cyst (cystectomy) during the detorsion procedure.

For patients with severely damaged ovaries or suspicious of ovarian cancer, if the ovary is clearly dead (necrotic) or is concerned that it might be cancerous, the preferred approach is to remove both the ovary and the fallopian tube (salpingo-oophorectomy). This is also the recommended procedure for postmenopausal patients.

For premenarchal patients with ovarian torsion and a normal ovary, oophoropexy may be done along with detorsion to reduce the risk of future torsion. If a cyst or mass is present, the surgeon may perform detorsion and cystectomy without oophoropexy.

Make an appointment at Gleneagles Hospitals

If you suspect that you are experiencing symptoms of ovarian torsion, get in touch with us to find out more about our Obstetrics & Gynaecology Servicesat your nearest Gleneagles Hospital.

You may also contact the Health Screening Centre at your nearest Gleneagles Hospital for health screening appointments