Ovarian Torsion

Ovarian torsion is a medical emergency involving the twisting of the ovary and sometimes the fallopian tube, which can cut off blood flow. This condition requires prompt treatment to preserve ovarian function and prevent complications.

Ovarian torsion occurs when an ovary twists around the ligaments that hold it in place. This twisting can block blood flow to the ovary and the fallopian tube, leading to severe pain and potential loss of the ovary if not treated quickly.

Pathophysiology

Structure

The ovaries are small, oval-shaped organs located on either side of the uterus. They produce eggs (ova) and hormones like estrogen and progesterone. Each ovary is connected to the uterus by the fallopian tube and supported by ligaments.

Blood Supply

Ovaries receive blood through the ovarian arteries, which branch from the abdominal aorta. Proper blood flow is essential for ovary health and function.

Nerve Supply

Nerves around the ovaries transmit pain signals to the brain. When torsion occurs, these nerves send intense pain signals due to reduced blood flow and tissue damage.

Types of Ovarian Torsion

  1. Adnexal Torsion: Involves the ovary and the fallopian tube.
  2. Ovarian Pedicle Torsion: Specifically involves the stalk (pedicle) of the ovary.
  3. Partial Torsion: Only part of the ovary twists.
  4. Complete Torsion: The entire ovary and fallopian tube twist.

Causes of Ovarian Torsion

  1. Ovarian Cysts: Fluid-filled sacs can increase the ovary’s weight.
  2. Ovarian Masses: Tumors or growths can predispose torsion.
  3. Pregnancy: Hormonal changes can affect ligaments.
  4. Enlarged Ovaries: Conditions like polycystic ovary syndrome (PCOS).
  5. Previous Ovarian Surgery: Scarring can alter ligament strength.
  6. Pelvic Infections: Inflammation may loosen ligaments.
  7. Congenital Abnormalities: Naturally longer ligaments.
  8. Rapid Weight Gain or Loss: Can shift pelvic structures.
  9. Physical Activity: Sudden movements or sports injuries.
  10. Use of Fertility Medications: Can cause ovarian enlargement.
  11. Endometriosis: Scar tissue can affect ovary placement.
  12. Fibroids: Uterine growths can impact pelvic anatomy.
  13. Trauma: Injury to the lower abdomen.
  14. Pelvic Adhesions: Bands of scar tissue.
  15. Abdominal Masses: Pressure from other organs.
  16. Hormonal Imbalances: Affect ovary size and position.
  17. Genetic Factors: Predisposition to ligament laxity.
  18. Low Body Weight: May lead to pelvic instability.
  19. Delayed Puberty: Abnormal pelvic development.
  20. Post-Menopausal Changes: Tissue laxity increases risk.

Symptoms of Ovarian Torsion

  1. Sudden, Severe Abdominal Pain: Often on one side.
  2. Nausea and Vomiting: Common with acute pain.
  3. Fever: May indicate infection or inflammation.
  4. Swelling of the Abdomen: Due to fluid buildup.
  5. Dizziness or Fainting: From pain or shock.
  6. Lower Back Pain: Radiates from the abdomen.
  7. Pain During Physical Activity: Movement exacerbates pain.
  8. Urinary Symptoms: Frequent urination or urgency.
  9. Changes in Menstrual Cycle: Irregular periods.
  10. Pain During Sexual Intercourse: Discomfort post-torsion.
  11. Tenderness in the Lower Abdomen: Sensitive to touch.
  12. Bloating: Abdominal distension.
  13. Fatigue: Persistent pain can lead to exhaustion.
  14. Numbness: Around the pelvic area.
  15. Rapid Heartbeat: From pain and stress.
  16. Shortness of Breath: Due to severe pain.
  17. Rebound Tenderness: Pain when releasing abdominal pressure.
  18. Palpable Mass: Swollen ovary may be felt.
  19. Localized Heat: Area around the ovary feels warm.
  20. Irregular Bowel Movements: Constipation or diarrhea.

Diagnostic Tests

  1. Ultrasound (Transvaginal): First-line imaging to assess blood flow.
  2. Doppler Ultrasound: Evaluates blood flow to the ovary.
  3. Pelvic MRI: Detailed images of pelvic organs.
  4. CT Scan: Identifies masses or other pelvic issues.
  5. Physical Examination: Assess pain and abdominal tenderness.
  6. Blood Tests: Check for infection or inflammation.
  7. Urinalysis: Rule out urinary tract infections.
  8. Pregnancy Test: Determine if pregnancy-related.
  9. Laparoscopy: Minimally invasive surgery for diagnosis.
  10. Hysterosalpingography: Imaging of the fallopian tubes.
  11. Magnetic Resonance Angiography (MRA): Visualizes blood vessels.
  12. X-Ray: Less common, to rule out other issues.
  13. Biopsy: If a mass is suspected.
  14. Electrolyte Panel: Assess overall health.
  15. Complete Blood Count (CBC): Detects infection or anemia.
  16. C-Reactive Protein (CRP): Indicates inflammation.
  17. Lactate Levels: High levels suggest tissue damage.
  18. Serum AMH Levels: Ovarian reserve assessment.
  19. Pelvic Exam Under Anesthesia: Detailed internal assessment.
  20. Genetic Testing: If congenital factors are suspected.

Non-Pharmacological Treatments

  1. Rest: Minimize movement to reduce pain.
  2. Cold Compress: Apply to reduce swelling.
  3. Heat Therapy: Alternate with cold to relax muscles.
  4. Elevate Abdomen: Lie down with hips elevated.
  5. Breathing Exercises: Manage pain and anxiety.
  6. Hydration: Drink water to prevent dehydration.
  7. Dietary Adjustments: Light meals to reduce nausea.
  8. Position Changes: Find comfortable positions.
  9. Supportive Devices: Abdominal binders for support.
  10. Distraction Techniques: Engage in light activities.
  11. Relaxation Techniques: Meditation or mindfulness.
  12. Acupressure: Gentle pressure to alleviate pain.
  13. Massage Therapy: Light abdominal massage.
  14. Aromatherapy: Use calming scents.
  15. Herbal Remedies: Consult a doctor before use.
  16. Physical Therapy: Gentle exercises post-recovery.
  17. Avoid Heavy Lifting: Prevent strain on abdomen.
  18. Sleep Positioning: Comfortable and supportive.
  19. Monitor Symptoms: Keep track of pain and changes.
  20. Support Groups: Emotional support from others.
  21. Educational Counseling: Learn about the condition.
  22. Mind-Body Practices: Yoga or tai chi.
  23. Biofeedback: Control pain responses.
  24. Avoid Caffeine: May reduce anxiety.
  25. Limit Alcohol: Prevent interactions with treatments.
  26. Smoking Cessation: Improve overall health.
  27. Pacing Activities: Balance rest and activity.
  28. Use of Pillows: Support body parts during rest.
  29. Environmental Modifications: Create a comfortable space.
  30. Safety Planning: Ensure quick access to medical care if needed.

Drugs Used in Treatment

  1. Pain Relievers (NSAIDs): Ibuprofen, naproxen.
  2. Acetaminophen: For mild pain.
  3. Antiemetics: Ondansetron for nausea.
  4. Antibiotics: If infection is present.
  5. Sedatives: To reduce anxiety and pain.
  6. Muscle Relaxants: To alleviate abdominal spasms.
  7. IV Fluids: Prevent dehydration.
  8. Steroids: Reduce inflammation.
  9. Hormonal Treatments: If related to hormonal imbalance.
  10. Alpha-Agonists: To manage blood pressure.
  11. Beta-Blockers: Control heart rate.
  12. Analgesic Adjuvants: Tramadol for severe pain.
  13. Vasopressors: If blood pressure drops dangerously.
  14. Anticoagulants: Prevent blood clots post-surgery.
  15. Proton Pump Inhibitors: Protect stomach lining if on NSAIDs.
  16. Electrolyte Supplements: If imbalances occur.
  17. Anti-Inflammatories: Corticosteroids for severe inflammation.
  18. Biologics: In specific inflammatory conditions.
  19. Antidepressants: For chronic pain management.
  20. Topical Analgesics: For localized pain relief.

Note: Medication should always be taken under the guidance of a healthcare professional.

Surgical Treatments

  1. Laparoscopy: Minimally invasive surgery to untwist the ovary.
  2. Laparotomy: Open surgery for severe cases.
  3. Oophorectomy: Removal of the affected ovary.
  4. Salpingo-Oophorectomy: Removal of ovary and fallopian tube.
  5. Detorsion: Untwisting the ovary to restore blood flow.
  6. Cystectomy: Removal of ovarian cysts.
  7. Ovarian Drilling: To reduce ovarian size in PCOS.
  8. Adhesion Removal: Eliminating scar tissue.
  9. Ovarian Fixation (Pexy): Securing the ovary to prevent recurrence.
  10. Hysterectomy: In extreme cases, removal of the uterus.

Prevention of Ovarian Torsion

  1. Regular Check-ups: Monitor ovarian health.
  2. Manage Ovarian Cysts: Treat or remove cysts as advised.
  3. Maintain Healthy Weight: Prevent excessive ovarian enlargement.
  4. Limit Fertility Treatments: Under medical supervision.
  5. Monitor Hormonal Health: Address imbalances promptly.
  6. Avoid Trauma: Protect the pelvic area from injuries.
  7. Educate on Symptoms: Early recognition of torsion signs.
  8. Surgical Intervention: Secure ovaries during pelvic surgeries.
  9. Healthy Lifestyle: Balanced diet and regular exercise.
  10. Stress Management: Reduce overall body strain.

When to See a Doctor

  • Sudden, Severe Abdominal or Pelvic Pain: Especially on one side.
  • Persistent Nausea and Vomiting: Accompanied by pain.
  • Fever: With abdominal discomfort.
  • Swelling or Bloating: Unexplained abdominal changes.
  • Dizziness or Fainting: During or after pain onset.
  • Pain During Urination or Bowel Movements: With other symptoms.
  • Irregular Menstrual Cycles: Especially if painful.
  • Changes in Sexual Function: Pain during intercourse.
  • Any Suspected Ovarian Mass: Before torsion occurs.
  • History of Ovarian Issues: Increased vigilance needed.

Frequently Asked Questions (FAQs)

  1. What is ovarian torsion?
    • It’s the twisting of the ovary and sometimes the fallopian tube, cutting off blood flow.
  2. What causes ovarian torsion?
    • Ovarian cysts, masses, congenital factors, and hormonal changes are common causes.
  3. What are the symptoms of ovarian torsion?
    • Severe abdominal pain, nausea, vomiting, and swelling are typical signs.
  4. How is ovarian torsion diagnosed?
    • Through imaging tests like ultrasound and MRI, along with physical exams.
  5. Is ovarian torsion a medical emergency?
    • Yes, it requires immediate treatment to prevent ovarian damage.
  6. Can ovarian torsion be treated without surgery?
    • In some cases, detorsion can be done laparoscopically, but surgery is often needed.
  7. What is the recovery time after surgery for ovarian torsion?
    • It varies, but generally a few weeks for full recovery.
  8. Can ovarian torsion recur?
    • Yes, especially if underlying risk factors are not addressed.
  9. Does ovarian torsion affect fertility?
    • If treated promptly, fertility can often be preserved, but delays may impact it.
  10. Who is at higher risk for ovarian torsion?
    • Women with ovarian cysts, during pregnancy, or with certain congenital conditions.
  11. How quickly should ovarian torsion be treated?
    • Ideally within 6 hours to maximize ovarian viability.
  12. Are there long-term effects of ovarian torsion?
    • Possible hormonal imbalances or fertility issues if not treated timely.
  13. Can ovarian torsion occur during pregnancy?
    • Yes, it’s a potential complication during pregnancy.
  14. Is ovarian torsion more common in one age group?
    • It can occur at any age but is more common in women of reproductive age.
  15. How can ovarian torsion be prevented?
    • Regular medical check-ups, managing ovarian cysts, and maintaining a healthy lifestyle.

Conclusion

Ovarian torsion is a serious condition that demands immediate medical attention. Understanding its causes, symptoms, and treatments can help in early detection and effective management. If you experience sudden and severe abdominal pain or other related symptoms, seek medical help promptly to ensure the best possible outcome.

 

Authors

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

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Last Update: January 12, 2025.

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