What Is Ovarian Torsion?

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Ovarian torsion in female anatomy occurs when the ovary and fallopian tube, which connects the ovaries to the uterus, twists around the supporting tissues and blood vessels. This twisting cuts off the blood supply to the organs.

Ovarian torsion is an emergency condition for which diagnosis and intervention must occur quickly to save the ovary and corresponding reproductive organs. It can occur in people of all ages but is more prominent in adolescents and young women of reproductive age.

This article discusses the signs, causes, and treatment for ovarian torsion.

Woman with abdominal pain

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Types Of Ovarian Torsion

Partial

A partial ovarian torsion occurs when the ovary and fallopian tube only partly twist to cut off the blood supply.

Usually, the symptoms associated with a partial ovarian torsion are not as severe as a complete ovarian torsion. The ovary and fallopian tube will sometimes twist sporadically over several days or months, leading to recurring abdominal pain and partial torsion.

Complete

A complete ovarian torsion is when the ovary and fallopian tube twist entirely to cut off the blood supply to the tissues.

Ovarian Torsion Symptoms

The most common symptom of ovarian torsion is acute lower abdominal pain, followed by nausea and vomiting. Often, the pain comes and goes, and it is thought that the ovary might be twisting and untwisting during this time. Complete torsion is associated with significant pain.

Right vs. Left Side

The ovary on the right side of the body is more likely to twist than the ovary on the left side, because the left-sided intestine helps keep the left ovary in a stable position.

Causes

More than 80% of people with ovarian torsion have a large ovarian cyst (fluid-filled sacs in or on the surface of an ovary) or a mass. The larger the ovarian cyst or mass, the more likely torsion will occur. It can happen with any size mass, but healthcare providers are most concerned about masses greater than 5 centimeters.

Ovarian torsion is more likely to occur with a benign (noncancerous) tumor than with ovarian malignancy (cancerous tumor).

When mature eggs are released from the ovary during ovulation, some people develop multiple ovarian follicular cysts. These cysts can also increase the risk of ovarian torsion.

People who are at risk for having enlarged cysts or masses include people:

  • Taking hormones to induce ovulation
  • Undergoing in vitro fertilization and developing hyperstimulation syndrome
  • With polycystic ovarian syndrome (PCOS)
  • Who are pregnant
  • With a previous history of ovarian torsion

Adolescents With Ovarian Torsion

Almost half of adolescent girls with ovarian torsion have normal ovaries without a cyst or mass.

Diagnosis

Healthcare providers must be highly vigilant for ovarian torsion to catch it early. Before testing, they can only rely on a person’s medical history, physical exam, and risk factors for ovarian torsion. There are no specific blood tests that can indicate ovarian torsion.

A pelvic ultrasound is the best imaging test to diagnose ovarian torsion. If the pelvic ultrasound does not definitively show ovarian torsion but the healthcare provider is still worried about it, magnetic resonance imaging (MRI) or computed tomography (CT) imaging of the abdomen and pelvis might help determine a diagnosis.

However, MRI is very expensive and takes a long time to obtain, and CT imaging can miss the diagnosis. Neither is typically recommended to evaluate for ovarian torsion.

Direct visualization during a laparoscopic procedure, which entails making small incisions in the abdomen and sending in a slender tool with a tiny camera attached, is the best way to diagnose ovarian torsion when a provider highly suspects the condition.

Treatment

The goal of ovarian torsion treatment is to untwist the tissue and vessels to return adequate blood flow to the ovary. This requires a surgical procedure. The options include a laparoscopic or open procedure.

A laparoscopic approach is less invasive than open surgery and is the more popular choice. However, if cancer of the ovaries or fallopian tube is suspected, the gynecologist may want to do an open procedure.

New recommendations suggest that gynecologists do all they can to preserve ovarian function and future fertility. This means they untwist the tissues and attempt to keep the ovary in place rather than remove it. Ovarian tissue is good at restoring function after being without its blood supply.

The only way to know whether an ovary is healthy enough to remain in the body is by looking at it. Sometimes, it can be restored even if the tissue has turned black or blue.

The amount of time since symptom onset is not always a reliable indicator of whether the tissue has died. Studies have shown that ovarian function can be restored many days after symptom onset. However, sometimes, too much time passes, and healthcare providers need to remove the ovary.

Experts recommend removing a large cyst or mass to prevent recurrent ovarian torsion if one is found during a surgical procedure. Sometimes, gynecologists can remove the cyst fluid to make it smaller after untwisting the tissue. But even this method cannot prevent ovarian torsion from recurring.

Surgical Management in Pregnant People and Adolescents

The management of ovarian torsion is the same in pregnant people as nonpregnant people. Laparoscopic surgery is safe to use for treating ovarian torsion during pregnancy.

Experts recommend that adolescents should not have a torsed ovary removed during surgical treatment unless the ovarian tissue completely falls apart.

Prognosis

If a person with ovarian torsion does not seek medical care, the ovary becomes ischemic and necrotic, meaning the tissue will die because of a lack of blood flow. Although rare, when this occurs, the area can bleed or become infected, and the infection can spread throughout the rest of the abdomen.

In recent years, gynecologists have moved toward untwisting the tissue and vessels to save the ovary rather than removing the ovary. Previously, there was concern that the act of unraveling would lead to blood clots that spread to the lungs. However, this surgery rarely leads to blood clots.

People who have ovarian torsion can still become pregnant afterward. Ovaries left in place have an excellent ability to return to normal function. Still, if one ovary needs to be removed, a person has a second ovary with normal function.

Summary

Ovarian torsion is an emergency condition in which the ovary and fallopian tube twist around the surrounding tissues, cutting off blood supply. It requires a quick diagnosis and intervention to save the ovary and reproductive parts. People with large ovarian cysts or masses are most likely to develop torsion. Gynecologists aim to untwist the tissues and keep the ovary to prevent infectious complications and infertility.

A Word From Verywell

Ovarian torsion is painful and frightening. If you develop severe lower abdominal pain and are of reproductive age, there is a chance you have ovarian torsion. If you are someone with a known ovarian cyst or mass, the chances are even higher. Do not wait to see your primary healthcare provider and instead seek emergency care at the hospital.

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4 Sources
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