Ovarian torsion occurs when the ovary and fallopian tube are rolled up on themselves, causing the ovarian artery and vein that irrigate them to be twisted. The ovarian blood supply is totally or partially interrupted, causing a progressive death of the ovarian cells, to the point of losing the ovary for good if the torsion is prolonged over time (hours or days).
Ovarian torsion occurs more frequently in women who have an ovarian mass, usually a simple cyst or other types of benign tumours, which make the ovary heavier than usual. Women who have suffered an ovarian torsion are more likely to suffer a second torsion, either of the same ovary or of the opposite ovary.
It manifests with sudden onset of intense lower abdominal pain, which varies in intensity over time, occurring in peaks. It may be accompanied by nausea, vomiting and fever.
Diagnosis is based on clinical examination and transvaginal gynaecological ultrasound. Sometimes this is not enough and laparoscopic surgery must be performed to directly observe the ovary and reach a definitive diagnosis. This surgery is at the same time the treatment of the torsion: the torsion is removed and, if its condition permits, the ovary is preserved. If an ovarian cyst or benign tumour is observed, the operation is used to remove it.
- M Laufer. Ovarian and tube torsion. UpToDate. Last updated 13 may 2021.
- F moro et al. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. Ultrasound Obstet Gynecol 2020; 56: 934–943.
