Is Ovarian Torsion an Emergency?

Ovarian torsion causes sudden onset of symptoms, which may be severe in a few cases. 

The symptoms can disrupt the stability of the patient, and may include:

• Acute onset of severe abdominal pain
• Pelvic pain
• Cramping on one side
• Nausea and vomiting
• Fever
• Tenderness in the lower abdomen

Ovarian torsion is not readily diagnosed because the symptoms of it mimic other various medical conditions, such as ruptured ovarian cysts, appendicitis, or ectopic pregnancy.

The exact cause of ovarian torsion is unknown, but it could occur if the ovary is unstable. 

Women with the following conditions may have certain risk factors for ovarian torsion:

• Polycystic ovarian disease
• Formation of cysts, such as follicular cyst, corpus luteum cyst, dermoid cyst, and cystadenomas
• Endometriosis, where the endometrial tissue grows on the ovary, which puts extra weight on the ovary, causing instability of the ovary
• A long ovarian ligament that connects the ovary to the uterus
• Severe pelvic infection, which may cause ovarian cysts
• Tubal ligation
• Treatment for infertility that stimulates ovary for ovulation

Ovarian torsion is a rare condition seen among women of all ages and even in the fetus. However, it is the most common among women aged 20 to 40 years old.

Diagnosis of ovarian torsion is difficult because there is a chance of misdiagnosis. A thorough evaluation of the patient is to be done to confirm the diagnosis.

Pelvic examination

• Following an assessment of the symptoms and medical history, the doctor will perform a pelvic exam to rule out the presence of a mass.

Radiological evaluation

• Ultrasound scan
  • Ultrasound is the most done radiological test, where the abdomen and pelvis are studied with the use of ultrasound waves. This diagnostic technique provides pictures of ovaries and detects the presence of an ovarian cyst or mass. The ultrasound probe is placed on the areas where the woman has tenderness to evaluate the cause.
  • An abdominal and pelvic ultrasound scan can be done where the ultrasound probe is placed on the abdomen and pelvis region externally. Another method is the transvaginal scan, where the probe is inserted into the vagina for a better picture of the pelvic region.
• Magnetic resonance imaging (MRI)
  • The patient is passed through an MRI machine, which emits magnetic and radio waves that provide clear pictures of the ovary, the viable tissue, and the surrounding blood flow.
• Computed tomography (CT) scan
  • CT scan uses X-rays. The patient is placed in the CT scan machine, and X-rays emitted from the machine produce cross-sectional images of the ovary, which looks like a slice of bread that shows tiny details.
  • With a pelvic exam, the doctor may establish the presence of a mass. However, imaging techniques help rule out a cyst, the presence of tissue other than the ovarian tissue, or cancerous growth in the ovary.

There are certain cases where the ovarian torsion untwists itself spontaneously without the need for any medical treatment. However, it is not recommended to wait for the ovary to untwist on its own.

Surgery

The surgeon accesses the ovary and untwists it manually. Surgery can be done in two ways.

1. Laparoscopy
   • This surgical procedure is most preferred, especially during pregnancy, because it is less invasive, usually done under the influence of general anesthesia, and performed on an outpatient basis, which takes less recovery time.
   • Small incisions are done on the lower abdomen. Thin instruments are inserted through the incisions, and with the help of the scope, the ovaries are accessed. Using a probe, the surgeon untwists the ovary.
2. Laparotomy
   • This surgical procedure requires a larger incision in the lower abdomen to access the ovary and untwist it. This procedure is done under the influence of general anesthesia, and it requires a longer hospital stay and recovery time.

If ovarian torsion leads to the death of the ovary and fallopian tube, they must be removed surgically to prevent further complications. The surgeon may perform the following surgeries depending on the situation:

• Oophorectomy: If the ovary dies, the surgeon removes the dead ovary laparoscopically and closes all the blood vessels that supply the ovary to prevent hemorrhage.
• Salpingo-oophorectomy: In the procedure, both the fallopian tube and ovary are removed laparoscopically.

Ovarian torsion does not cause infertility. With surgical procedures, the ovary is untwisted so that it functions normally. However, in some instances, the ovary may be removed if the ovarian tissue succumbs to the poor blood supply. The women may not have a problem with conception if they have another healthy ovary.

The surgery can be performed on a pregnant woman, and it does not cause any complications to the mother and the fetus.