Ovarian Torsion – The twisted tale of ovaries

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Of late, have you been experiencing excruciating pain on one particular side of your lower abdomen? Don’t neglect and ignore. Ovarian torsion, though uncommon, can be a possibility.

Ovarian Torsion

What is ovarian torsion?

An ovarian torsion (adnexal torsion) is typically the rotation or twisting of a pathologically enlarged ovary, cutting off its blood and venous supply, causing severe abdominal pain and necrosis (premature death of body tissue).

It is an infrequent gynaecological emergency and unfortunately a frequently missed diagnosis. Since there are several surgical and non-surgical conditions that have similar symptoms of abdominal pain etc., ovarian torsion is often not initially considered as a possibility.

Although age is no bar for this condition, greater incidence is seen among females between the ages of of 20 to 30 years (in early reproductive years).

Signs and symptoms of ovarian torsion

The classic sign of ovarian torsion is the sudden onset of excruciating unilateral lower abdominal pain which often radiates towards the groin. This may be accompanied by nausea and vomiting. The pain usually intensifies on exercising or aggressive physical movement. On examination, severe abdominal tenderness is found.

Causes of ovarian torsion

Conditions or risk factors that can trigger ovarian torsion include:

  • Excessively long fallopian tube
  • Larger than normal ovary
  • Enlarged ovarian cyst
  • Presence of an ovarian tumour
  • Pregnancy, particularly during the first 3 months
  • Prior tubal ligation
  • Taking medications to induce ovulation (stimulation of ovary)
  • History of pelvic surgery

Treatment options

Treatment of a twisted ovary is by and large surgical. The ovary must be untwisted as soon as possible to restore blood flow. Surgery at the earliest is performed to relieve the ovarian torsion, or to take out the necrotic ovary that is damaged by the lack of blood supply.

Home care post surgery includes:

  • Surgical wound care
  • Following prescribed medicine as directed
  • Avoidance of caffeine
  • Cessation of smoking
  • For painful pelvic cramps, a warm bath is recommended
  • A hot water bottle or heating pad may be placed on the lower abdomen

Prognosis of ovarian torsion

The prognosis of ovarian torsion is excellent with early diagnosis and appropriate treatment.

  • Most patients with ovarian torsion usually have a delayed diagnosis, which often results in infarction and necrosis of the ovary.
  • Loss of a single ovary is unlikely to result in significantly reduced fertility.
  • Death due to ovarian torsion is highly unlikely.
  • Early diagnosis allows conservative laparoscopic surgery and reduction in complications.

Photograph via sxc.hu

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