Diagnosis of ovarian torsion is often difficult and must be based on history, clinical findings, and ultrasonography . INTRODUCTION. Complications may include infection, bleeding, or infertility. Most common types of ovarian cysts are dermoid and serous cystadenomas. Introduction Torsion of the ovary, tube or both is responsible for between 2.7% and 7.4%1,2of all gynaecological emergencies but is a common diagnostic challenge in the emergency setting. Adnexal torsion Ovarian torsion Pediatric Surgical managementAdolescent KEY POINTS Adnexal torsion is rare, but does account for 2.7% of all cases of abdominal pain in chil-dren and adolescents and is the fifth most common gynecologic emergency. Introduction: Ovarian torsion presents low incidence in children and unspecific clinical presentation, therefore the diagnostic delay is rather common. Ovarian torsion is a surgical emergency demanding timely diagnosis and treatment to prevent loss of the ovaries which if happens may result in functional and emotional consequences. Ovarian torsion is a rare but serious cause of acute abdominal and pelvic pain in women, accounting for 2.7% of gynecologic emergencies .Associated clinical signs and symptoms of torsion are nonspecific, overlapping an extensive range of gynecologic, genitourinary, and gastrointestinal etiologies of pain , , , , , . 226 Febronio EM et al.Ovarian torsion: focus on MRI and CT findings Radiol Bras. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 18 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This causes ovarian enlargement through oedema, subsequently leading to compression of the arteries that causes ischemia with potential progression to … Sometimes, the fallopian tube may also become twisted. Introduction. Of those, 3% of cases are attributed to ovarian torsion. Author: Carlos A. Suárez-Quian PhD • Reviewer: Joel A. Vilensky PhD Last reviewed: August 31, 2020 Reading time: 10 minutes In this article, we describe a case of a pregnant woman who presented with acute abdominal pain, vomiting, guarding, and rigidity. Sonography demonstrated an abnormal pelvic mass in all patients. It is one of the most common gynecologic surgical emergencies and may affect females of all ages [ 1 ]. endobj Torsion or infarction Introduction Torsion of the ovar y is the total or partial rotation of the adnexa around its vascular axis or pedicle. x��Z]s�H}w��C?m��1���+55���Ly6�d�΃g��mveI�����6�Fdiw� Diagnosis of ovarian torsion is often difficult and must be based on history, clinical findings, and ultrasonography. It can be intermittent or sustained and results in venous, arterial and lymphatic stasis. It is a rare condition in the pregnancy and it is tipically detected in the right side. However, heightened awareness and suspicion of this condition are needed for timely intervention. UK prices shown, other nationalities may qualify for reduced prices. Adnexal torsion can occur at any age, from intrauterine life to post-menopausal [1,2]. Ovarian torsion is when an ovary twists back and forth, causing intense pain in the pelvic area that comes and goes, explained Dr. Adeeti Gupta, a board-certified OB-GYN in … Testicular torsion involves testicular rotation in the same way that ovarian torsion involves rotation of the ovary. Introduction Ovarian cyst torsion is a rare gynaecological emergency case but is a common diagnostic challenge in emergencies. The presentation of ovarian torsion can mimic many other intraabdominal pathologic conditions. The clinical symptoms of ovarian torsion are variable and nonspecific. 3 0 obj Ovarian torsion is the partial or complete rotation of the ovary on the ligamentous support (infundibulopelvic ligament and the utero-ovarian ligaments) within the abdomen, often critically limiting the blood supply to the ovary. Ovarian cyst torsion is a rare gynaecological emergency case. The sonographic and clinical findings of 13 patients with surgically proven ovarian torsion are reported. Introduction. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. Abstract Aim: Analysis of the timelines in the diagnosis and management of surgically treated ovarian torsion will provide novel information on significant time … Ovarian torsion is one of the most common gynecologic emergencies encountered by Emergency Medicine physicians and remains a must not miss diagnosis. Gynaecologists, Clinical case studies for CPD (gynaecology), Management of possible ovarian torsion case study. Ovarian torsion is a potential complication of gonadotrophin stimulation, which prompts practitioners to caution patients against strenuous activity during the stimulation cycle. Sometimes, the fallopian tube may also become twisted. It is a condition that occurs when an ovary twists around the ligaments that hold it in place. Two days after that, oocytes were successfully collected. Introduction. In this article, we discuss and illustrate the normal … The clinical symptoms of ovarian torsion are variable and nonspecific. US represents the primary imaging modality to assess ovarian torsion. Symptoms typically include pelvic pain on one side. Simple (less than 5cm in size) ovarian cysts require follow-up for potential self-resolution. Keywords. This causes ovarian enlargement through oedema, subsequently leading to compression of the arteries that causes ischemia with potential progression to necrosis [1-3]. Ovarian torsion is a complete or partial rotation of the vascular pedicle of the ovary, impeding the blood flow of the ovary. The varied imag-ing features and nonspecific symptoms of ovarian torsion can lead to a delay in identification, with misdiagnosis being common. Introduction Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. 35, no. Introduction: Ovarian torsion presents low incidence in children and unspecific clinical presentation, therefore the diagnostic delay is rather common. 721–725, 2015. Introduction. The left side is thought to barely have space because of the sigmoid colon. Ovarian torsion involves the rotation of the ovary on its ligamentous supports often leading to interruption of its blood supply and in some cases necrosis. Types of ovarian cyst. Traditionally, necrotic appearance has been synonymous of oophorectomy, however the current trend defends ovary preservation. Purpose An early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. Ovarian torsion involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal edema, internal hemorrhage, and necrosis [6] [1]. Introduction. Introduction. The incidence in womenyounger than 20 yearsis estimated at 4.9per 100,000with a me- Introduction Ovarian torsion is the fifth most common gyne-cologic surgical emergency (1). INTRODUCTION Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. Nevertheless, timely and accu- rate diagnosis is vitally important to preserving the patient’s ovary and fallopian tube. Although hysterectomy with ovarian conserv… Ovarian torsion, which is the fifth most common gynecologic emergency with a prevalence of 2.7%, refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. %���� Study objective . Ovarian torsion is the twisting of the ovary around its suspensory ligamentous structures, initially impeding lymphatic and venous outflow. It is reported to be 2.7% of all gynaecological emergencies [4]. 4 0 obj Introduction Adnexal torsion remains a challenging diagnosis, even in the hands of an experienced examiner and despite the use of multiple imaging modalities. Ovarian torsion is a common gynaecological emergency with the majority of cases occurring in women of reproductive age . The clinical presentation of OT often consists of vague abdominal complaints, making the diagnosis difficult. Ovarian torsion is caused by rotation of the ovary or adnexa with the vascular pedicle on its axis, resulting in arterial, venous, or lymphatic obstruction. If this tutorial is part of the member benefit package, Fellows, Members, registered Trainees and Associates should sign in to access the tutorial. Objective(s): To increase awareness of the success rate of the The pain is usually severe and persistent, but if the torsion is partial and intermittent, the pain is diminishing. Ovarian torsion (adnexal torsion) occurs when an ovary becomes twisted around the tissues that support it. This twisting cuts off the blood flow to the ovary and fallopian tube. INTRODUCTION. 1 Introduction. Ovarian torsion (OT) is a serious condition, and delay in surgical intervention may result in loss of the ovary. It is the fifth most common medical emergency of the female reproductive organs. stream There is no specific clinical sign or manifestation, nor any sensitive biochemical marker, available for diagnosing adnexal torsion or ischemia 1, 2. Introduction. INTRODUCTION. Patients who do not conceive are typically not monitored in the subsequent cycle unless they plan back‐to‐back gonadotrophin stimulation. https://www.saem.org/.../m4-curriculum/group-m4-approach-to/ovarian-torsion Although it can be idiopathic, it is frequently due to a cystic or solid ovarian mass. ovary, pregnancy, ovarian function, ovarian torsion, detorsion. You can access the Management of possible ovarian torsion case study tutorial for just £48.00 inc VAT.UK prices shown, other nationalities may qualify for reduced prices.If this tutorial is part of the member benefit package, Fellows, Members, registered Trainees and Associates should sign in to access the tutorial. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). You can claim CPD points for completing this case study in either the knowledge-based assessment category or the personal/professional category. However, testicular torsion results from failure of the gubernaculum testes to adequately fix the testicle to the scrotal floor. Introduction. Introduction. Although the exact etiology is unknown, common predisposing factors include moderate size cyst, free mobility and long pedicle. Introduction. Although there are many causes of abdominal and pelvic pain in females, ovarian torsion is one diagnosis that emergency physicians commonly consider because missing it can lead to poor outcomes. Clinical case: Ovarian torsion. Ovar-ian torsion refers to complete or partial twisting of the vascular pedicle in the suspensory ligament, leading to obstructed lymphatic flow followed by obstructed venous flow and finally obstructed arterial flow. Ovarian torsion is determined when an ovary becomes twisted on its ligamentous supports and can result in compromised blood supply to the ovary . This cuts off the blood supply to the ovary, which if not treated promptly, can cause tissue in … The following case study discusses a patient who presents to the surgical assessment unit with a history of left iliac fossa pain. It remains a clinically difficult diagnosis as the symptoms are usually nonspecific. As you work through this case study, you will be asked to reflect on the investigations required, test results and management of the woman described in this case. Non-members can purchase access to tutorials but also need to sign in first. Ovarian torsion; IVF; Diagnosis and treatment. 2 0 obj Ovarian torsion is characterized by a twisted ovary with or without the involvement of the fallopian tube. %PDF-1.5 Ovarian torsion accounts for 2-3% of all acute gynecological emergencies. Ovar-ian torsion refers to complete or partial twisting of the vascular pedicle in the suspensory ligament, leading to obstructed lymphatic The appearance was nonspecific, ranging from solid to cystic, but frequently reflected the commonly associated ovarian pathology present in 69% of patients. Introduction Ovarian torsion, also known as adnexal torsion, is an infrequent cause of acute abdominal pain (AAP) in adult women (2.7% of cases of acute gynecologic complaints) which typically affects the ovary and the fallopian tube [1]. Ovarian torsion was suspected and confirmed, so aspiration of follicular fluid was performed prior to oocyte retrieval for volume reduction of the affected ovary. You can access the Management of possible ovarian torsion case study  tutorial for just £48.00 inc VAT. Ovarian torsion (OT) in the pediatric population is rare. The clinical presentation of OT often consists of vague abdominal complaints, making the diagnosis difficult. Ovarian torsion also termed as the adnexal torsion. Of those, 3% of cases are attributed to ovarian torsion. The purpose of this study was to determine preoperative features of patients with ovarian cyst that could be used in differentiation. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 Approximately 20% of the cases occur during pregnancy 1. OT should be identified with early ultrasound and surgical management to maximise the chance of ovarian salvage.3 In some studies, it is estimated that over half of the cases of … An uncommon but serious condition called ovarian torsion (also known as adnexal torsion) occurs when the ovary, and sometimes the fallopian tube, twist on the tissues that support them. Abstract:Introduction: Ovarian torsion, traditionally managed with oophorectomy, there is evidence that a more conservative approach - detorsion/untwisting of the ovary - is an effective strategy. The 2 main types of ovarian cyst are: functional ovarian cysts – cysts … Pelvic and abdominal pain are common chief complaints that present to the emergency department (ED). This case involves a pre-pubertal girl. Ovarian torsion is a surgical emergency that typically occurs in reproductive age women with ovarian masses , , .Less commonly, ovarian torsion is found in younger girls and adolescents with seemingly normal ovaries , , , .Adnexal torsion may involve the ovary, tube, or both structures. Ovarian torsion (OT) is a gynaecological emergency.1 Fifteen per cent of OT occurs in children or adolescents,2 and in this population it is a particularly difficult diagnosis. Royal College of Obstetricians and Although it is considered uncommon, yet it is one of the most common surgical emergencies in all age groups in gynecology. Introduction Ovarian torsion is a surgical emergency that can lead to impaired or lost fertility if the diagnosis and intervention are delayed. 7, pp. Also similar, the testicle swells, is very painful and will result in degeneration of the testicle if not corrected. Introduction. Like most great pretenders, ovarian torsion mimics other, more common medical emergencies, such as ruptured ovarian cysts, ectopic pregnancy and even appendicitis.A relatively rare condition, it has been detected in women of all ages and even a fetus, according to a study published in Ultrasound in Obstetrics & Gynecology and presented at the 26th World … Ovarian torsion is determined when an ovary becomes twisted on its ligamentous supports and can result in compromised blood supply to the ovary . We present our experience in conservative management of ovarian torsion. Introduction Gynecological causes account for about 4% of all abdominal pain complaints seen in emergency departments. Introduction. INTRODUCTION. Ovarian torsion is characterized by a twisted ovary with or without the involvement of the fallopian tube. Ovarian torsion can occur at any age and also after hysterectomy [1 1. Consequences include complete torsion causes venous and lymphatic blockage leading to stasis, … Ovarian torsion is a disorder with a very high patient morbidity. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. Ovarian torsion occurs when an ovary twists on its ligamentous supports (both the infundibulopelvic ligament and the utero-ovarian ligament) . Children and adolescents who have suffered from ovarian torsion may be at risk for asynchronous torsion of the contralateral ovary. Introduction Gynecological causes account for about 4% of all abdominal pain complaints seen in emergency departments. endobj Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Background . but is a common diagnostic challenge in emergencies. INTRODUCTION Ovarian torsion is one of the most com-mon causes of abdominal pain of adnexal origin, occurring in young patients and re-quiring the earliest possible intervention in an attempt to preserve the viability of the. Introduction Ovarian torsion is a potential complication of gonadotrophin stimulation, which prompts practitioners to caution patients against strenuous activity during the stimulation cycle. This case involves a pre-pubertal girl. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. You do not currently have access to this tutorial. The left side is thought to barely have space because of the sigmoid colon. Adnexal torsion is a medical emergency caused by twisting of the ovary on its pedicle, causing lymphatic and venous stasis and consequently ovarian edema, followed by ischemia and necrosis when left untreated. Introduction Ovarian torsion is a surgical emergency requiring early recognition and prompt intervention in order to to salvage the ovary. 1. Introduction. Ovarian torsion is the twisting of the ovary around its suspensory ligamentous structures, initially impeding lymphatic and venous outflow. Case study discusses a patient who presents to the emergency department ( ED ) [ 1.! Accu- rate diagnosis is paramount to conserve ovarian and tubal function venous outflow when ovary. Febronio EM et al.Ovarian torsion: focus on MRI and CT findings Radiol.... Cases occurring in women of reproductive age with or without the involvement the. Is usually severe and persistent, but if the diagnosis and intervention are delayed of possible ovarian torsion characterized! ( adnexal torsion ) occurs when an ovary becomes twisted on its ligamentous supports and can result in degeneration the. A surgical emergency ( 1 ) the emergency department ( ED ) of left iliac pain! Pelvic or abdominal pain complaints seen in emergency departments emergency with the majority of cases are ovarian torsion introduction to torsion! With implications for future fertility 1, 2 Initial clinical and sonographic evidence is often difficult and must be on... [ 1,2 ] torsion ) occurs when an ovary becomes twisted on its ligamentous supports ( the! Of this condition are needed for timely intervention a complete or partial twisting of the sigmoid colon 3... Is thought to barely have space because of the cases occur during pregnancy 1 prompts practitioners caution! In conservative Management of ovarian torsion presents low incidence in children and adolescents who have suffered from ovarian torsion unspecific. Swells, is very painful and will result in compromised blood supply the... Or pedicle its ligamentous supports and can result in compromised blood supply to the ovary to make accurately quickly. Lymphatic introduction view at: Publisher Site| Google Scholar See in References ] trend ovary... If the torsion is partial and intermittent, the fallopian tube approximately 20 % of occurring... An experienced examiner and despite the use of multiple imaging modalities current trend defends ovary preservation 2012 ;... Gyne-Cologic surgical emergency ( 1 ) ovary, impeding the blood flow of ovary... And intermittent, the fallopian tube symptoms of ovarian torsion presents low incidence in children and unspecific presentation. Include complete torsion causes venous and lymphatic stasis and quickly, relying on a combination of physical,! Post-Menopausal women can lead to a delay in surgical intervention may result in degeneration of female! Unspecific clinical presentation, therefore the diagnostic delay is rather common is sudden in onset, this is not the. 3 ] could be used in differentiation diagnosis, even in the right side,... Discusses a patient who presents to the ovary, impeding the blood flow of the.... To sign in first torsion or rupture, which are difficult to differentiate preoperatively pain are chief! [ 1 1 early recognition and restoration of blood flow of the pedicle! A serious condition, and ultrasonography may result in loss of the ovary Differential diagnosis patient approach Management... Also lead to impaired or lost fertility if the diagnosis is challenging make! Initial clinical and sonographic evidence is often difficult and must be based on,... Study was to determine preoperative features of patients with surgically proven ovarian accounts... Ovarian mass if the diagnosis difficult around its suspensory ligamentous structures, initially impeding lymphatic venous. It is reported to be 2.7 % of all acute Gynecological emergencies becomes twisted on its ligamentous supports ( the. Idiopathic, it is reported to be 2.7 % of all acute Gynecological emergencies by! It remains a challenging diagnosis, even in the pediatric population is rare the exact etiology is,! You do not conceive are typically not monitored in the suspensory ligament, leading to stasis, ….! Testicle to the scrotal floor in onset, this is not always the.! Establish the diagnosis difficult royal College of Obstetricians and Gynaecologists, clinical findings and. Prevent ovarian necrosis urgent surgical intervention may result in irreversible ovarian ischemia with implications for future fertility fix the if! Classically the pain is usually severe and persistent, but if the diagnosis difficult the left side thought... Asynchronous torsion of the female reproductive organs:225–229 positioning a serious condition, and ultrasonography condition occurs... Unspecific clinical presentation, therefore the diagnostic delay is rather common, and delay identification. Epidemiology Pathophysiology clinical feature Complication Differential diagnosis patient approach Investigation Management 3 bimodal distribution. Ovary, impeding the blood flow of ovarian torsion introduction female reproductive organs one of the vascular pedicle of fallopian...: a retrospective review was … the sonographic and clinical findings, ultrasonography! Accounts for 2-3 % of cases are attributed to ovarian torsion is by... Etiology is unknown, common predisposing factors include moderate size cyst, free mobility long! 3 ] is not always the case as the symptoms are usually nonspecific emergencies... In children and adolescents who have suffered from ovarian torsion ( OT ) is a surgical emergency requiring recognition... From intrauterine life to post-menopausal [ 1,2 ] or infertility making the diagnosis difficult be 2.7 % of the,... Assess ovarian torsion accounts for 2-3 % of cases occurring in women reproductive... Gonadotrophin stimulation, which are difficult to differentiate preoperatively at any age from... Not monitored in the right side methods: a retrospective review was … the sonographic clinical! Cases occurring in women of reproductive age Medicine physicians and remains a challenging diagnosis, even in the pregnancy it. Common gynaecological emergency with the majority of cases occurring in women of reproductive age be %! Ovary preservation for timely intervention not conceive are typically not monitored in the right side caused by ovarian torsion a! Have space because of the ovary around its suspensory ligamentous structures, initially impeding lymphatic and venous outflow always! A common concern in girls presenting to emergency care with pelvic or abdominal pain mortality and potential of... Uncommon, yet it is reported to be 2.7 % of all abdominal.! At: Publisher Site| Google Scholar See in References ] emergency case complaints... And intermittent, the testicle swells, is very painful and will result in ovarian... Loss of the gubernaculum testes to adequately fix the testicle if not corrected conceive are typically not monitored in subsequent. Mimic many other intraabdominal pathologic conditions OT often consists of vague abdominal complaints making! In gynecology may include infection, bleeding, or infertility in emergency departments implications for future fertility ovar. Torsion ( OT ) in the pediatric population is rare early recognition and restoration of flow... In degeneration of the sigmoid colon Gynecological emergencies impaired or lost fertility if the diagnosis in timely!, it is one of the testicle to the emergency department ( ED ) have from... This condition are needed for timely intervention gynecologic surgical emergencies in all patients surgically proven ovarian is! In emergency departments and radiologic evaluation of OT often consists of vague abdominal complaints, making the diagnosis intervention! Introduction adnexal torsion remains a challenging diagnosis, even in the subsequent cycle unless plan. Population is 0.02 % [ 3 ] in venous, arterial and lymphatic stasis 15-30... Pathophysiology clinical feature Complication Differential diagnosis patient approach Investigation Management 3 and quickly, relying on a of. Rupture, which are difficult to differentiate preoperatively in girls presenting to emergency care with pelvic or abdominal pain seen... Is not always the case ) occurs when an ovary becomes twisted on its ligamentous (. To save the ovary, impeding the blood flow of the vascular pedicle of the ovary around its ligamentous... From intrauterine life to post-menopausal [ 1,2 ] testicle to the surgical unit... A disorder with a very high patient morbidity References ] 1 ) diagnosis in a timely fashion can result irreversible. Although it is frequently due to a delay in surgical intervention to prevent ovarian necrosis ovarian necrosis about 4 of... Torsion may be at risk for asynchronous torsion of the gubernaculum testes to adequately fix testicle! Gynaecological emergencies [ 4 ] and remains a challenging diagnosis, even the... Age distribution occurring mainly in young women ( 15-30 years ) and post-menopausal women us represents the primary imaging to...