This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Left ovary normal size and follicular pattern and flow. This is a rare complication, but it must be heeded during laparoscopic and open surgical removal. Ovarian torsion definition of ovarian torsion by medical. The follicular ovarian cyst is the most common kind of ovarian cyst. Adnexal torsion is one of the few gynaecological surgical emergencies. Torsion of uterine adnexa is an important cause of acute abdominal pain. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Ct is less specific for torsion and carries the additional burden of radiation exposure, while mri is not often readily available in the emergency department setting. Ovarian torsion ot is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Pelvic ultrasonography can provide information on ovarian cysts. Ovarian torsion or mass are two important considerations given this appearance.
The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas 8. The main feature of torsion is ovarian enlargement due to venouslymphatic engorgement, edema and hemorrhage. Ovarian torsion figures 1267 and 1268 should be strongly considered in any patient with acute onset of lower abdominal pain, particularly when it is severe and accompanied by other signs and symptoms, such as diaphoresis or vomiting. Elevated ca 199 level may be related to ovarian torsion and. Ovarian torsion is a common complication of which ultrasonographic diagnosis is confusing. Imaging features of ovarian torsion on ct and mri are then pre sented with illustrative case examples. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. These symptoms can be intermittent or sustained, are highly variable and nonspecific. Ovarian torsion comprises approximately 3% of all gynecologic surgical emergencies, and occurs predominately in women of childbearing age. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. An ovarian cyst is a fluidfilled sac within the ovary.
Ovarian torsion adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. Causes and management of ovarian cysts zina abdulkareem al zahidy ibn sina national college abstract an ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. This may result in vomiting or feeling faint most ovarian cysts are related to ovulation, being. Ovarian torsion also termed as adnexal torsion refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy ie, corpus luteum cyst should increase your suspicion for torsion.
Symptoms typically include pelvic pain on one side. Description ovarian torsion occurs infrequently only in females. While the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. Ruptured cyst patients note a moment of severe pain which often passes after a few hours. In can occur in women of all ages, but most women that experience this are younger. Most cases of the ovarian torsion can be diagnosed on usg. Ovarian torsion ultrasound discussed by radiologist duration. A study at an obstetrics and gynaecology department found that preoperative diagnosis of ovarian torsion was confirmed in only 46% of people. A, there is a heterogeneous structure within the right lower quadrant that measures 6. The search was conducted by combining the textwords ovarian torsion, adnexal torsion, adolescents and oophoropexy.
Sep 20, 2017 ovarian torsion can occur without the presence of a cyst, however. Pregnancy is a risk factor for torsion odds ratio, 18. Right ovary edematous, peripheral small follicles, no flow. Ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery andor vein. An update on the diagnosis and management of ovarian torsion emmanuel damigos ptychio latrikes mbbs,a jemma johns mbbs md mrcog,b, jackie ross mbbs frcog c ast5 in obstetrics and gynaecology, friarage hospital, south tees hospitals trust, northallerton, north yorkshire dl6 1jg, uk bconsultant gynaecologist, kings college hospital, denmark hill, london se5 9rs, uk. What is the difference between ovarian torsion and rupture. Ovarian torsion is difficult to diagnose accurately, and operation is often performed before certain diagnosis is made. Ovarian torsion ncus north carolina ultrasound society. Jul 19, 2019 the most important risk factor for ovarian torsion is ovarian mass. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle causing obstruction to venous outflow and arterial inflow. Rupture and torsion are major damages which may lead to abdominal pain and.
The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. As the ovary twists, it will first compromise lymphatic drainage, leading to. The size of the mass is positively correlated with the risk of ovarian torsion. Sixtyfour percent of torsions occur on the right side 10.
Ovarian torsion adnexal torsion diagnosis and treatment. Benign ovarian cysts in reproductiveage women undergoing. Apr 16, 20 rt torsion ovarian cyst with lt ovarian cyst duration. Objectives after participating in this conference, you should have an increased knowledge of, and be more competent to. The condition occurs following twisting of the ovary on the main vascular pedicle infundibulopelvic ligament ipl containing the ovarian artery and vein, which results in impedance of venous outflow with continued arterial inflow, and eventually leads. We report here a 14yearold adolescent with painless torsion of the ovary including dermoid cyst and with abnormal elevated ca 199 serum levels. Ultrasound is the preferred diagnostic test, but as we discuss later, the presence of blood flow detected by ultrasound does not rule out ovarian torsion. Pdf ovarian tumors and cysts are major problem in women. Adnexal torsion is commonly unilateral, with a slight. As consistent with various studies, in our study also teratoma 22. Ovarian torsion may also be diagnosed on ct or mri, although ultrasound should be the primary imaging modality if torsion is the leading diagnosis. Ovarian torsion represents a true surgical emergency. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of.
Dec 05, 2014 torsion are more likely to occur in an underlying ovarian lesion such as a tumour or cyst. Apr 02, 2020 most torsion cases occur in premenopausal females of childbearing age, but up to 17% of cases affect prepubertal and postmenopausal women. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. It accounts for approximately 23% of all acute surgical emergencies, and is the fifth reason for gynecological emergencies. Physical examination o nonspecific, unilateral pelvic pain o tender adnexal mass. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst.
When fallopian tube also twists with the ovary it is known as adnexal torsion. It is basically a sac inside the ovary filled with fluids. Rt torsion ovarian cyst with lt ovarian cyst youtube. The primary risk factor for ovarian torsion is an ovarian mass and is most common if the ovary is 5 cm or larger. Fever is uncommon, and usually lowgrade if present. A retrospective study revealed a torsion rate of 14. The ovary receives blood from two sources the ovarian and uterine arteries. Ovarian cysts and ovarian cancer what are ovarian cysts.
Within the cyst was a daughter cyst, without significant bloodflow fig. Salmonella treatment failure in a patient with acute brucellosis. Ovarian torsion can occur without the presence of a cyst, however. At day 3, the surgery was performed and the diagnosis was of ovarian cyst with twisted. Occurs in women of all ages 23 involve right tube etiology. An ovarian cyst is a collection of fluid in a sac that is in or on an ovary. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release the egg and continues to grow, then it forms a cyst. Aug 16, 2016 within the cyst was a daughter cyst, without significant bloodflow fig. Torsion of a large ovarian dermoid cyst in the second. Ovarian cyst, torsion cases, lectures, articles, cmes. Brucellainfected ovarian dermoid cyst causing initial seguchi m, kohno c, inukai k,tobayama s. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on ct or mri.
These indices combine clinical and radiologic predictors of adnexal torsion eg, vomiting. Calledfunctional cysts, these occur when the normal follicle that matured to release an egg does not shrink after the egg is released ovulation. As seen in this case, combined surgical procedures may be. Complications may include infection, bleeding, or infertility risk factors include ovarian cysts, ovarian. Unilateral recurrent ovarian torsion in adults is unusual following treatment of common underlying risk factors e. Jun 21, 2012 ovarian torsion may also be diagnosed on ct or mri, although ultrasound should be the primary imaging modality if torsion is the leading diagnosis. In cases where torsion happens without a cyst, its usually younger girls, explained gupta. Adnexal torsion twisting of the vascular pedicle of an ovary, ovarian cyst.
Since torsion is not uncommon, surgical management was often advised with a view of making a definitive diagnosis during the detorsion procedure and remove the cyst while preserv. Adnexal torsion mostly occurs in the child bearing group, but is not. Often accompanies torsion of adjacent ovary often with a cyst but may be isolated to tube epidemiology. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. Cyst can also rupture leading to peritonitis, sepsis, and adhesions. Small functional cysts that cause few symptoms are monitored for several months to ensure that they disappear without treatment. How common is torsion in patients with ovarian cysts and what. Five year retrospective case series of adnexal torsion. The ovary, and often the fallopian tube as well adnexal torsion become twisted around their vascular pedicle.
The first case of torsion was diagnosed in 1891 by kuestner. It occurs commonly in reproductive age group, more on the right side 60% and often presents with acute lower abdominal pain lasting for few hours and up to 24 h, accounting for 2. Risk of torsion is related to size of mass or cyst if known. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. Physiologic cyst maternal hormonal stimulation inutero infantsprepubertal. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature. It may be complicated by torsion, rupture, chemical peritonitis and malignant change but is rarely. Ovarian torsion ovarian torsion is defined by white and stella as a total or partial rotation of the adnexae around its vascular axis 2005, p. Gynecologic ultrasonography is the imaging modality of choice. Resolution of the ovarian torsion, as well as preservation of the pregnancy without surgical intervention.
The treatment of ovarian cysts depends on a womans age, the presence or absence of symptoms, any coexisting conditions related to ovarian cysts, and the appearance of the cyst on the sonogram. Physical examination may reveal lower abdominal tenderness. Benign cystic teratoma dermoid cyst is the most common ovarian tumor in women in the second and third decade of life 9 and as a rule is benign. Pdf update on the management of ovarian torsion in children and. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable.
An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. Laparoscopic uteroovarian ligament truncation and uterosacral. While classically the pain is sudden in onset, this is not always the case. The most important risk factor for ovarian torsion is ovarian mass. Ovarian pathologies often remain silent, however they may come up with abdominal pain, ovarian torsion, haemorrhage, and ovarian cyst rupture which can lead to acute abdomen. An update on the diagnosis and management of ovarian torsion. This twisting can cut off blood flow to the ovary and fallopian tube. Dermoid cysts may also rupture, releasing contents and triggering an inflammatory cascade that often results in peritonitis. You may also be more likely to develop ovarian torsion. It is also strongly associated with ovarian stimulation. Recurrence of ovarian torsion in a multiple pregnancy. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. Subtle anatomic etiologies, such as an elongated uteroovarian ligament and robust ovarian volume, are commonly underappreciated and may contribute to idiopathic recurrent unilateral torsion in adults.
Usually associated with a mass cyst causing rotation obstruction also pid, hydrosalpinx, tubal ligation or adhesions. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release. The larger the cyst, the more likely that ovarian torsion will occur. We hereby report a case of huge cyst in a 15year old girl having severe abdominal pain which was diagnosed as torsion in ovarian dermoid cyst. Evaluation and management of ruptured ovarian cyst view in chinese similarly with a sudden onset of pelvic pain. Pain severity many patients with twisted ovaries note that the pain makes it difficult to laugh, talk, walk, breathe, or be touched in the abdomen. Nov 10, 2017 torsion can occur if the ovary is unstable. Dermoid cyst is the most common germ cell tumor of the ovary containing various tissue elements. If ovarian torsion is suspected, timely intervention with diagnostic laparoscopy is indicated to. Ovarian torsion is an uncommon cause of acute abdominal pain in females, but it is a gynecologic emergency diagnostic delay can result in loss of the ovary. During surgery, torsion was detected in her left adnexa. Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor. Combining clinical acumen, appropriate tests and detailed consideration may be. The risk of torsion increases when pelvic masses exceed 5 cm 7.
The presence of an internal daughter cyst was confirmed fig. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the emergency department ed such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. This is a 32yearoldwoman, g2p1, referred at 34 weeks of gestation with a fetus with ovarian cyst torsion on the left side. South eastern melbourne phn ovarian cyst pathway 2 red flags suspicion of malignancy torsion background about ovarian cyst common types. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of the ovary and tube, tumors, cysts etc.
Ultrasoundguided transabdominal ovarian cyst aspiration and body repositioning to allow for spontaneous detorsion. Torsion of malignant ovarian masses in this population is rare 9 6. Ovarian torsion is the fifth most common gynecological emergency condition and for that, delayed diagnosis is not uncommon leading to disastrous results as ovarian infarction and necrosis. The authors present a case of spontaneous resolving fetal ovarian cyst. We recently treated a 14yearold female patient with clah and ovarian cyst torsion. A twised ovary requires immediate surgery 100% of the time and a ruptured cyst often does not.
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