Ovarian torsion (adnexal torsion) is a medical emergency. It occurs when the ovary or ligaments that support the ovaries and fallopian tubes twist, cutting off the blood supply to your ovary, fallopian tube, or both.Ovarian torsion, in itself, is not life-threatening. It can only be treated with surgery, and treatment should be prompt to prevent complications, such as the loss of an ovary or fallopian tube.
Ovarian torsion can be of two main types:
Adnexal torsion: This is the most common type of torsion (twisting of an organ or body part). Here, both the ovary and the fallopian tube twist on their ligaments. The terms ovarian torsion and adnexal torsion are often used interchangeably.
Isolated torsion: Only one organ — either the ovary or the fallopian tube, but not both — twists. Isolated torsion can affect the ovary or the fallopian tube.
Most commonly, someone with ovarian torsion will experience:
Less common symptoms may include:
Fever
Vaginal bleeding
Vaginal discharge
The most common cause of ovarian torsion is having a mass on your ovary that is 5 centimeters (cm) or larger. This is because the weight that a larger mass puts on the ovary and surrounding ligaments increases the risk that the ovary will twist on itself. These ovarian masses can be cysts or (usually noncancerous) tumors.Other factors that raise the risk of ovarian torsion include:
To diagnose ovarian torsion, your gynecologist will likely perform a variety of tests, including the following:
Pelvic Exam Your doctor will check for any masses, discharge, tenderness, or other symptoms in your pelvic area.
Ultrasound Your gynecologist will likely carry out both a pelvic and transvaginal ultrasound. An ultrasound helps detect ovarian torsion in approximately 84 percent of cases.
Surgery The only way to definitively diagnose ovarian torsion is through surgery. This is because an ovary may be torsed (twisted) at one point in time, but not at the time of the ultrasound. Alternatively, the ovary may not have complete blood flow cut off, due to their dual blood supply source.
Blood Tests Your doctor will also likely order some bloodwork as part of your consultation, such as a complete blood count, a complete metabolic panel, and a serum hCG, which measures levels of your hCG hormone and determines if you’re pregnant
Imaging Tests An MRI or CT scan are not usually done for ovarian torsion, but your doctor may recommend them to rule out other abdominal issues, such as appendicitis, ruptured ovarian cyst, ectopic pregnancy (pregnancy outside of the uterus), kidney infection (pyelonephritis), diverticulitis, and pelvic inflammatory disease (PID) — all of which have some symptoms in common with ovarian torsion.
The only way to treat ovarian torsion is through surgery. The surgery is called “detorsion,” or untwisting of the ovary, and it’s usually done by a gynecologist.
Detorsion Surgery
The types of surgery that doctors usually perform for ovarian torsion are:
Laparoscopy In laparoscopy, the surgeon makes a few small incisions and uses a thin tube with a camera on it to visualize the area of concern, perform the untwisting, and, if necessary, remove the cyst or mass that caused the torsion. This is a minimally invasive procedure and the most common way to treat ovarian torsion. You can usually go home the same day after a laparoscopy.
Open Surgery Your surgeon will make a larger incision in your stomach to perform the necessary procedures. This surgery usually requires an overnight stay in the hospital.
Medication Options
Ovarian torsion cannot be treated with medication. But depending on your unique circumstances, your doctor may prescribe medication if you’re in severe pain from the torsion or after surgery.Possible medications include:
Pain relievers, such as acetaminophen (Tylenol), or NSAIDs, such as ibuprofen (Motrin, Advil), to relieve pain before or after surgery
Narcotics such as codeine or morphine, if you’re in severe pain
Laxatives to counter the side effects of narcotic drugs, such as constipation
If you know you have some risk factors for torsion, such as a history of hormonal or fertility treatments, keep your regular scans and appointments to make sure your ovaries don’t have enlarged follicles or cysts, which can raise the risk of torsion.Once ovarian torsion has been surgically treated, it doesn’t usually come back. But to prevent the torsion from returning in some patients, such as postmenopausal women or people who have had a cancerous tumor in their ovary, doctors may recommend removing the affected ovary and fallopian tube (a procedure called salpingo-oophorectomy).
The best results from surgery are seen in people who’ve seen a medical professional as quickly as possible after developing symptoms. Most women (over 90 percent) recover fully with surgery, especially if the condition is diagnosed promptly. Surgeons are also able to salvage the ovary or fallopian tube affected in the vast majority of cases, especially with quick and timely intervention.Once it’s been surgically treated, ovarian torsion doesn’t usually happen again.
If treatment is delayed, possible complications from ovarian torsion include:
Hemorrhage (excessive bleeding)
Peritonitis (inflammation or infection of the abdominal cavity)
Losing the ovary
The need to surgically remove both the fallopian tube and the ovary
Impaired fertility or infertility
Scar tissue in the pelvic area (called adhesions), which may affect fertility
Atrophied ovaries (when ovaries become smaller and reduce in weight), which may affect fertility
It’s important to remember that the vast majority of people affected recover fully with treatment.
Ovarian torsion can affect any person with ovaries, but it occurs most often in women of reproductive age. It can also happen in children and teens, with about 20 percent of cases occurring in girls before they’ve had their first menstruation.
Conditions related to ovarian torsion include:
Ovarian torsion is a twisting of the ovary, the fallopian tube, or both. It is a medical emergency that can only be treated with surgery.
If left untreated, ovarian torsion can lead to complications such as infertility or loss of the ovary.
Surgery is usually done laparoscopically and is therefore minimally invasive, and you typically go home the same day.
The vast majority of people recover fully from ovarian torsion, especially if they receive treatment promptly.
