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A Common Gyn Emergency: Ovarian Torsion, Dr. Lee ObGyn Mcallen, Texas

Posted on November 25, 2012 by admin | Posted in Uncategorized

I have been on call this weekend and it appears it’s the weekend of ovarian torsions. I have had two patients that presented with the typical symptoms of severe acute lower abdominal pain, nausea, and vomiting. Along with a pelvic ultrasound finding of a large ovarian cyst. Both cysts were large, 10 centimeters or the size of a large grapefruit. I was able to remove both of these cysts laparoscopically and the patients went home within 12 hours of their surgery.

Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in ischemia or lack of blood flow. It is one of the most common gynecologic emergencies. The fallopian tube often twists along with the ovary. Ovarian torsion occurs in all age groups, but the majority of cases occur in women of reproductive age. My patients were at the  ages of 16 and 40.

The primary risk factor for ovarian torsion is an ovarian mass and is most common if the ovary is 5 cm (size of an apple) or larger. The classic presentation of ovarian torsion is the acute onset of pelvic pain, often with nausea and possibly vomiting, in a woman with an “adnexal mass” or ovarian cyst.

A definitive diagnosis is made by direct visualization of a rotated ovary at the time of surgical evaluation. The decision to proceed with surgery is based upon a clinical diagnosis, which is often based upon the presence of acute pelvic pain and an adnexal mass with a sonographic appearance consistent with torsion, and after exclusion of other conditions.

So if you have a known ovarian cyst and develop acute abdominal pain then it is important to be evaluated immediately. As time goes on blood flow to the ovary is compromised and the ovarian tissue will eventually become necrotic of no longer be functional. One of my patients was a 16 year old. I was able to take her to the operating room within a few hours of her getting to the ER. She was able to retain her ovary as the blood supply had only been compromised for a short duration of time.

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