Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. The ovary and fallopian tube are typically involved. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. A quick and confident diagnosis is required to save the adnexal structures from infarction.
Ovarian torsion involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal edema, internal hemorrhage, and infarction with the subsequent sequelae. Ovarian torsion classically occurs unilaterally in a pathologically enlarged ovary. Torsion of a normal ovary is most common among young children.
Pregnancy is associated with, and may be responsible for, torsion in approximately 20% of adnexal torsion cases.
Ovarian tumors, both benign and malignant, are implicated in 50-60% of cases of torsion. Approximately 17% of cases have been found to occur in premenarchal or postmenopausal women.
Classically, patients present with the sudden onset (commonly during exercise or other agitating movement) of severe, unilateral lower abdominal pain that worsens intermittently over many hours. Approximately 25% of patients experience bilateral lower quadrant pain described as sharp and stabbing or, less frequently, crampy. Nausea and vomiting occur in approximately 70% of patients.
Ultrasonography with color Doppler analysis is the method of choice for the evaluation of adnexal torsion because it can show morphologic and physiologic changes in the ovary and can help in determining whether blood flow is impaired.
In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy are critical.