Ovarian torsion is a gynecologic emergency that occurs when the ovary twists around the ligaments that support it. This twisting can block blood flow to the ovary and surrounding structures, which can lead to tissue damage if it is not treated quickly.
This condition most often causes sudden pelvic or lower abdominal pain, usually on one side of the body. Other symptoms such as nausea or vomiting can also occur and may appear suddenly along with the pain.
Ovarian torsion requires prompt medical evaluation because early treatment can help preserve the ovary and prevent complications. Diagnosis usually involves imaging tests and clinical evaluation, while treatment most often requires surgery to untwist the ovary and restore normal blood flow.
Main symptoms
Ovarian torsion usually causes sudden symptoms that appear when blood flow to the ovary becomes restricted.
Common symptoms include:
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Sudden, severe pelvic or lower abdominal pain, usually on one side
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Nausea
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Vomiting
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Pain that may come and go as the ovary twists and untwists
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Abdominal tenderness
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Fever in some cases
Symptoms can vary between individuals. In some cases, especially in children or adolescents, the pain may be less obvious and develop gradually.
Possible causes
Ovarian torsion occurs when the ovary rotates around the ligaments that hold it in place. This rotation compresses the blood vessels that supply the ovary, which can reduce or completely block blood flow.
Several conditions can increase the risk of ovarian torsion.
1. Ovarian cysts or masses
Large ovarian cysts or benign masses are the most common causes. When the ovary becomes enlarged due to a cyst or tumor, it becomes heavier and more likely to twist.
2. Enlarged ovaries
Ovaries that become enlarged due to hormonal stimulation or fertility treatments may be more mobile and prone to twisting.
3. Pregnancy
Hormonal and anatomical changes during pregnancy can increase the likelihood of ovarian torsion, especially during the early stages.
4. Longer or more mobile ligaments
Some people naturally have ligaments that allow the ovary to move more freely. Increased mobility can make torsion more likely.
Ovarian torsion is not contagious and cannot be transmitted from person to person because it is a mechanical condition rather than an infection.
Confirming a diagnosis
Diagnosis of ovarian torsion is based on symptoms, physical examination, and imaging tests. Doctors often suspect the condition when sudden pelvic pain occurs along with nausea or vomiting.
Ultrasound with Doppler imaging is commonly used to evaluate blood flow to the ovary. In some situations, CT or MRI scans may also be used. However, the condition is often definitively diagnosed during surgery, typically through laparoscopy.
Treatment options
Ovarian torsion is considered a surgical emergency because delayed treatment can lead to permanent damage to the ovary.
1. Laparoscopic surgery
The most common treatment is minimally invasive surgery called laparoscopy. During this procedure, the surgeon untwists the ovary to restore blood flow. In many cases, the ovary can be preserved if treated quickly.
2. Removal of the ovary
If the ovary has lost blood supply for too long and the tissue is no longer viable, removal of the ovary may be necessary. This procedure is called an oophorectomy.
3. Oophoropexy
In certain cases, especially if torsion happens more than once, a procedure called oophoropexy may be performed. This surgery secures the ovary in place to reduce the chance of future twisting.
Prevention measures
There is no guaranteed way to prevent ovarian torsion, but managing certain risk factors may help reduce complications.
Examples include:
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Monitoring large ovarian cysts or masses
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Careful medical supervision during fertility treatments
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Seeking prompt medical care for sudden pelvic pain
Early recognition of symptoms and rapid treatment are the most important factors in preserving ovarian function and preventing long term complications