Ovarian torsion: Difference between revisions
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==Background== | ==Background== | ||
*Ovarian torsion is the rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. It is also referred to as adnexal torsion and tubo-ovarian torsion. | |||
*Occurs in females of all ages (most common in reproductive age women) | *Occurs in females of all ages (most common in reproductive age women) | ||
*Ovarian cysts (usually > | *Ovarian cysts (usually > 4cm) and neoplasms account for 94% of cases in adults.<ref>Amirbekian S et al. Ultrasound Evaluation of Pelvic Pain. Radiol. Clin. North Am. 2014;52 (6): 1215-1235</ref> However in children they are only less common in children. | ||
* | *In children hypermobility of the ovary many be the primary cause of torsion. | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
Torsion occurs from either of the two causes: | |||
#Hypermobility of the ovary | |||
#Adnexal mass | |||
*Cysts greater than 4cm more likely to torse<ref>M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282</ref> | *Cysts greater than 4cm more likely to torse<ref>M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282</ref> | ||
* | *Absence of ovarian Doppler flow is highly specific for torsion, but normal Doppler flow does not completely exclude torsion | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 10:23, 6 November 2015
Background
- Ovarian torsion is the rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. It is also referred to as adnexal torsion and tubo-ovarian torsion.
- Occurs in females of all ages (most common in reproductive age women)
- Ovarian cysts (usually > 4cm) and neoplasms account for 94% of cases in adults.[1] However in children they are only less common in children.
- In children hypermobility of the ovary many be the primary cause of torsion.
Pathophysiology
Torsion occurs from either of the two causes:
- Hypermobility of the ovary
- Adnexal mass
- Cysts greater than 4cm more likely to torse[2]
- Absence of ovarian Doppler flow is highly specific for torsion, but normal Doppler flow does not completely exclude torsion
Clinical Features
- Nausea/vomiting (70%)
- Sudden and sharp pain in the lower abdomen (59%)
- can be intermittent
- Fever (<2%)
Differential Diagnosis
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Diagnosis
- Ultrasound (sensitivity 46-70%)
- Diminished or absent blood flow in the ovarian vessels (presence of flow does not r/o)
- Ovarian mass > 2.5-3 cm
- Enlarged ovarian volume
- Loss of echogenicity
- Edema
- Free fluid
- CT may be used to r/o other possible causes of lower abdominal pain; also exclude presence of pelvic mass
- Gold standard: direct visualization!
Treatment
- Emergent OB/GYN consult in ED