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{{Ovarian torsion}}
'''For patient information, click [[Ovarian torsion (patient information)|here]]'''


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{{SK}} Adnexal torsion
{{SK}} Adnexal torsion


==Overview==
==[[Ovarian torsion overview|Overview]]==
Ovarian torsion refers to a twisting of the ovary. If the torsion involves the ovary and the oviduct it is called adnexal torsion. Ovarian torsion is in the differential diagnosis of unilateral abdominal pain in a woman. Approximately 60% of the time it occurs on the right side of the abdomen.


==Epidemiology and Demographics==
==[[Ovarian torsion historical perspective|Historical Perspective]]==
Obviously ovarian torsion only occurs in women. Ovarian torsion is the fifth most common gynecologic emergency. 83% of cases occur in women of reproductive age, with a median age at presentation of 28 years.


==Pathophysiology==
==[[Ovarian torsion pathophysiology|Pathophysiology]]==
In general, ovarian torsion occurs in association with an enlarged ovary.  Because ovarian enlargement plays a critical role, 50% to 60% of cases of ovarian torsion are due to either benign or malignant ovarian tumors,  usually over 4 cm in size. An enlarged ovary that occurs in early pregnancy due to enlargement of the corpus lutiem can also predispose a woman to ovarian torsion.  Likewise women undergoing fertility treatment who develop theca lutein cysts are at risk of ovarian torsion.  Ovarian torsion can occur in children if a long fallopian tube is present.


==Differential Diagnosis of Underlying Causes of Ovarian Torsion==
==[[Ovarian torsion causes|Causes]]==
===Gynecologic Disorders===
Infertility drugs


Long fallopian tube in children
==[[Ovarian torsion differential diagnosis|Differentiating Ovarian Torsion from other Conditions]]==


Benign and malignant [[ovarian tumor]]s
==[[Ovarian torsion epidemiology and demographics|Epidemiology and Demographics]]==


[[Pregnancy]]
==[[Ovarian torsion risk factors|Risk Factors]]==


==Differential Diagnosis of  Disorders That Ovarian Torsion Should Be Distinguished from==
==[[Ovarian torsion natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
[[Appendicitis]]


[[Ectopic pregnancy]]
==Diagnosis==
 
[[Ovarian torsion history and symptoms|History and Symptoms]] | [[Ovarian torsion physical examination|Physical Examination]] | [[Ovarian torsion laboratory findings|Laboratory Findings]] | [[Ovarian torsion CT|CT]] | [[Ovarian torsion MRI|MRI]] | [[Ovarian torsion ultrasound|Ultrasound]] | [[Ovarian torsion other imaging findings|Other Imaging Findings]] | [[Ovarian torsion other diagnostic studies|Other Diagnostic Studies]]
== Diagnosis==
Abdominal ultrasound is helpful in establishing the diagnosis in patients with suspected torsion.
 
<div align="left">
<gallery heights="175" widths="175">
Image:Ovarian-torsion-001.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-002.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-003.jpg|CT patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-004.jpg|Coronal T2  patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-005.jpg|Sag T2  patient#1 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-006.jpg|Axial T2 patient#1  <small>Image courtesy of RadsWiki and copylefted</small>
</gallery>
</div>
 
<div align="left">
<gallery heights="175" widths="175">
Image:Ovarian-torsion-101.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-102.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-103.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-104.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
Image:Ovarian-torsion-105.jpg|8 y/o female with right lower quadrant pain patient#2 <small>Image courtesy of RadsWiki and copylefted</small>
</gallery>
</div>


==Treatment==
==Treatment==
Associated symptoms of nausea and [[vomiting]] can be treated with antiemetics. Dehydration secondary to vomiting can be treated with intravenous fluids.
[[Ovarian torsion medical therapy|Medical Therapy]] | [[Ovarian torsion surgery|Surgery]] | [[Ovarian torsion primary prevention|Primary Prevention]] | [[Ovarian torsion secondary prevention|Secondary Prevention]] | [[Ovarian torsion cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ovarian torsion future or investigational therapies|Future or Investigational Therapies]]
 
===Early Conservative Management===
If there is no evidence of vascular compromise, or [[peritonitis]] then laparoscopy can be used to uncoil the torsed ovary.
 
===Salpingo-oophorectomy===
If there is evidence of vascular compromise, or peritonitis, the salpingo-oophorectomy may be  required.  Unfortunately, the visual characteristics of the ovaries such as size, color, and edema may not accurately reflect the extent of injury.  Therefore, most studies support a strategy of early conservative management, which is successful in 88% of cases.
 
===Treatment to Reduce the Risk of Recurrent Torsion===
Among young women in whom there is a long ligament, laparoscopic triplication of the utero-ovarian ligament has been utilized to reduce the risk of recurrent torsion. Patients with [[polycystic ovarian disease]] are also at risk of recurrence.


== Case Studies ==
[[Ovarian torsion case study one|Case #1]]
==Related Chapters==
* [[Testicular torsion]]
* [[Ovary]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Disease]]


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Latest revision as of 19:56, 7 March 2013

Ovarian torsion Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Ovarian Torsion from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Adnexal torsion

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Ovarian Torsion from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters


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