In the setting of acute pelvic pain, ovarian torsion is often a leading diagnostic consideration. Rapid diagnosis and intervention are necessary to preserve ovarian function. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Methods: During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. Reduction of ovarian torsion 1 week after embryo transfer in a patient with bilateral hyperstimulated ovaries. In another study, of 32 premenarchal patients with ovarian torsion, the main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). Adnexal torsion is a term that is inclusive of either the ovary, fallopian tube, or both. Gray scale US combined with Doppler US is the method of choice for imaging of lower abdominal and pelvic pain in female patients. The diagnosis is challenging to make accurately and quickly, relying on a combination of physical exam, history and radiologic evaluation. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. Here, we discuss the major diagnostic considerations of acute pelvic pain and an enlarged ovary. It is the fifth most common cause of gynaecological surgical emergencies [1]. Gray-scale mode ultrasound is used to visualize static ovarian anatomy but can be very useful in diagnosing torsion, with specificities ranging from 93-100%. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian mass, heterogeneous stroma of the ovary on the side of pain as well as an abnormal location of the ovary can all be seen in ovarian torsion. Ovarian torsion can occur prenatally and … Patients present with acute lower abdominal pain and concomitant nausea, vomiting. [17] Ovaries with torsion can frequently be anterior to the uterus. Abdominal pain, vomiting, ovarian enlargement, and absence of ovarian venous Doppler flow are the most frequently shown clinical and sonographic indicators of ovarian torsion. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described [1?? They both can be fake-outs. Ovarian torsion occurs when the ovary becomes twisted. The symptoms of ovarian torsion are highly variable, leading to a potential delay in diagnosis with lifelong sequela for fertility [2]. Ovarian torsion is "a situation in which the ovary twists on its own blood supply," Karen Wang, M.D., assistant professor of gynecology and obstetrics at Johns Hopkins University, tells SELF. This includes the cases in which you are concerned about appendicitis. Acute pelvic pain is the leading reason for emergency visits to gynecology departments [1]. Ovarian torsion may occur in a normal ovary [30% cases]; however, cysts and tumors are the leading causes of excessive rotation of the ovary, leading to torsion. Ovarian torsion should also be considered in patients with a recent history of either infertility treatment or strenuous physical activity presenting with severe lower-quadrant pain. While it can rarely occur with a normal ovary, the majority of cases are associated with some type of ovarian pathology (e.g., tumor, cyst, hyperstimulation syndrome secondary to infertility treatments). OBJECTIVE To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. Early diagnosis is important to prevent loss of the adnexa or ovary and, more rarely, potentially fatal thrombophlebitis or peritonitis. Acute pelvic pain is the leading reason for emergency visits to gynecology departments [1]. Ovarian Torsion. Doppler and gray-scale sonographic classification of adnexal torsion. In a retrospective review of 87 cases of torsion, Houry et al. Failure to establish the diagnosis in a timely fashion can result in irreversible ovarian ischemia with implications for future fertility. Pinto AB, Ratts VS, Williams DB, et al. Unilateral pelvic pain in a girl is ovarian torsion until proven otherwise. [1] Ovarian torsion is the partial or complete rotation of the ovary on the axis between the utero-ovarian and infundibulopelvic ligaments. Major advantages of US are that it is radiation-free, cost-effective, and has easy availability. Ovarian torsion, premenarchal girls, laparoscopic detorsion Introduction. Often the pain is severe and abrupt, but trying to tease this out is often not fruitful. Abdominal tenderness was present in 64.1%.On abdominal ultrasound, an enlarged ovary was identified in 28.9% 11) . The same increase can be anticipated after ovarian torsion, and this may aid in rapid diagnosis and treatment of ovarian torsion. Objective: To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. According to literature reports, right sided torsion is more common than left. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Pathophysiology. METHODS During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. By definition, ovarian torsion arises from the twisting of the ligamentous supports and vascular pedicle supplying the ovary or fallopian tubes or both resulting in … Right ovarian torsion ... MD Presentation A 30 year old woman with intermittent right adnexal pain of 24 hours duration was referred by the ER for pelvic ultrasound . Priya Raj had abdominal pain from ovarian torsions for months, but doctors mistook it for other ailments before she was diagnosed in the ER during COVID-19. Abdominal pain was significantly more common in women with adnexal torsion than women without adnexal torsion (97.7% vs. 23.3%, P < .01), and the intensity of the abdominal pain was also more severe in women with adnexal torsion than that in women without adnexal torsion (mean scale… Ovarian torsion has an incidence rate of 2/10 000 to 4.9/100 000 [1]. Ovarian torsion is a feared and difficult to diagnose emergency due to its relatively nonspecific presenting symptoms. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ... Goldberg Y, Bardicef M, Lissak A, et al. Pain from ovarian torsion has classically pain been described as sharp, sudden, and unilateral; however, in practice these historical features can not be used to reliably rule out cases of torsion. Ovarian torsion is a gynecological emergency and is caused by the twisting of the ovary and fallopian tube on the vascular pedicle. The symptoms of ovarian torsion are highly variable, leading to a potential delay in diagnosis with lifelong sequela for fertility [2]. Sonographic findings associated with ovarian torsion include a rounded and enlarged ovary on the ipsilateral side with pain. It is sometimes seen in pregnancy and may also be associated with sudden increases in intra-abdominal pressure that can occur with coughing or hiccupping. Ovarian torsion accounts for up to 2.7% of all cases of acute abdominal pain. ?12].However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to CT or MRI (the latter in pregnant or young patients) as the first imaging study. Gray‐scale ultrasound and color and power Doppler are important diagnostic tools that may assist in cases of suspected ovarian torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Reported signs and symptoms associated with ovarian torsion: Stabbing pain, 70% Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ... Owing to the lack of ionizing radiation, widespread availability, and lack of need for sedation, gray scale, with color Doppler ultrasound examination is often the initial imaging obtained when there is suspicion of gynecologic pathology. Ovarian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2.7% to 3%. The torsion score was given by the following equation: Score = Absence of leucorrhoea and metrorrhagia * 25 + Ovarian cyst larger than 5 cm * 25 + Pain lasting less than 8 h * 20 + Vomiting * 20 + Abdominal or lumbar pain … Ovarian torsion is when an ovary twists back and forth, causing intense pain in the pelvic area that comes and goes, explained Dr. Adeeti Gupta, a board-certified OB-GYN in New York. Concomitant ovarian and tubal torsion has been shown to occur in up to 67% of cases of adnexal torsion (10,11). Ovarian torsion accounts for up to 2.7% of all cases of acute abdominal pain. Ovarian Torsion Definition Ovarian torsion is the twisting of an ovary on its ligamentous supports and can result in a com-promised blood supply. We measured plasma D-dimer levels 2 h after the operation because various studies have shown that D-dimer increases within minutes after the onset of ischemia and remains elevated for 6–12 h ( Acosta et al. 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 symptoms are non-specific ranging from abdominal pain, nausea, vomiting or low-grade fever. Ovarian torsion is an infrequent but significant cause of acute lower abdominal pain. Ovarian torsion. 1 – 4 It may signal either a necrotic adnexa or an unimpaired vascularly twisted ovary. Some symptoms include, lower abdominal pain, nausea, and vomiting. Prior abdominal surgeries and ovarian hyperstimulation syndromes are also known causes. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. A twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary. Eight girls (group 1) had ovarian torsion in a normal ovary, and twenty-one girls (group 2) had ovarian torsion including a mass or cyst. In torsion, the ovary typically appears hypoechoic secondary to edema from obstructed lymphatic or venous flow. found that 70% of patients reported “sharp or stabbing” pain. Some causes of ovarian torsion may be related to an ovarian cyst, certain medications, pelvic surgery and pregnancy. Ovarian torsion is the twisting of the ovary on its vascular pedicle that can lead to vascular compromise and necrosis. Ovarian enlargement is common with ovulation induction and therefore predisposes the patient to torsion. 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