intermittent ovarian torsion symptoms

Most patients present with severe non-specific lower abdominal and pelvic pain, either intermittent or sustained, nausea, and vomiting. Myth #2: All Patients with Ovarian Torsion Present with Acute Severe Pain and Vomiting. The classic presentation of ovarian torsion includes acute onset of moderate to severe pain with nausea and vomiting in a patient with a prior history of an adnexal mass. Sonographic whirlpool sign in ovarian torsion. Because of a normal adnexa in 69% of cases in premenarchal patients, a high index of suspicion is necessary in any premenarchal patient with acute-onset abdominal pain 12). Given the severe pain and possibly free fluid in the pelvis, the patient of adnexal torsion develops a fever. Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. doi:10.2214/AJR.10.7293, Ovarian torsion. As in nonpregnant patients, abdominal pain and vomiting are the most common symptoms 44 , 59 , 61 . Ovarian torsion usually occurs on just one side and can cause sudden, intense pain and vomiting. Footnote: 50 year old female with acute severe right iliac fossa pain. Therefore, the absence of tenderness cannot be used to rule out torsion. When the ovary twists around the surrounding tissue that supports, it hampers the blood supply. Congenitally malformed and elongated fallopian tubes may be seen, particularly in young, prepubertal patients. Nausea and vomiting are also a common symptom of having a twisted ovary. Comparison of adnexal torsion between pregnant and nonpregnant women. 2016:8426270. J Ultrasound Med. Ovarian torsion can be intermittent or sustained and results in venous, arterial and lymphatic stasis. Although ovarian torsion in very young children is rare, a case of ovarian cyst torsion was reported in a 2-year-old 6). Malignant tumors are much less likely to result in torsion than benign tumors are. Bider D, Mashiach S, Dulitzky M et-al. Clinical, surgical and pathologic findings of adnexal torsion in pregnant and nonpregnant women. The ovarian torsion in such cases is often intermittent and partial. It is characterized by intermittent scrotal or testicular pain, followed by eventual spontaneous detorsion and resolution of pain. Sudden onset of lower abdominal and pelvic pain is the classic symptom of ovarian torsion. A raised white cell count is common. Radiol. Ovarian torsion classically occurs unilaterally in a pathologically enlarged ovary. 27(5):632.e1-3. The result of vascular compromise secondary to ovarian torsion is hemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset. nausea, vomiting, or diarrhea. With ovarian torsion, the right ovary is frequently involved, but, on occasion, it is bilateral. With this disorder, pain in the lower abdomen is the main indicator. 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 18). Koumoutsea EV, Gupta M, Hollingworth A, Gorry A. Ovarian torsion can occur in women of all ages, from infancy to post-menopause, although it is prevalent mostly in women in their reproductive years. Diagnosis Ultrasonography. It appears as twisting of the thickened vascular pedicle of the enlarged ovary. The median age reported by a large review was 28 years. Characteristics and Management of Ovarian Torsion in Premenarchal Compared With Postmenarchal Patients. Although the loss of a single ovary is unlikely to result in significantly reduced fertility and no cases of death due to ovarian torsion have been reported, early diagnosis allows conservative laparoscopic treatment and reduction in complications. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond☆. Frequent urination 7. Let’s talk about the symptoms of ovarian torsion. Symptoms of ovarian torsion occur due to occlusion of vascular flow from torsion of the vascular pedicle. It may be described as sharp and stabbing or, less frequently, crampy. Laparoscopy can be used for both confirmation of the diagnosis and treatment. Ovarian torsion in premenarchal girls usually presents with intermittent abdominal pain and abdominal tenderness. The lack of oxygen supply causes the tissue of the ovary to die. Ovarian torsion occurs due to two main reasons 7): Torsion of a normal ovary more commonly occurs in young children when developmental abnormalities predispose the ovary to torsion, such as excessively long Fallopian tubes or an absent mesosalpinx. Adolescents are also at risk; this may be because of changes in the weight of their maturing adnexa 5). So, ovarian torsion during pregnancy occurs most likely in the first trimester, and rarely in the second and third trimesters. The ovarian ligament is a muscular and fibrous stalk that connects the ovary to the uterus. Arch Pediatr Adolesc Med. The abdomen may feel tender. Although conservative treatment has been proposed during pregnancy, surgical intervention may be necessary if ovarian torsion is highly suspected. It increases their chances of having ovarian torsion because the extra length makes it easier for the ovary to twist and entangle itself. palpable adnexal mass. How is Ovarian Torsion Diagnosed? Abdominal pain 4. The whirlpool sign or whirl sign of ovarian torsion is characterized by the appearances of a twisted ovarian pedicle seen on ultrasound or even on CT scan. In a retrospective review of 87 cases of torsion, Houry et al. However, most patients with ovarian torsion have a delayed diagnosis, often resulting in infarction and necrosis of the ovary. Common imaging findings of ovarian torsion in the prepubescent and adolescent populations include asymmetric enlargement of the ovary, peripheral loca-tion of ovarian follicles, and midline location of the ovary. Nausea and vomiting may also occur. Sometimes ovarian torsion resolves itself on its own, as it did with Philipps. J Pediatr Adolesc Gynecol. 2017 Jul – Aug. 46 (4):317-329. Complications of ovarian torsion include the following: The physical examination, like the history, is typically nonspecific and is highly variable. What Causes Ovarian Torsion? Abdom Imaging. Ovarian cysts were more commonly demonstrated in postmenarchal patients, and a normal adnexal appearance on ultrasound was more common in premenarchal patients. Patients may have symptoms for several hours or days, and thus, ovarian torsion may be present even with a longer duration of symptoms. Ganer Herman H, Shalev A, Ginat S, Kerner R, Keidar R, Bar J, et al. Other signs and symptoms are nonspecific. Doctors usually suspect adnexal torsion based on symptoms and results of a physical examination. 2015 Sep. 126 (3):514-20. North Am. May be localized to either side or diffuse, or may radiate to the back, flank, or groin. Am Fam Physician 2008; 78:379. The pain is vague and not localized and it’s hard to tell where exactly it hurts. Ovarian torsion is the fifth most common gynecologic surgical emergency (,1). 2007;26 (10): 1289-301. Gray-scale and spectral findings are correlated with the age of the torsion (ie, acute torsion or chronic torsion) and the degree of the twist or torsion. The chances of ovarian torsion are higher for the right ovary because the sigmoid colon on the left doesn’t leave much space and scope for the left ovary to flip over. J Ultrasound Med. A minority of patients, however, complain of mild pain that follows a more prolonged time course. Involved masses are nearly all larger than 4-6 cm, although torsion is still possible with smaller masses. It is usually unilateral and sometimes associated with nausea, vomiting, low-grade fever and mild leukocytosis. abdominal/pelvic tenderness . For days or occasionally weeks before the sudden pain, women may have intermittent, colicky pain, presumably resulting from intermittent torsion that spontaneously resolves. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. Clin. Adnexal mass is a lump in the tissues of the ovary and the fallopian tube. In the context of patient's symptoms concurrently improving this may well represent a degree of hyperemia following de-torsion. Presenting symptoms can include intermit- tent, sharp lower abdominal pain with radiation to the flank, nausea and vomiting, fever, and leukocytosis.8 There may be ultrasounographic findings of an echo- genie mass, … Here is a detailed article about the diagnosis and treatment of ovarian torsion. Most patients present with severe non-specific lower abdominal and pelvic pain, either intermittent or sustained, nausea, and vomiting. Detorsion of the adnexa during pregnancy has not been found to compromise fetal well-being. Lower Abdominal and Pelvic Pain; Sudden onset of lower abdominal and pelvic pain is the classic symptom of ovarian torsion. This can be felt in the entire region or only on one side. Also known as the adnexal torsion and twisted ovary, the condition usually affects only one ovary at a time. | What does Ovarian Torsion Feel Like? However, the presence of enhancement does not exclude torsion because a twisted ovary, with its redundant blood supply, can appear to enhance normally, presumably because the torsion is intermittent or of recent onset . Fever may occur as a late finding as the ovary becomes necrotic. Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and either operated on or observed by a gynecologist. Ovarian torsion is a great example of something you want to nip in the bud; it causes mild, easily mistaken symptoms for a long while, before suddenly turning into a major medical problem. enable_page_level_ads: true Sudden in onset, the pain associated with ovarian torsion can be severe and worsen with activity. 2009 Jun. Required fields are marked *. J Ultrasound Med. So, the ovarian torsion pain can come and go. The characteristics of this condition are very subtle and doctors find it hard to diagnose in spite of using laparoscopy. Adnexal torsion is commonly unilateral, with a slight (3:2) right-sided predilection (presumably due to the protective effects of the sigmoid colon on the left) 17). There is adnexal tenderness. In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy are critical, regardless of whether laboratory and radiologic studies yield normal results. Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. A raised white cell count is common. Nausea and vomiting occur in approximately 70% of patients, mimicking a gastrointestinal source of pain and further obscuring the diagnosis. The arterial blood supply is still intact at this point. Instability and asymmetry are the main reasons for ovarian torsion. Anatomic changes affecting the weight and the size of the ovary may alter the position of the fallopian tube and allow twisting to occur. When inducing ovulation with the help of medication, the ovaries get stimulated, making them prone to flipping over. Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Besides, there are no lab tests that can definitively confirm ovarian torsion. A unilateral, tender adnexal mass has been reported in between 50 and 90% of patients. It can be detected on ultrasound confirming the diagnosis along with the other suggestive imaging features and clinical presentation 14). Studies reveal that ovarian torsion is the fifth most common gynecologic surgical emergency, accounting for 2.7% of cases of acute gynecologic complaints in 1 series. This … Curr Probl Diagn Radiol. Pregnancy is associated with, and may be responsible for, torsion in approximately 20% of adnexal torsion cases 9), probably secondary to the ovarian enlargement that occurs during ovulation in combination with laxity of the supporting tissues of the ovary. Adnexal torsion causes sudden, severe pelvic pain and sometimes nausea and vomiting. The result of vascular compromise secondary to ovarian torsion is hemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset. The corpus luteum cyst goes away on its own by the second trimester. Before the sudden pain, women may have intermittent, crampy pain for days or occasionally even for weeks. 2015 Mar 28. Ultrasonography in early pregnancy should address the cervix and the adnexa for early diagnosis and management of ovarian masses, thus avoiding later emergency situations and the possibility of preterm deliveries 13). Ovarian torsion (OT) occurs primarily in women of child-bearing age, but is rare in the pediatric population. 2005 Jun. 35 (7):721-5, Ashwal E, Hiersch L, Krissi H, Eitan R, Less S, Wiznitzer A, et al. 2004 Dec;23(12):1643-9; quiz 1650-1. https://doi.org/10.7863/jum.2004.23.12.1643, Duigenan S, Oliva E, Lee SI. 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