Ovarian Torsion

Twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary

Aetiology

Occurs due to 2 main reasons:
  • Hypermobility of the ovary
  • Adnexal mass, most commonly a dermoid cyst

Clinical presentation

Symptoms

  • Severe non-specific lower abdominal and pelvic pain, either intermittent or sustained
  • Nausea and vomiting

Signs

  • Adnexal tenderness

Investigations

  • Bloods - raised white cell count
  • US - initial imaging modality of choice
  • CT - useful for ruling out ovarian torsion if a normal ovary/adnexa is seen on US

Management

  • Urgent surgery
    • Most ovaries are not salvageable, in which case a salpingo-oophorectomy is required
    • In the case of a non-infarcted adnexa, surgical untwisting can be performed
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