Ovarian Torsion: Pathophysiology, Causes, Signs, Symptoms, Tests, Treatment- Conservative

Ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery and/or vein. Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of the ovary and tube, tumors, cysts etc. In majority of the cases, ovarian torsion is found in women aged between 20 and 40 years. Pregnancy and menopause increases the risk. Other risk factors include increase in the length of ovarian ligaments, ovaries, which are enlarged due to other medical conditions, increased size of corpus luteum in pregnancy, and jolting movements. Treatment comprises of uncoiling the ovaries via laparoscopy, oophoropexy to stabilize the ovary in order to prevent future torsions. Surgical removal of ovary is done in severe cases where the ovary has become necrosed due to cut off in the blood supply.

The development of torsion is related to the development of an ovarian mass. During a woman’s reproductive years, the usual growth of large corpus luteum cysts poses as a risk factor for rotation or torsion. Ovarian tumors also commonly cause the torsion due to their mass effect. Torsion of the ovary commonly occurs with torsion of the fallopian tube along with their shared vascular pedicle surrounding the broad ligament. Rarely, the ovary may rotate around the mesovarium or the fallopian tube may rotate around the mesosalpinx. In more than half of the cases, torsion occurs unilaterally, with the right side being slightly more prevalent.

• Congenital and developmental abnormalities, such as, increased length of the fallopian tube or absent mesosalpinx.
• Spasms or congestion in the blood vessels of the mesosalpinx.
• Other medical condition such as fibromas or ovarian cysts, tumors of the ovary or tubes.
• Injury or trauma to the ovaries or fallopian tubes.

• Abrupt onset of acute/intense pain which is usually unilateral in the lower abdomen.
• Pain may radiate to the back, laterally or towards the thigh.
• Nausea.
• Vomiting.
• Diarrhea.
• Constipation.
• Patient may be tachycardic.
• Fever indicates that necrosis has set in.

It is difficult to diagnose ovarian torsion correctly. Doppler ultrasound helps with the diagnosis. Laparoscopy helps in confirming the diagnosis.

Conservative treatment of ovarian torsion comprises of laparoscopy in order to uncoil or straighten out the torsed/rotated ovary. Oophoropexy may also be done to stabilize the ovary which is likely to torse in the future. NSAIDs such as ibuprofen and naproxen help in pain control. Surgery for removing the ovaries is done in severe cases where the blood supply to the ovary is cut off for a prolonged period of time and results in necrosis of the ovary. As of now, there is no known way to prevent ovarian torsion.