Table of ContentsView AllTable of ContentsTypesSymptomsCausesDiagnosisTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Types
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Ovarian torsionin female anatomy occurs when theovaryandfallopian tube, which connects the ovaries to theuterus, twists around the supporting tissues and blood vessels. This twisting cuts off the blood supply to the organs.
Ovarian torsion is an emergency condition for which diagnosis and intervention must occur quickly to save the ovary and corresponding reproductive organs. It can occur in people of all ages but is more prominent in adolescents and young women of reproductive age.
This article discusses the signs, causes, and treatment for ovarian torsion.
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Types Of Ovarian Torsion
Partial
A partial ovarian torsion occurs when the ovary and fallopian tube only partly twist to cut off the blood supply.
Usually, the symptoms associated with a partial ovarian torsion are not as severe as a complete ovarian torsion.The ovary and fallopian tube will sometimes twist sporadically over several days or months, leading to recurring abdominal pain and partial torsion.
Complete
A complete ovarian torsion is when the ovary and fallopian tube twist entirely to cut off the blood supply to the tissues.
Ovarian Torsion Symptoms
Right vs. Left SideThe ovary on the right side of the body is more likely to twist than the ovary on the left side, because the left-sided intestine helps keep the left ovary in a stable position.
Right vs. Left Side
The ovary on the right side of the body is more likely to twist than the ovary on the left side, because the left-sided intestine helps keep the left ovary in a stable position.
More than 80% of people with ovarian torsion have a largeovarian cyst(fluid-filled sacs in or on the surface of an ovary) or a mass.The larger the ovarian cyst or mass, the more likely torsion will occur. It can happen with any size mass, but healthcare providers are most concerned about masses greater than 5 centimeters.
Ovarian torsion is more likely to occur with a benign (noncancerous) tumor than withovarian malignancy(cancerous tumor).
When mature eggs are released from the ovary duringovulation, some people develop multipleovarian follicular cysts. These cysts can also increase the risk of ovarian torsion.
People who are at risk for having enlarged cysts or masses include people:
Adolescents With Ovarian TorsionAlmost half of adolescent girls with ovarian torsion have normal ovaries without a cyst or mass.
Adolescents With Ovarian Torsion
Almost half of adolescent girls with ovarian torsion have normal ovaries without a cyst or mass.
Healthcare providers must be highly vigilant for ovarian torsion to catch it early. Before testing, they can only rely on a person’s medical history, physical exam, and risk factors for ovarian torsion.There are no specific blood tests that can indicate ovarian torsion.
A pelvicultrasoundis the best imaging test to diagnose ovarian torsion.If the pelvic ultrasound does not definitively show ovarian torsion but the healthcare provider is still worried about it,magnetic resonance imaging(MRI) orcomputed tomography(CT) imaging of the abdomen and pelvis might help determine a diagnosis.
However, MRI is very expensive and takes a long time to obtain, and CT imaging can miss the diagnosis. Neither is typically recommended to evaluate for ovarian torsion.
Direct visualization during alaparoscopic procedure, which entails making small incisions in the abdomen and sending in a slender tool with a tiny camera attached, is the best way to diagnose ovarian torsion when a provider highly suspects the condition.
The goal of ovarian torsion treatment is to untwist the tissue and vessels to return adequate blood flow to the ovary. This requires a surgical procedure. The options include a laparoscopic or open procedure.
A laparoscopic approach is less invasive than open surgery and is the more popular choice. However, if cancer of the ovaries or fallopian tube is suspected, thegynecologistmay want to do an open procedure.
New recommendations suggest that gynecologists do all they can to preserve ovarian function and future fertility.This means they untwist the tissues and attempt to keep the ovary in place rather than remove it. Ovarian tissue is good at restoring function after being without its blood supply.
The amount of time since symptom onset is not always a reliable indicator of whether the tissue has died. Studies have shown that ovarian function can be restored many days after symptom onset.However, sometimes, too much time passes, and healthcare providers need to remove the ovary.
Experts recommend removing a large cyst or mass to prevent recurrent ovarian torsion if one is found during a surgical procedure.Sometimes, gynecologists can remove the cyst fluid to make it smaller after untwisting the tissue. But even this method cannot prevent ovarian torsion from recurring.
Surgical Management in Pregnant People and AdolescentsThe management of ovarian torsion is the same in pregnant people as nonpregnant people. Laparoscopic surgery is safe to use for treating ovarian torsion during pregnancy.Experts recommend that adolescents should not have a torsed ovary removed during surgical treatment unless the ovarian tissue completely falls apart.
Surgical Management in Pregnant People and Adolescents
The management of ovarian torsion is the same in pregnant people as nonpregnant people. Laparoscopic surgery is safe to use for treating ovarian torsion during pregnancy.Experts recommend that adolescents should not have a torsed ovary removed during surgical treatment unless the ovarian tissue completely falls apart.
The management of ovarian torsion is the same in pregnant people as nonpregnant people. Laparoscopic surgery is safe to use for treating ovarian torsion during pregnancy.
Experts recommend that adolescents should not have a torsed ovary removed during surgical treatment unless the ovarian tissue completely falls apart.
If a person with ovarian torsion does not seek medical care, the ovary becomes ischemic and necrotic, meaning the tissue will die because of a lack of blood flow. Although rare, when this occurs, the area can bleed or become infected, and the infection can spread throughout the rest of the abdomen.
In recent years, gynecologists have moved toward untwisting the tissue and vessels to save the ovary rather than removing the ovary. Previously, there was concern that the act of unraveling would lead toblood clotsthat spread to the lungs.However, this surgery rarely leads to blood clots.
People who have ovarian torsion can still become pregnant afterward. Ovaries left in place have an excellent ability to return to normal function. Still, if one ovary needs to be removed, a person has a second ovary with normal function.
Summary
Ovarian torsion is an emergency condition in which the ovary and fallopian tube twist around the surrounding tissues, cutting off blood supply. It requires a quick diagnosis and intervention to save the ovary and reproductive parts. People with large ovarian cysts or masses are most likely to develop torsion. Gynecologists aim to untwist the tissues and keep the ovary to prevent infectious complications and infertility.
A Word From Verywell
Ovarian torsion is painful and frightening. If you develop severe lower abdominal pain and are of reproductive age, there is a chance you have ovarian torsion. If you are someone with a known ovarian cyst or mass, the chances are even higher. Do not wait to see your primary healthcare provider and instead seek emergency care at the hospital.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Huang C, Hong MK, Ding DC.A review of ovary torsion.Tzu Chi Med. 2017;29(3):143-147. doi:10.4103/tcmj.tcmj_55_17Sasaki KJ, Miller CE.Adnexal torsion: review of the literature.J Minim Invasive Gynecol. 2014;21(2):196-202. doi:10.1016/j.jmig.2013.09.010American College of Obstetricians and Gynecologists Committee.Adnexal torsion in adolescents: ACOG Committee Opinion No, 783.Obstet Gynecol. 2019;134(2):e56-e63. doi:10.1097/AOG.0000000000003373Wang Z, Zhang D, Zhang H, et al.Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: a retrospective study.Medicine. 2019;98(5):e14321. doi:10.1097/MD.0000000000014321
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Huang C, Hong MK, Ding DC.A review of ovary torsion.Tzu Chi Med. 2017;29(3):143-147. doi:10.4103/tcmj.tcmj_55_17Sasaki KJ, Miller CE.Adnexal torsion: review of the literature.J Minim Invasive Gynecol. 2014;21(2):196-202. doi:10.1016/j.jmig.2013.09.010American College of Obstetricians and Gynecologists Committee.Adnexal torsion in adolescents: ACOG Committee Opinion No, 783.Obstet Gynecol. 2019;134(2):e56-e63. doi:10.1097/AOG.0000000000003373Wang Z, Zhang D, Zhang H, et al.Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: a retrospective study.Medicine. 2019;98(5):e14321. doi:10.1097/MD.0000000000014321
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Huang C, Hong MK, Ding DC.A review of ovary torsion.Tzu Chi Med. 2017;29(3):143-147. doi:10.4103/tcmj.tcmj_55_17Sasaki KJ, Miller CE.Adnexal torsion: review of the literature.J Minim Invasive Gynecol. 2014;21(2):196-202. doi:10.1016/j.jmig.2013.09.010American College of Obstetricians and Gynecologists Committee.Adnexal torsion in adolescents: ACOG Committee Opinion No, 783.Obstet Gynecol. 2019;134(2):e56-e63. doi:10.1097/AOG.0000000000003373Wang Z, Zhang D, Zhang H, et al.Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: a retrospective study.Medicine. 2019;98(5):e14321. doi:10.1097/MD.0000000000014321
Huang C, Hong MK, Ding DC.A review of ovary torsion.Tzu Chi Med. 2017;29(3):143-147. doi:10.4103/tcmj.tcmj_55_17
Sasaki KJ, Miller CE.Adnexal torsion: review of the literature.J Minim Invasive Gynecol. 2014;21(2):196-202. doi:10.1016/j.jmig.2013.09.010
American College of Obstetricians and Gynecologists Committee.Adnexal torsion in adolescents: ACOG Committee Opinion No, 783.Obstet Gynecol. 2019;134(2):e56-e63. doi:10.1097/AOG.0000000000003373
Wang Z, Zhang D, Zhang H, et al.Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures: a retrospective study.Medicine. 2019;98(5):e14321. doi:10.1097/MD.0000000000014321
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