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The Common Vein Copyright 2008

 

Definition

Ovarian Torsion

Adnexal torsion is a twisting of the ovary around its pedicle including its neurovascular bundle, usually caused by an associated benign tumor, resulting in an acute pain syndrome.  There may be spontaneous untwisting with symptomatic resolution or progressive venous congestion, followed by arterial compromise.  Torsion may be complicated by hemorrhagic infarction.

The diagnosis is based on the clinical presentation of acute severe lower abdominal pain and tenderness often associated with nausea and vomitting..usually in a young female or in post menopausal woman.  Torsion is also seen with increased frequency during pregnancy.and the diagnosis is confirmed using ultrasound which shows a twisted vascular pedicle (“whirlpool” sign) (Lee Graif) or snail shell sign (and lack of flow to the ovary.  The ovary is swollen, and this is the most constant finding. (Albayram).  The lack of arterial flow is only seen in 73% of patients, while absent or decreased venous flow is more frequent.  (Albayram). CTscan show an enlarged ovarysmooth wall thickening, fallopian tubethickening.

Treatment includes urgent laparoscopic evaluation to determine viability.  if the ovary looks viable then the pedicle is untwisted and pexied to prevent recurrence.  If infarction has occurred then the ovary needs to be removed

References

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