These indices combine clinical and radiologic predictors of adnexal torsion eg, vomiting, adnexal volume, and the adnexal volume ratio volume of affected. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on ct or mri. Twenty patients who had never received cc had a baseline ovarian cyst on transvaginal ultrasound evaluation, for an incidence of. Five year retrospective case series of adnexal torsion. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable.
Because many ovarian cysts cause no symptoms, they are often diagnosed incidentally by chance during tests for other conditions. The size of a cyst is the main factor in whether or not ovarian torsion may occur, jones said. General information o commonly associated with cysts or tumors usually benign1 o clinical presentation can be nonspecific. In prepubescent girls, an ovarian torsion can occur without associated adnexal pathology. This is a 32yearoldwoman, g2p1, referred at 34 weeks of gestation with a fetus with ovarian cyst torsion on the left side.
Ovarian torsion is commonly seen in women of reproductive age but can occur in other age groups as well. Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Jun 05, 2018 ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery andor vein. A twisting of the ovary andor fallopian tube on its vascular and ligamentous supports, blocking adequate blood flow to the ovary. Imaging features of ovarian torsion on ct and mri are then pre sented with illustrative case examples.
Surgical removal is usually necessary to exclude a primary ovarian neoplasm and to address the possibility of an acute ischemic event torsion. Description ovarian torsion occurs infrequently only in females. Schnobrich, in equine internal medicine fourth edition, 2018. What are the signs and symptoms of ovarian torsion.
The incidence of ovarian torsion ranges from 2% to 5% in patients who have surgical treatment for adnexal masses. Jun 27, 2017 ovarian torsion adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ. The estimated incidence of ovarian torsion in women with ovarian malignancy was found to be below 2%. However, this tissue did not exhibit the normal follicular pattern seen in healthy ovaries. Benign ovarian cysts in reproductiveage women undergoing. However, a nonspecific clinical presentation in conjunction with a highly variable imaging appearance makes the diagnosis of ovarian torsion challenging.
When fallopian tube also twists with the ovary it is known as adnexal torsion. While the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. When there are symptoms, you might have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. Ovarian cysts are more likely to occur in women with benign ovarian masses, rather than in those with malignancy. What factors in the patients history make you more suspicious for torsion. By combining the clinical presentation and the results of the. Abdominal pain, ovarian cyst, ovarian torsion, pelvic pain. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. We hereby report a case of huge cyst in a 15year old girl having severe abdominal pain which was diagnosed as torsion in ovarian dermoid cyst.
Gynecologic ultrasonography is the imaging modality of choice. Hunt, md ovarian teratomas include mature cystic teratomas dermoid cysts. Patients with a complex or solid cyst who are postmenopausal should be referred to a gynecologic oncologist for surgical evaluation. The incidence of ovarian torsion among women of all ages is 5. This is because ovarian torsion is literally, the twisting of the ovary that can be caused by various disease, disorder, or other abnormalities within the reproductive system. In can occur in women of all ages, but most women that experience this are younger. In early pregnancy, a torsion can occur secondary to a corpus luteal cyst or laxity of the adjacent tissues. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Ovarian torsion definition of ovarian torsion by medical. As the ovary twists, it will first compromise lymphatic drainage, leading to. A summary of the pathologic results is given in table 1. A normal ultrasound scan does not exclude adnexal torsion and the decision to. She presented to the antenatal clinic with acute pain abdomen.
Most often seen in women of reproductive age between 20 and 40 years. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. Diagnostic features on ct and mri with pathologic correlation shauna duigenan1 esther oliva2 susanna i. Within the cyst was a daughter cyst, without significant bloodflow fig. Ovarian cysts are common, especially during a womans childbearing years. This patient has previously presented twice with right sided ovarian torsion with the background of polycystic ovaries in the last two consecutive years. The larger the cyst, the more likely that ovarian torsion will occur. Ovarian cyst, torsion cases, lectures, articles, cmes. A study at an obstetrics and gynaecology department found that preoperative diagnosis of ovarian torsion was confirmed in only 46% of people ultrasound. Management of ovarian cysts royal berkshire hospital. Benign teratoma dermoids are at high risk for ovarian torsion as they are. Pelvic ultrasound, which allows the doctor to visualize. This study demonstrates the importance of combining both clinical and.
In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release the egg and continues to grow, then it forms a cyst. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. A, there is a heterogeneous structure within the right lower quadrant that measures 6. The presence of an internal daughter cyst was confirmed fig. Due to previous history, there was a high index of clinical suspicion that this may be a. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. Etiologies are quite diverse with ovarian lesions and corpus luteal cysts being the most two common. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. Apr 02, 2020 an ovarian cyst that underwent torsion twisting of the vascular pedicle. Nov 10, 2017 torsion can occur if the ovary is unstable. Torsion of a cyst will usually cause pain and present as an acute abdomen. The size of the mass is positively correlated with the risk of ovarian torsion.
For example, the most common ovarian cyst in adolescents are functional cysts, which typically regress in 8 weeks. Ovarian torsion society for academic emergency medicine. Torsion of uterine adnexa is an important cause of acute abdominal pain. Simple ovarian cysts 5cm in diameter can lead to ovarian torsion.
Pain and nausea are the most common symptoms of ovarian torsion. Ovarian cysts and ovarian cancer what are ovarian cysts. A missed diagnosis of ovarian torsion in a patient with. Ovarian cysts treatment algorithm bmj best practice. Ovarian torsion represents a true surgical emergency. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. The most common neoplasm that caused torsion was a dermoid cyst in 3 20% of the 15 patients fig. This ultrasound case shows many of the typical features of an ovarian torsion. Corpus luteum cysts may also cause the ovary to twist around the ovarian ligament. Abnormal ovarian enlargement should be suspected if an ovary is greater than 10 cm in diameter and the increased size cannot be attributed to recent ovulation or a follicle and persists for more than a month. Ovarian torsion most commonly affects women under 30. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature.
After the surgical removal of an ovarian cyst,the resulting defect in the ovarian surface may either be closed with sutures,treated with bipolar cautery or left open. The most common precipitating factor for ovarian torsion is the presence of an ovarian cyst or mass which rotates the ovary around the infundibulopelvic and utero ovarian ligaments. Ovarian cyst which ruptures, or undergoes torsion or if it shows evidence of malignancy, requires immediate surgery, irrespective of the period of gestation. Ovarian torsion or mass are two important considerations given this appearance. Characteristics of baseline ovarian cysts in clomiphene. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. Ovarian torsion adnexal torsion diagnosis and treatment. Ovarian torsion, also sometimes termed adnexal torsion or tubo ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle. The ovary is distended with absent doppler flow and some adjacent free fluid. Spectrum of imaging findings1 the accurate diagnosis of ovarian torsion is imperative, as loss of the ovary can have longterm consequences in terms of fertility. Endometriomata rarely cause ovarian torsion as they are often associated with adhesions and other endometriotic deposits throughout the pelvis. In most cases, the ovarian mass or cyst is a benign tumorous growth rather than a malignant one. To understand the ovarian torsion symptoms, you must first know the difference between a sign and a symptom. Ovarian torsion occurs in around 2%15% of patients who have surgical treatment of adnexal masses.
Ovarian cysts september 2018 this written information is for guidance only and does not replace consultation and advice by your health care provider. Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of the ovary and tube, tumors, cysts etc. Objectives after participating in this conference, you should have an increased knowledge of, and be more competent to. Of the 466 transvaginal ultrasound examinations, 83 revealed baseline ovarian cysts. Aug 16, 2016 within the cyst was a daughter cyst, without significant bloodflow fig. The ovary receives blood from two sources the ovarian and uterine arteries.
Sixtyfour percent of torsions occur on the right side 10. Risk of torsion is related to size of mass or cyst if known. An ovarian cyst is a sac filled with fluid that forms inside or on the surface of an ovary. The ovary also contains a 4 cm dermoid cyst with an echogenic rokitansky nodule dermoid. Ovarian torsion is defined by rotation of the adnexa on its fibrovascular pedicle, compromising the blood flow and leading, in some cases, to infarction of the tube. The larger the mass, the more likely ovarian torsion will occur. Predisposing factors include an underlying ovarian tumor especially one 6 cm, hypermobile adnexa, and elongated fallopian tubes. Ovarianadnexal torsion is a rather frequent occurrence in women of reproductive age group worldwide. This condition is called ovarian torsion, and can cut off the blood flow to the ovary. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and.
An update on the diagnosis and management of ovarian torsion. Ovarian torsion symptoms, diagnosis and treatment bmj. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. Ovarian cysts are closed, saclike structures within the ovary that are filled with a liquid or semisolid substance ovarian cysts may not cause signs or symptoms. Ovarian torsion is difficult to diagnose accurately, and operation is often performed before certain diagnosis is made.
Ovarian torsion usually presents as acute severe pelvic pain and is caused by partial or complete rotation of the ovarian vascular pedicle. B infertility as with endometriotic cyst, polycystic ovarian syndrome. Dec 31, 2009 in this case we report a 23 yearold primigravida with 30 weeks presenting with torsion of the ovarian cyst. At one end of the cyst, we observed a welldemarcated, solid, homogeneous, yellowwhite mass 8. Studies have shown the low accuracy of clinical evaluation for diagnosing ovarian torsion ovarian torsion. Torsion commonly associated with ovarian cysts, which can act as a catalyst to the torsion process. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard.
Ovarian torsion is defined as a partial or complete twisting of the ovary around its vascular pedicle and ligamentous supports. Guideline for the management of ovarian cysts in children. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. Ovarian tumour or cyst can be easily removed till 28 wks of gestation thereafter it is not readily accessible and may precipitate preterm labour. Ovarian torsion, also sometimes termed adnexal torsion or tuboovarian torsion. Ovarian torsion can occur at any age with the greatest incidence in women 2030 years of age. Ovarian cysts and torsion in assisted reproduction and pregnancy an ovarian cyst 25 mm simple or complex cyst can be found in up to 5% of pregnancies,19 with a % torsion rate. It is basically a sac inside the ovary filled with fluids.
This may result in vomiting or feeling faint most ovarian cysts are related to ovulation, being. Compressed ovarian tissue at the periphery and fallopian tube could be identified. The ovary, and often the fallopian tube as well adnexal torsion become twisted around their vascular pedicle. Benign cystic teratoma dermoid cyst is the most common ovarian tumor in women in the second and third decade of life 9 and as a rule is benign. This twisting can cut off blood flow to the ovary and fallopian tube. You may also be more likely to develop ovarian torsion. How common is torsion in patients with ovarian cysts and what. Pdf update on the management of ovarian torsion in children and. The follicular ovarian cyst is the most common kind of ovarian cyst. Benign teratoma dermoids are at high risk for ovarian torsion as they are heavy, secondary to their semi solid components. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary.
If a child has symptoms of an ovarian cyst, doctors can use multiple tests to make a diagnosis. Ovarian torsionpathophysiologycausessignssymptomstests. Causes and management of ovarian cysts zina abdulkareem al zahidy ibn sina national college abstract an ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. It can be intermittent or sustained and results in venous, arte. Fact sheet ovarian cysts management of an ovarian cyst if you have an ovarian cyst, managing it will depend on what type of cyst it is, how big it is, and what problems you are experiencing.
The search was conducted by combining the textwords ovarian torsion, adnexal torsion, adolescents and oophoropexy. Dec 05, 2014 adnexal torsion is one of the few gynaecological surgical emergencies. For benign ovarian cysts that require surgical man agement, laparoscopy has recently been accepted as the. Often, ovarian torsion occurs because of a cyst on the ovary. Larger cysts are more likely to cause signs and symptoms such as pain in the abdomen, pelvis, sometimes radiating to the low back, is the most common symptom. Nov 23, 2016 ovarian torsion is most common among women of childbearing age, so if youre postmenopausal you can relax a little. Jaspan, do facoog chairman the department of obstetrics and gynecology the einstein health care network, philadelphia, pa. Many simple ovarian cysts are asymptomatic and only identified incidentally on ultrasound. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas 8. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the emergency department ed such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as. You need to go in and be evaluated immediately, especially if you have a known ovarian cyst, jones told healthline. The lower rate of torsion on the left side is attributed to the protective nature. Corpus luteum cysts also have the potential to rupture, causing sudden, sharp pain and some internal bleeding. In relative frequency, functional cysts account for about 24% of all ovarian cysts, benign cysts 70% and malignant 6% 1.
Pelvic ultrasonography can provide information on ovarian cysts. Combining clinical acumen, appropriate tests and detailed consideration may be the best practice at the present time. Most ovarian cysts are small and dont cause any problems. In the absence of infection, ovarian torsion, or endometrioma, these should be regarded with suspicion for malignancy. Torsion of malignant ovarian masses in this population is rare 9 6.
Ovary hypertrophy an overview sciencedirect topics. Differentiate between mature cystic teratomas, immature teratomas, and monodermal teratomas on the basis of histologic and radiologic. Ovarian torsion is the fifth most common gynecological emergency condition and for that, delayed diagnosis is not uncommon leading to disastrous results as ovarian infarction and necrosis. It may be complicated by torsion, rupture, chemical peritonitis and malignant change but is rarely. The primary risk factor for ovarian torsion is an ovarian mass approach to the patient with an adnexal mass view in chinese a woman with an adnexal mass may be associated with adnexal torsion, rupture of an ovarian cyst, or a ruptured ectopic pregnancy.
Larger ovarian cysts can cause pain and pressure symptoms. Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle causing obstruction to venous outflow and arterial inflow. Ovarian cysts can be physiologic or malignant and are known to occur in children of all ages. In 70% of cases, it is diagnosed in women between 20 and 39 years of age. What signs or symptoms make the diagnosis of ovarian torsion more likely. Four patients 27% had an underlying neoplasm as the cause of their torsion. In most series, the right ovary is reported to undergo torsion more often than the left 7, 8, 14, 17. Solid cysts may be associated with necrotic tissue. The most common adnexal mass associated with ovarian torsion is an ovarian dermoid cyst. With young women, the tissue is more flexible, and the ovary can move and twist. The patient presented with a short history of severe lower abdominal pain. An ovarian cyst is a fluidfilled sac within the ovary. Guideline for the management of ovarian cysts in children and adolescents external link opens in a new window.
Jul 19, 2019 the most important risk factor for ovarian torsion is ovarian mass. A 31yearold nulliparous patient presents with a threeday history of right sided colicky abdominal pain and associated nausea. Ovarian torsion accounts for about 3% of gynecologic emergencies. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy.
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