Ovarian Torsion

Abstract

Approximately 90 % of patients with adnexal torsion present with moderate to severe pelvic pain and are subsequently discovered to have an adnexal mass. Symptoms may be constant or intermittent. Transvaginal pelvic ultrasound is the recommended imaging study for most patients. The presence of a unilateral adnexal mass associated with the symptom complex described above is an indication for surgical evaluation. Most adnexal masses associated with torsion are ≥5 cm. Doppler studies may reveal diminished or absent venous flow. One should visualize and explore the pelvis and adnexal structures bilaterally. Additionally, other potential causes of abdominal pain should be evaluated including appendicitis, diverticulitis, and Meckel’s diverticulum. Once the diagnosis is confirmed, detorsion is followed by assessment for viability with an emphasis on adnexal preservation, especially nulliparous females. Both oophoropexy and shortening of the infundibular ligament have been proposed as strategies to prevent recurrence.