Knowing Ovarian Torsion- A Gynaec Emergency

Did you know that torsion of an ovary accounts for about 2-3% of the cases in a gynecological emergency? Most of these cases are sudden, acute, and indeed severe. The main challenge here is delayed diagnosis due to similar complications in the ovary. As the clinical features are nonspecific ad the ultrasound is the mainstay in making a preoperative diagnosis, the exact incidence of the condition is unknown and a definitive diagnosis is often made intraoperatively. 

Ovarian Torsion: Complete or partial rotation of ligamentous supports which include lymphatics, arteries, and veins due to mechanical obstruction resulting in ischemia and infarction.

Adnexal Torsion: It is the torsion of fallopian tubes and ovaries together. It occurs in 67% of cases of adnexal torsion. 

A risk factor exists when the ovarian mass is bigger than 5 cm in diameter. The most common cause is cysts in the ovaries which include benign cystic teratoma, cystadenoma, hemorrhagic cyst, and cysts caused by ovulation-inducing agents. 

Torsion is commonly seen in adolescents and can occur due to:

Marked mobility of fallopian tubes or mesosalpinxLengthening of pelvic support ligamentsSudden changes in intra-abdominal pressure

Pelvic inflammatory disease, endometriosis or malignancies are not associated with torsion commonly as adhesions make the ovaries immobile. Ovarian torsion can be seen after a laparoscopic hysterectomy. This is due to less adhesion formation, which is the result of lesser peritoneal trauma and inflammatory response in laparoscopic surgeries. Torsion involving Para tubal or Para ovarian cysts has also been found.

The gold standard to treat ovary torsion is surgery, and this is the only way to confirm the torsion. Laparoscopy and laparotomy are the keys to confirming torsion. It is said that laparoscopic management in pregnancy is controversial. Why is it so? What are the further steps?

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