Ovarian torsion overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Ovarian torsion refers to a twisting of the ovary. If the torsion involves the ovary and the oviduct it is called adnexal torsion. Ovarian torsion is in the differential diagnosis of unilateral abdominal pain in a woman. Approximately 60% of the time it occurs on the right side of the abdomen.

Obviously ovarian torsion only occurs in women. Ovarian torsion is the fifth most common gynecologic emergency. 83% of cases occur in women of reproductive age, with a median age at presentation of 28 years.

Patients with ovarian torsion often present with sudden onset of sharp and usually unilateral lower abdominal pain. 70% of the cases are accompanied by nausea and vomiting. In case of necrosis, fever occurs.

Abdominal ultrasound is helpful in establishing the diagnosis in patients with suspected torsion.

Associated symptoms of nausea and vomiting can be treated with antiemetics. Dehydration secondary to vomiting can be treated with intravenous fluids.

Conservative treatment of ovarian torsion includes laparoscopy to uncoil the torsed ovary and possibly oophoropexy to fixate the ovary which is likely to torse again. In severe cases, where blood flow is cut off to the ovary for an extended period of time, necrosis of the ovary can occur. In these cases the ovary must be surgically removed.

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