Ovarian torsion

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

Synonyms and keywords: Adnexal torsion

Overview

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

Overview

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.

Epidemiology and Demographics

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.

Diagnosis

History and Symptoms

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.

Ultrasound

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

Treatment

Medical Therapy

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

Surgery

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.

References

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Historical Perspective

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References

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Pathophysiology

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References

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Causes

Overview

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Urofollitropin, choriogonadotropin alfa
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Choriogonadotropin alfa

References

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Differentiating Ovarian Torsion from other Conditions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: vSyed Hassan A. Kazmi BSc, MD [2]

Overview

Prostatitis should be differentiated from other conditions presenting with lower abdominal pain, nausea and vomiting.

Differentiating Ovarian Torsion from other Diseases

Prostatitis should be differentiated from other conditions presenting with lower abdominal pain, nausea and vomiting. The differentials include the following:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]^[22]^[23]^[24]^[25]^[26]^[27]^[28]^[29]^[30]^[31]^[32]^[33]^[34]

Category	Disease	History	Signs and Symptoms											Physical Examination			Laboratory abnormalities
Category	Disease	History	Nausea/vomiting	Hematuria	Location of pain	Fever	Tachycardia	Hypotension	Hypertension	Anorexia	Constipation	Rebound abdominal tenderness	Urinary frequency/Urgency/Dysuria	Costovetebral angle tenderness	Pelvic Examination	Rectal Examination	Complete Blood Count (CBC)	Urinalysis	BUN	Creatinine	Stone analysis	Urine Beta- hCG	Abnormal Liver Function Tests (LFTs)	Serum Amylase/Lipase	Abdominal/Pelvic CT scan	Serum Parathyroid hormone levels (PTH)
Renal Pathology	Nephrolithiasis	Primary hyper parathyroidism Inadequate dietary calcium intake Hypercalciuria Hyperoxaluria Cystinuria Renal tubular acidosis Infection with urease producing bacteria (Ureaplasma urealyticum, Klebsiella, Protues)	+	+	Flank/back pain radiating to groin	–	+	–	–	+/-	–	–	+	–	–	–	–					–	–	–	Non-contrast CT scan may show stone as radiolucency	+/-
	Pyelonephritis	Urinary tract infection Immunocompromised state (Diabetes, immunosuppressive medications) Urinary tract obstruction History of pyelonephritis Pregnancy Presence of urinary catheter, stent, nephrostomy tube	+	+ (microscopic)	Costovertebral angle Positive renal punch sign	+	+	+	–	+/-	–	+	+	+	Urethritis Vaginitis	–	Leukocytosis	Pyuria Positive leukocyte esterase			–	–	–	–	Globaly decreased contrast uptake Foci from abscess pockets	–
	Renal infarct	Sickle cell disease or trait Thrombosis Trauma Hypertension Cardiac arrhythmia Coagulopathy Atherosclerosis	+	+	Flank pain	+	+	–	+	–	–	–	–	–	–	–	Leukocytosis	Red blood cells Proteinuria			–	–				–
	Renal papillary necrosis	Analgesic use (Phenacetin, acetaminophen, NSAIDs) Pyelonephritis Urinary tract obstruction Sickle cell disease Tuberculosis Cirrhosis Diabetes Vasculitis Renal vein thrombosis	–	+ (microscopic)	Flank pain	+	+/-	–	+	–	–	–	+	–	–	–		Bacteriuria Pyuria Microscopic hematuria			–	–	–	–	Blunted renal calyces Contrast material–filled clefts in the renal medulla Non-enhanced lesions surrounded by rings of excreted contrast material Hyperattenuated medullary calcifications	–
	Renal cell carcinoma	Weight loss History of smoking Obesity Von-Hippel Lindau disease Night sweats Malaise Flank mass	+	+ (microscopic)	Flank pain	–	–	–	+	+	+/-	–	–	–	–	–	Anemia	Microscopic hematuria Renal cell casts Urinary aquaporin-1 (AQP1) and adipophilin (ADFP)- proximal renal tubular cancer			–	–	–	–	Non-contrast CT: Lesions are soft tissue attenuation Areas of calcification and necrosis Contrast-enhanced: Homogenous (small lesions) to irregular (large lesions) contrast enhancement	–
	Uretral stricture	Prior urinary tract surgery Congenital Urinary catheterization Direct penile trauma	–	+/-	–	–	–	–	–	–	–	–	+	–	–	–	–	–			–	–	–	–	–	–
Gynecological Pathology	Pelvic inflammatory disease	Endometritis Saplingitis Cesarian section Septic abortion Urinary tract infection Tuberculosis Actinomycosis	–	–	Right/left upper quadrant	+	+	+	–	+	–	–	+	–	Cervical motion tenderness Adnexal tenderness Foul smelling vaginal/urtetheral discharge	–	Leukocytosis	Bacteriuria (Neisseria gonorrhoeae or Chlamydia trachomatis, polymicrobial) Pyuria			–	–	–	–	Thickening of the uterosacral ligaments Haziness of the pelvic fat Periovarian stranding Enhancement of the adjacent peritoneum Thick-walled, complex fluid collection with septa formation (abscess pockets)	–
	Ovarian torsion	Sudden acute pain Sharp pain aggravated by walking Intermittent/colicky pain	+	–	Unilateral poorly localized lower abdominal	–	+	–	–	–	–	–	–	–	Adnexal tenderness Adnexal mass	–	–	–	–	–	–	–	–	–	Twisted ovarian pedicle Enlarged ovary (>4.0 cm) Distended pedicle Possible underlying ovarian lesion	–
	Ectopic pregnancy	History of previous ectopic pregnancy Tubal surgery Intrauterine device usage History of pelvic surgery History of pelvic inflammatory disease Sub-fertility Sternous excercise Increased maternal age Cigarette smoking	+	–	Lower abdominal Unilateral shoulder or neck pain (referred)	–	+	–	–	+	–	+ (if ruptured)	+	–	Vaginal bleeding	–	Low platelet distribution width (decreased platelet activation) Monocytosis	–	–	–	–	+	+/-	–	N/A	–
Abdominal Pathology	Cholecystitis	Female gender Obesity Pregnancy (increased progesterone promotes biliary stasis) Rapid weight loss Oral contraceptive use Increasing age Total parenteral nutrition	+	–	Right upper abdominal quadrant pain Flank pain	+	+	–	–	+	–	–	–	–	–	–	Leukocytosis	–	–	–	Bilirubin (pigment) stones Cholesterol stones	–	+	+/-	Gallbladder distention Wall thickening Mucosal hyperenhancement, Pericholecystic fat stranding or fluid Gallstones	–
	Appendicitis	Male gender Adolescents Diet low in fiber and high in refined carbohydrates History of appendicitis in first degree relatives	+	–	Pain in umblical area Radiating to right lower abdominal quadrant	+	+	–	–	+	–	+	+/-	–	–	–	Leukocytosis	–	–	–	–	–	–	+ (if perforation)	Larger than 6 mm in diameter, Appendiceal wall thickening Wall enhancement after contrast media infusion Inflammatory fat stranding Phlegmon Free fluid Free air bubbles Abscess Adenopathy	–
	Diverticulitis	Diverticulosis Low fiber diet Old age	+	–	Left lower abdominal quadrant	+	+	–	–	+	+	–	–	–	–	Bleeding Rectal mass Rectal tenderness	Leukocytosis	–	–	–	–	–	–	+ (if perforation)	Colonic wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen) Pericolic fat stranding	–
	Abdominal aortic aneurysm	Hypertension Cigarette smoking Pulsatile abdominal mass	–	–	Epigastric pain Deep boring pain in the back May radiate to flank	–	+	+	–	–	–	+ (if rupture)	–	–	–	–	–	–	–	–	–	–	–	–	Ultrasound more sensitive than CT scan CT scan may accurately predict the aneurysmal size Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold	–
	Portal vein thrombosis	Mutated JAK2 V617F Anti-phospholipid syndrome Paroxysmal nocturnal hemoglobinuria Homocysteinuria Factor V Leiden Prothrombin mutation G20210A Protein C or S deficiency Oral contraceptive use Cirrhosis Pregnancy and post-partum	+	–	Abdominal or lumbar pain	+	+	+	–	+	–	+ (if bowel ischemia or infarction-secondary to extension of thrombus to superior mesenteric vein)	–	–	–	Hematochezia	Anemia Thrombocytopenia	–	–	–	–	–	+	+ (if bowel infarction, perforation)	On non-contrast CT: Hyperdense thrombus On contrast CT Non-enhancing defect of bland thrombus Tumor thrombus exhibits enhancement
	Duodenal ulcer	Pain relieved by intake of food Helicobacter pylori infection Tobacco smoking NSAID use EtOH use Older age Female gender Family history of duodenal ulcers	+	–	Epigastric pain	+	+	+	–	–	–	+ (if perforation)	–	–	–	Melena	Anemia	–			–	–	–	+ (if bowel perforation)	Endoscopy > CT scan for diagnosis	–
	Ischemic colitis	Age > 60 years Hemodialysis Hypertension Hypoalbuminemia Diabetes mellitus	+	–	Acute-onset abdominal cramping	+	+	+ (if necrosis and sepsis)	+	+	+	+ (if transmural necrosis)	–	–	–	Hematochezia	Leukocytosis (if necrosis) Anemia (if perforation and bleeding)	–			–	–	–	+ (if bowel perforation)	Bowel wall thickening Thumbprinting Pericolonic stranding with or without ascites. Double halo or target sign Submucosal edema or hemorrhage Pneumatosis coli (if infarction)	–

References

↑ Worcester EM, Coe FL (June 2008). “Nephrolithiasis”. Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.
↑ Semins MJ, Matlaga BR (February 2010). “Medical evaluation and management of urolithiasis”. Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.
↑ Venkatesh L, Hanumegowda RK (June 2017). “Acute Pyelonephritis – Correlation of Clinical Parameter with Radiological Imaging Abnormalities”. J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.
↑ Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). “Diagnostic significance of clinical and laboratory findings to localize site of urinary infection”. Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.
↑ Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). “Acute pyelonephritis: clinical characteristics and the role of the surgical treatment”. J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.
↑ Saeed K (2012). “Renal infarction”. Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.
↑ Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). “Embolic renal infarction mimicking renal colic”. Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.
↑ Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). “The clinical spectrum of acute renal infarction”. Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.
↑ Brix AE (2002). “Renal papillary necrosis”. Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.
↑ Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). “Renal papillary necrosis: an update”. Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.
↑ Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). “Renal cell carcinoma: diagnosis, staging, and surveillance”. AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.
↑ Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). “[The role of CT scan in the diagnosis of renal cell carcinoma]”. Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.
↑ Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). “Imaging renal cell carcinoma with ultrasonography, CT and MRI”. Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
↑ Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). “Urethral stricture: etiology, investigation and treatments”. Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.
↑ Mundy AR, Andrich DE (January 2011). “Urethral strictures”. BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.
↑ Maciejewski C, Rourke K (February 2015). “Imaging of urethral stricture disease”. Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.
↑ Soper DE (August 2010). “Pelvic inflammatory disease”. Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
↑ Paavonen J (October 1998). “Pelvic inflammatory disease. From diagnosis to prevention”. Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.
↑ Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). “CT findings of acute pelvic inflammatory disease”. Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.
↑ Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). “The clinical diagnosis of pelvic inflammatory disease–reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department”. BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.
↑ Washington C, Carmichael JC (December 2012). “Management of ischemic colitis”. Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.
↑ Chawla YK, Bodh V (March 2015). “Portal vein thrombosis”. J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
↑ “Imaging of Abdominal Aortic Aneurysms – – American Family Physician”.
↑ Aggarwal S, Qamar A, Sharma V, Sharma A (2011). “Abdominal aortic aneurysm: A comprehensive review”. Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.
↑ Destigter KK, Keating DP (August 2009). “Imaging update: acute colonic diverticulitis”. Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.
↑ Hameed AM, Lam VW, Pleass HC (February 2015). “Significant elevations of serum lipase not caused by pancreatitis: a systematic review”. HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.
↑ “Imaging for Suspected Appendicitis – – American Family Physician”.
↑ “CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)”.
↑ “Epididymitis and Orchitis: An Overview – – American Family Physician”.
↑ Jia JB, Houshyar R, Verma S, Uchio E, Lall C (January 2016). “Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology”. Eur J Radiol. 85 (1): 261–267. doi:10.1016/j.ejrad.2015.10.013. PMID 26526901.
↑ Bratt O, Lilja H (January 2015). “Serum markers in prostate cancer detection”. Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.
↑ “Prostate Cancer (Prostate Carcinoma): Symptoms – National Library of Medicine – PubMed Health”.
↑ Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M (November 2014). “The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy”. Ginekol. Pol. 85 (11): 823–7. PMID 25675798.
↑ Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (October 2011). “Diagnosis and management of ectopic pregnancy”. J Fam Plann Reprod Health Care. 37 (4): 231–40. doi:10.1136/jfprhc-2011-0073. PMC 3213855. PMID 21727242.

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Epidemiology and Demographics

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

Overview

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.

References

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Risk Factors

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

Risk Factors

Infertility drugs

Long fallopian tube in children

Benign and malignant ovarian tumors

Pregnancy

References

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Natural History, Complications and Prognosis

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References

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Diagnosis

Treatment

Case Studies

Case #1

Related Chapters

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[pmid18486720-1] Worcester EM, Coe FL (June 2008). “Nephrolithiasis”. Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.

[pmid21789078-2] Semins MJ, Matlaga BR (February 2010). “Medical evaluation and management of urolithiasis”. Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.

[pmid28764263-3] Venkatesh L, Hanumegowda RK (June 2017). “Acute Pyelonephritis – Correlation of Clinical Parameter with Radiological Imaging Abnormalities”. J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.

[pmid17375337-4] Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). “Diagnostic significance of clinical and laboratory findings to localize site of urinary infection”. Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.

[pmid19399273-5] Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). “Acute pyelonephritis: clinical characteristics and the role of the surgical treatment”. J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.

[pmid22969301-6] Saeed K (2012). “Renal infarction”. Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.

[pmid24812524-7] Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). “Embolic renal infarction mimicking renal colic”. Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.

[pmid12389340-8] Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). “The clinical spectrum of acute renal infarction”. Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.

[pmid12512867-9] Brix AE (2002). “Renal papillary necrosis”. Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.

[pmid7038374-10] Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). “Renal papillary necrosis: an update”. Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.

[pmid18806169-11] Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). “Renal cell carcinoma: diagnosis, staging, and surveillance”. AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.

[pmid15536955-12] Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). “[The role of CT scan in the diagnosis of renal cell carcinoma]”. Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.

[pmid20479778-13] Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). “Imaging renal cell carcinoma with ultrasonography, CT and MRI”. Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.

[pmid23596502-14] Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). “Urethral stricture: etiology, investigation and treatments”. Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.

[pmid21176068-15] Mundy AR, Andrich DE (January 2011). “Urethral strictures”. BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.

[pmid26816803-16] Maciejewski C, Rourke K (February 2015). “Imaging of urethral stricture disease”. Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.

[pmid20664404-17] Soper DE (August 2010). “Pelvic inflammatory disease”. Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.

[pmid9891675-18] Paavonen J (October 1998). “Pelvic inflammatory disease. From diagnosis to prevention”. Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.

[pmid24802548-19] Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). “CT findings of acute pelvic inflammatory disease”. Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.

[pmid17054801-20] Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). “The clinical diagnosis of pelvic inflammatory disease–reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department”. BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.

[pmid24294125-21] Washington C, Carmichael JC (December 2012). “Management of ischemic colitis”. Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.

[pmid25941431-22] Chawla YK, Bodh V (March 2015). “Portal vein thrombosis”. J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.

[urlImaging_of_Abdominal_Aortic_Aneurysms_-_-_American_Family_Physician-23] “Imaging of Abdominal Aortic Aneurysms – – American Family Physician”.

[pmid21523201-24] Aggarwal S, Qamar A, Sharma V, Sharma A (2011). “Abdominal aortic aneurysm: A comprehensive review”. Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.

[pmid20676257-25] Destigter KK, Keating DP (August 2009). “Imaging update: acute colonic diverticulitis”. Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.

[pmid24888393-26] Hameed AM, Lam VW, Pleass HC (February 2015). “Significant elevations of serum lipase not caused by pancreatitis: a systematic review”. HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.

[urlImaging_for_Suspected_Appendicitis_-_-_American_Family_Physician-27] “Imaging for Suspected Appendicitis – – American Family Physician”.

[urlCT_Findings_of_Acute_Cholecystitis_and_Its_Complications_:_American_Journal_of_Roentgenology_:_Vol._194,_No._6_(AJR)-28] “CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)”.

[urlEpididymitis_and_Orchitis:_An_Overview_-_-_American_Family_Physician-29] “Epididymitis and Orchitis: An Overview – – American Family Physician”.

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Ovarian torsion

Overview

Epidemiology and Demographics

Diagnosis

History and Symptoms

Ultrasound

Treatment

Medical Therapy

Surgery

References

References

References

Overview

Life Threatening Causes

Common Causes

Causes by Organ System

Causes in Alphabetical Order

References

Overview

Differentiating Ovarian Torsion from other Diseases

Renal Pathology

Gynecological Pathology

Abdominal Pathology

References

Overview

References

Risk Factors

References

References

Diagnosis

Treatment

Case Studies

Related Chapters

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