Ovarian Torsion – Help From emedicine.medscape.com And From Radiopaedia

All that follows are excerpts from the article, Ovarian Torsion
Updated: Jun 27, 2017 Author: Erik D Schraga, MD from emergencymedicine.medscape.com.

And after those excerpts I’ve included a link to the Ovarian Torsion Article from Radiopaedia.

Abdominal pain in women always requires that we first rule out a complication of pregnancy like ectopic pregnancy. So abdominal pain in girls and women always requires a pregnancy test.

Diagnostic Considerations

Confident and early diagnosis of ovarian torsion (adnexal torsion) is imperative. Color Doppler ultrasonography has a vital role in the examination of women with lower abdominal and pelvic pain. [18, 19]

More than 50% of patients with torsion in the pediatric age group have normal-sized ovaries. In those with indicative histories and absence of alternative diagnoses, further investigation must be sought.

In addition to the conditions listed in the differentials, problems to be considered include the following:

Ovarian tumor

Tubal ovarian abscess

Ureteral calculi

Perforated colonic carcinoma

Differential Diagnoses

Practice Essentials

Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. The ovary and fallopian tube are typically involved. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. A quick and confident diagnosis is required to save the adnexal structures from infarction. [123,4]

Pregnancy is associated with, and may be responsible for, torsion in approximately 20% of adnexal torsion cases. [7 Ovarian tumors, both benign and malignant, are implicated in 50-60% of cases of torsion. Approximately 17% of cases have been found to occur in premenarchal or postmenopausal women. [8

Classically, patients present with the sudden onset (commonly during exercise or other agitating movement) of severe, unilateral lower abdominal pain that worsens intermittently over many hours. Approximately 25% of patients experience bilateral lower quadrant pain described as sharp and stabbing or, less frequently, crampy. Nausea and vomiting occur in approximately 70% of patients.

Ultrasonography with color Doppler analysis is the method of choice for the evaluation of adnexal torsion because it can show morphologic and physiologic changes in the ovary and can help in determining whether blood flow is impaired. [9,1011]

In a patient with a history and physical examination findings suggestive of ovarian torsion, gynecologic consultation and subsequent laparoscopy are critical. [121314]

And here is the Ovarian Torsion Article from Radiopaedia:

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