Definition

Ovarian torsion is a condition where the ovary twists around the ligaments that hold it in place. This torsion can obstruct blood vessels to the ovary and fallopian tube (oviduct).

The ovary is a small organ located in the lower abdomen, while the fallopian tube connects the uterus and the ovary. In some cases, the tube may also become twisted, causing the ovary to swell. If left untreated, it may lead to infection and severe pain.

Ovarian torsion can occur in nearly all women of any age. However, 20% of cases occur in premenstrual girls, and 50% occur in women who have menstruated. Pregnancy is a risk factor for ovarian torsion, with an incidence rate of 8–15% in pregnant women.

Causes

Women aged 20 to 40 are at high risk for ovarian torsion, though it can occur at any age. Sometimes, cysts or tumors on ovarian tissue can cause the ovary to twist. Large tumors increase the risk of the ovary twisting around surrounding ligaments.

Another cause is abnormally long ligaments around the ovary. Long ligaments increase the likelihood of ovarian torsion. However, in some cases, the cause remains unknown.

Read more: Ovarian Cysts - Definition, Cause, Symptom, And Treatment AI Care (ai-care.id)

Risk Factor

Several risk factors increase the risk of ovarian torsion:

• Polycystic Ovary Syndrome (PCOS)
• Tubal ligation (a contraceptive method)
• Enlarged ovaries
• Hormonal treatments, such as fertility treatments
• Pregnancy
• History of ovarian torsion

Symptoms

Ovarian torsion can obstruct blood vessels, causing the following symptoms:

• Sudden, severe pelvic or lower abdominal pain
• Abdominal cramps
• Nausea
• Vomiting
• Fever (if ovarian tissue starts dying)
• Abnormal vaginal bleeding or discharge

In several cases, pain or cramps in the lower abdomen may come and go over several weeks, indicating the ovary may be trying to return to its normal position.

Read more: Polycystic Ovary Syndrome (PCOS) - Definition, Cause, Symptom, and Treatment AI Care (ai-care.id)

Diagnosis

A doctor will diagnose ovarian torsion through a medical interview about your symptoms, a physical examination, and additional tests if needed.

After discussing your symptoms and medical history, the doctor will examine the lower abdomen or pelvic area to check for tenderness or palpable lumps.

The doctor may recommend the following tests:

• Transvaginal Ultrasound: Inserting an instrument into the vagina to view the ovary, fallopian tubes, and blood flow
• Complete Blood Count: Checking white and red blood cell levels
• Abdominal Ultrasound: Examining internal abdominal organs to detect tumors (masses) that might cause torsion
• hCG Test: Elevated hCG levels may indicate pregnancy, a risk factor for ovarian torsion
• CT Scan or MRI: Helping to confirm the diagnosis
• Diagnostic Laparoscopy: A procedure involving a small incision in the abdomen to insert a camera and examine the ovary

Management

Surgery is the only possible method for managing ovarian torsion. The doctor will also provide medication to relieve symptoms like abdominal pain, nausea, and vomiting before or after surgery.

Surgery must be performed promptly to prevent blood flow obstruction and ovarian tissue death.

Surgical options include:

• Laparoscopy: Making a small incision in the abdomen to insert tools to untwist the ovary, recommended for pregnant women with ovarian torsion.
• Laparotomy: Making a large abdominal incision, recommended if the ovary is not clearly visible or if there is severe bleeding.

Post-surgery, patients may be discharged within a few days. The doctor will recommend follow-up visits and advise avoiding strenuous physical activities and heavy lifting.

Pain relief medication will be provided for post-surgery pain.

Complications

The most likely complication of ovarian torsion is ovarian necrosis, where ovarian tissue dies due to prolonged lack of blood supply. If it occurs, the doctor will remove the ovary and affected tissue. Removing the ovary can impact fertility, as the ovary produces and releases eggs for fertilization.

Prevention 

There are no specific steps to prevent ovarian torsion, as it often occurs suddenly. However, you can:

• Manage and treat conditions that increase the risk of ovarian torsion, such as ovarian cysts or tumors
• Regularly visit the doctor if you have had a tubal ligation or a history of ovarian torsion
• Attend regular pregnancy check-ups

When to See a Doctor?

Seek immediate medical attention if you experience severe pelvic pain, nausea, and vomiting unrelieved by medication. These symptoms indicate an emergency. Do not wait for symptoms to subside. Visit your doctor immediately.

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