Cases and figures Epidemiology Ovarian torsion has a bimodal age distribution occurring mainly in young women years and post-menopausal women. There is adnexal tenderness. A raised white cell count is common. Pathology The result of vascular compromise secondary to ovarian torsion is hemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset. Torsion of a normal ovary more commonly occurs in young children when developmental abnormalities predispose the ovary to torsion, such as excessively long Fallopian tubes or an absent mesosalpinx.
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Post-menopausal women can experience ovarian torsion. People between the ages of 20 and 40 years old are most likely to experience ovarian torsion. However, women of all ages, from infancy to post-menopause, can experience ovarian torsion. Sometimes, the presence of a cyst or other tissue mass in the ovary can displace it. The extra weight or mass on the ovary can cause it to start to twist and rotate around its supporting ligaments.
Another common cause is an ovarian ligament, connecting the ovary to the uterus, that is longer than usual. A longer ovarian ligament makes ovarian torsion more likely. Assisted reproductive technologies ART , such as inducing ovulation , are another factor that can increase the risk for ovarian torsion. Pregnant women can experience ovarian torsion as well as those who are not pregnant. In the first trimester, women may have corpus luteum cysts that cause the ovary to twist.
Higher hormone levels during pregnancy can also relax tissues in the body, including the ligaments that hold the ovaries in place. If the ligaments are not taut, they may be more prone to twisting. Treatment Surgery is the only way to untwist an ovary. A doctor may also prescribe medications to reduce pain and nausea for comfort prior to the surgery. A doctor will often recommend performing surgery as quickly as possible.
If ovarian torsion restricts blood flow for too long, the ovarian tissue may die, and a surgeon will need to remove the ovary. Ideally, a doctor can perform the procedure using a laparoscopy. A laparoscopy involves making small, keyhole-like incisions in the abdomen. The doctor will insert several medical instruments, including a video camera, into the abdomen and pelvis and attempt to untwist the ovary.
Sometimes, if a doctor cannot see the ovary well enough, they may need to perform an open procedure. This means making a large incision under the navel to expose the ovary and untwist it. Most of the time, a person can return home the same day after an ovarian torsion procedure. If it shows signs of tissue death, the doctor may have to remove the ovary at a later date.
A doctor may make recommendations about follow-up care, such as avoiding heavy lifting or intense physical activity for a few weeks. A person can help relieve pain and discomfort by taking over-the-counter OTC medications, such as ibuprofen or acetaminophen.
People should report signs of an infection or another complication to a doctor as soon as possible. Signs of an infection include: a fever redness and inflammation at the incision sites foul-smelling discharge a wound that does not heal increasing pelvic pain Share on Pinterest ART increases the risk of ovarian torsion.
People who undergo ART have a much greater risk of experiencing ovarian torsion than those who do not. The elevated risk is usually due to the hormones required for in vitro fertilization or ovulation induction.
These hormones may cause the ovaries to enlarge, develop multiple cysts, or both. While ovarian cysts are usually harmless, they can increase the risk of ovarian torsion. While ART can be a successful treatment when a person has problems conceiving, people should always discuss the possible risks with a doctor and seek medical attention if they experience symptoms of ovarian torsion.
One possible complication of ovarian torsion is necrosis. Ovarian necrosis refers to the death of ovarian tissue due to blood loss. A doctor will remove the affected ovary surgically if this happens. Surgery for ovarian necrosis can affect fertility, as the ovaries produce and release eggs for fertilization. However, if a doctor does not remove the ovary, a person will be at risk of ovarian infections that can cause an abscess or peritonitis.
It is essential for anyone who experiences ovarian torsions to go to follow-up appointments to ensure the ovary is healing well and receiving enough blood. Outlook According to the American Pediatric Surgical Association , ovarian torsion is the fifth most common medical emergency involving the female reproductive organs. If a person seeks urgent medical attention and undergoes surgery to reduce the torsion, there are unlikely to be further complications.
However, if ovarian torsion has restricted blood flow to the ovary for too long, or the person has a cyst or tumor , they may require further treatment.
Torsión ovárica: fisiopatología, causas, signos, síntomas, pruebas, tratamiento conservador