Ovarian torsion

1. OVARIAN TORSION

2. Ovarian torsion
 Complete or partial rotation of the
ovary on its ligamentous supports ,
often resulting in impedance of its
blood supply.

4. The fallopian tubes may also
twist with the ovary
when this happens
it is called
“ADNEXAL TORSION”

5. The twisted ovary/tube causes vascular
stasis , progressive ovarian edema (size
increase) with associated ovarian
swelling, followed by gangrene (tissues
damage) , hemorrhagic necrosis (filled
with blood) & infarction of the affected
tissue

6. Torsion may be
-Complete
-Incomplete (partial)

7. Complete torsion
 It is associated with venous & arterial
occlusion.
 360 degree rotation of the vessels
 With complete torsion ,ovarian pedicle may
have one .Two or more twists.

8. Incomplete torsion
 Also known as partial or sub-torsion
 Arterial flow is present with incomplete
torsion
 Less than 360 degree rotation

9. Ovarian & adnexal torsion
usually occurs in an ovary
with a mass.
Ovarian & adnexal torsion is
more common in
childhood, pregnancy and
women undergoing ovulation
induction therapy

10. Torsion of an otherwise
normal ovary (no mass & not
enlarged) is most common in
children.
During the early pregnancy
,the presence of an enlarged
corpus luteum cyst likely
predisposes the ovary to
torsion.

11. Women undergoing ovulation induction therapy for
infertility are at increased risk secondary to
ovarian enlargement with multiple ovarian cysts
associated with ovulation hyperstimulation
syndrome (Ovarian hyperstimulation syndrome
is an exaggerated response to excess hormones.
It usually occurs in women taking injectable
hormone medications to stimulate the development
of eggs in the ovaries. Ovarian hyperstimulation
syndrome (OHSS) causes the ovaries to swell and
become painful.).

12.  Ovarian torsion is an unusual but serious
problem.
 Torsion typically involves not only the ovary
but frequently also the fallopian tube.

14. Signs & symptoms
 Patients typically present with
severe, acute, progressive, unilateral
lower quadrant abdominal pain .
 Onset of pain during exercise or
other agitating movement is
common.

15. Clinical presentation
 Nausea
 Vomiting
 Fever
 Leukocytosis

16. Normal Ovary and Unlikelihood ofTorsion
If the ultrasound shows that the ovary looks normal
in size and how it reflects sound waves, it's usually
a sign that there's no twisting issue (torsion).
Enlarged and Mixed-Up Appearance inTorsion:
But if the ovary is twisted, it tends to get bigger
and looks mixed-up on the ultrasound.This mix-up
is because of things like swelling, bleeding, or cells
dying.

17. Ultrasound is the modality
of choice.
Laparoscopy can be used for
both confirmation of
diagnosis & treatment.

18. Sonographic features
 1- Ovarian enlargement
 2- An ovarian mass
 3- Heterogenous appearance of the ovarian
stroma
 4- String of pearl appearance
 5-Abnormal ovarian location
 6- Decreased or absent ovarian flow on
doppler
 7-Whirlpool sign

19. Ovarian enlargement
 The affected ovary become
enlarged because of swelling
(edema) caused by problems with
blood and fluid drainage..

20. An ovarian mass
 The ovary that's affected often feels sore and
responds with pain when pressed using a
vaginal probe.

21. Heterogenous appearance of
ovarian stroma
 Heterogenous appearance of
ovarian stroma due to edema &
hemorrhage

22. String of pearl appearance
 Represents multiple small
peripheral follicles
 Same sonographic feature in
polycystic ovaries but with
different clinical context.

23. Abnormal ovarian location
 Torsed ovary is located anterior to
uterus instead of lateral to uterus.

24. Decreased or absent flow
 When ovarian torsion is
incomplete, the ovary may seem
normal on ultrasound, but signs of
blood vessel issues, like swollen
and twisted veins, can be detected
using color or power Doppler
imaging

25. Whirlpool sign
 The "whirlpool sign" in ovarian torsion refers
to the twisting or coiling of blood vessels
around the ovary's twisted center, seen in
imaging.

31. Twisted tube no ovarian flow