When fallopian tube also twists with the ovary it is known as adnexal torsion. Ovarian cyst an ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. The actual incidence of ovarian torsion in children is not well defined and varies in recent literature. Oophoropexy for ovarian torsion is easy to be done by many tools either suturing to the lateral pelvic wall, plication of the ovarian ligament or even fixation to the back of the uterus, but it is little bit difficult to do it for pregnant women with less manipulation. Pearls and pitfalls in diagnosis of ovarian torsion. We also present findings that can help determine the presence of hemorrhagic infarction in patients with adnexal torsion. Gehan mohamed pathogenesis of pos 1 increased gnrh from hypothalamus lead to excessive lh secretion relative to fsh by pituitary gland. Diagnosis and management of an ovarian cyst complicated by torsion in utero. For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable. Ovarian torsion ot is a rare cause of acute abdominal pain during puerperium. Diagnosis and management of an ovarian cyst complicated by.
On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. A free powerpoint ppt presentation displayed as a flash slide show on id. Adnexal torsion leading to ovarian cyst rupture with. In a study by fleischer et al, 29, nonviable, twisted ovaries demonstrated absence of central venous flow,, figs 7c,,, 9c, 9d. After laparoscopic detorsion, the cysts were drained and the ovarian cyst wall removed. Ovarian torsion adnexal torsion diagnosis and treatment. Torsion of paraovarian cyst resulting in secondary. Torsion is a complication of ovarian tumors, with an incidence 6.
Thank you for your interest in spreading the word about the bmj. Ovarian conservation in adnexal torsiona report of six cases. Ovarian torsion is defined as a partial or complete twisting of the ovary around its vascular pedicle and ligamentous supports. The presence of an internal daughter cyst was confirmed fig. Right fallopian tube and ovarian cyst were gangrenous with hemorrhagic fluid inside. Adnexal torsion in the third trimester of pregnancy.
You may also be more likely to develop ovarian torsion. In most cases, the ovarian mass or cyst is a benign tumorous growth rather than a. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. Pearls and pitfalls in diagnosis of ovarian torsion radiographics. Treatment of adnexal torsion using operative laparoscopy. Torsion of a paraovarian cyst and fallopian tube is rare, but it should be considered in the differential diagnosis of acute abdomen in women who are in the reproductive age group.
Pelvic ultrasonography can provide information on ovarian cysts. As the ovary twists, it will first compromise lymphatic drainage, leading to. Abdominal pain, ovarian cyst, ovarian torsion, pelvic pain. The larger the cyst, the more likely that ovarian torsion will occur. Most ovarian cysts are functional in nature, and harmless benign 3. We propose that using trocar site closure needle can be easier and faster technique to do this. The pregnancy continued without problems, and the patient was discharged on. In the normal procedure a follicle that contains the egg is in fact a fluid filled cyst, when due to some unusual reason the follicle doesnt release the egg and continues to grow, then it forms a cyst. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
The ovary is distended with absent doppler flow and some adjacent free fluid. Ovarian cysts represent the most common type of abdominal tumor in female neonates. Ovarian cystthe nest an ovarian cyst is a fluidfilled sac which develops in an ovary. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. Ct and mr imaging features of adnexal torsion radiographics. The ovary also contains a 4 cm dermoid cyst with an echogenic rokitansky nodule dermoid. Ovarian torsion in postmenopausal women and risk of malignancy. Although the variability of color doppler imaging limits its value in diagnosis of ovarian torsion, the utility of this modality may be in determining the preoperative viability of the ovary. Torsion commonly associated with ovarian cysts, which can act as a catalyst to the torsion process. Thus, it warrants immediate attention and decision to intervene is taken when there is. A and b, this patient was initially found to have normal arterial and venous flow.
Ovarian torsion figures 1267 and 1268 should be strongly considered in any patient with acute onset of lower abdominal pain, particularly when it is severe and accompanied by other signs and symptoms, such as diaphoresis or vomiting. No treatment may be needed for certain types of ovarian cysts which tend to go away on their own. The possibility that there may be a malignant cyst when dealing with adnexal torsion has very important consequences for surgical management even if the patients presenting with adnexal torsion are often operated upon as an emergency, whenever an ovarian cyst is responsible for the torsion the treatment must be carried out with the greatest of. Ovarian cysts larger than 4 cm in diameter have been shown to have a torsion rate of approximately 15%.
Intraoperatively a 17x17 cm ovarian cyst on right side with torsion at level of right cornua was encountered. The follicular ovarian cyst is the most common kind of ovarian cyst. Ovarian torsion society for academic emergency medicine. It is basically a sac inside the ovary filled with fluids. Ovarian cysts are the most frequent type of neonatal abdominal tumours with an estimated incidence of more than 30%. If not treated quickly, it can result in loss of an ovary. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign. Within the cyst was a daughter cyst, without significant bloodflow fig. Pdf adnexal torsionsymptoms, diagnosis and management. Ovarian torsion is more commonly seen in cysts that are 5 cm or greater. The ovary receives blood from two sources the ovarian and uterine arteries.
Risk of torsion is related to size of mass or cyst if known. Ovarian torsion has been estimated to account for 2. After further investigation, ot caused by large mucinous cyst was diagnosed. Torsion of the fallopian tube and paraovarian cyst is usually seen in the reproductive age group. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy ie, corpus luteum cyst should increase your suspicion for torsion. The most common precipitating factor for ovarian torsion is the presence of an ovarian cyst or mass which rotates the ovary around the infundibulopelvic and uteroovarian ligaments.
This ultrasound case shows many of the typical features of an ovarian torsion. What signs or symptoms make the diagnosis of ovarian torsion more likely. Since cancer normally leads to the adhesion of the ovary to the surrounding tissues, malignant tumors are less likely to cause torsion, compared to the benign. Ovarian torsion is a rare cause of abdominal pain in girls, accounting for 2. The main causes of surgical intervention for the studied ams were ruptured ovarian cyst in 27. Ovarian torsion occurs when an ovarian cyst or mass. Pdf diagnosis and management of an ovarian cyst complicated. What factors in the patients history make you more suspicious for torsion. Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. The risk of ovarian torsion rises by 5 fold during pregnancy. The purpose of this study was to evaluate the association between torsion angle and findings on ct scan.
Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of. Ovarian torsion occurs when ovarian cysts or neoplasms, usually. Adnexal torsion is one of the few gynaecological surgical emergencies. Some cause problems such as pain and irregular bleeding. In this article, we discuss and illustrate the common and uncommon ct and mr imaging features of adnexal torsion. The unusual and peculiar symptoms in this case make it of sufficient interest to report. Ct scan pelvis was suggestive of ovarian neoplasm with torsion. The paraovarian cyst was removed along with left sided fallopian tube and the patient made an uneventful recovery.
The history pointed to some obscure bladder trouble. Ovarian torsion involves the rotation of the ovarian vascular pedicle, causing obstruction to venous and, eventually, arterial flow that can lead to infarction. Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle causing obstruction to venous outflow and arterial inflow. Fever is uncommon, and usually lowgrade if present. We report six cases of conservative surgery for adnexal torsion. The larger the mass, the more likely ovarian torsion will occur. Being aware of the signs and symptoms of this condition can help identify it early so you can seek treatment. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described 112. An ovarian cyst is a fluidfilled sac within the ovary. Ovarian torsion can be suggested when ultrasound examination detects changes in the size and characteristic of cysts, resulting in the reclassification of simple cysts as complex cysts.
Most ovarian cysts are benign noncancerous and cause no symptoms. Ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery andor vein. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas. Consequently, it is not surprising that in one study, ovarian torsion was only considered in the admitting differential diagnosis of 1947% of patients with actual ovarian torsion. It consists of spectrum of pathologies including ovarian torsion, ovarian.
Ovarian torsion and necrosis are followed by intracystic hemorrhage. Ultrasound is the preferred diagnostic test, but as we discuss later, the presence of blood flow detected by ultrasound does not rule out ovarian. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. An ovarian mass cyst or neoplasm is a primary risk factor for torsion. Torsion of uterine adnexa is an important cause of acute abdominal pain. Its unclear how often ovarian torsion occurs, but doctors agree that its an uncommon diagnosis. Intrauterine complications such as torsion and rupture may occur. An update on the diagnosis and management of ovarian torsion. Ovarian cysts and torsion in assisted reproduction and pregnancy an ovarian cyst 25 mm simple or complex cyst can be found in up to 5% of pregnancies,19 with a % torsion rate. She was diagnosed to have torsion of ovarian cyst during pregnancy and a cystecomy was carried out. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in. Five year retrospective case series of adnexal torsion. A search of the literature shows that this condition is extremely rare. Thus, it warrants immediate attention and decision to intervene.
1211 1202 1425 784 578 754 637 1287 287 56 37 232 520 489 413 1522 1079 1210 1016 54 1143 1336 317 464 932 75 1475 1053 125 33 160 1244 593 832 414 1063 1328 926 806 1430 1223 1219 898 146 821 24 1072 1057