Everything You Need to Know About Ovarian

Torsion

An ovarian torsion is a condition that is characterized by the ovary getting twisted to the tissue
that surrounds it and, in some cases it can be the fallopian tube that is twisted. Both
abnormalities lead to the organ, whether it is the ovary or fallopian tube, not getting blood. Loss
of organ is usually the outcome for organs that aren´t supplied with blood, therefore it is most
important to react quickly and seek medical help. Therefore, the most important question for
patients is how to tell if this serious condition is present.

The first and most significant symptom of ovarian torsion is a severe pain in the lower abdomen.
Patients who feel extreme pain in the abdomen that isn't going away should definitely visit a
doctor as soon as possible to make sure that no severe condition is the reason behind that pain.
Some patients may experience nausea and vomiting. These symptoms usually occur all of a
sudden and don´t go away on their own without treatment.

What causes ovarian torsion?

A big risk factor for ovarian torsion is a previous condition affecting the ovaries, such as a cyst
or having had a tubal ligation, women who have a long ovarian ligament, which connect the
ovaries to the uterus. Pregnancy may also lead to the ovaries twisting to its surrounding tissue.

Women who are undergoing a hormonal treatment, for example, due to infertility, may also get
ovarian torsion as these hormonal supplements stimulate the ovaries. There are women
affected by ovarian torsion in different ages, however being in the reproductive years seems to
be the period of time when a woman is more likely to experience this type of torsion.

How is ovarian torsion diagnosed?

To diagnose the ovarian torsion, the doctor will first listen to all the symptoms that have been
occurring and do a physical exam. A ​ transvaginal ultrasound​is also necessary to take a look at
the ovaries, fallopian tube and how the blood is flowing. This type of exam is commonly
sufficient to be able to diagnose an ovarian torsion. A urine test is also tested, not to diagnose
this condition directly, but more to rule out other conditions that present similar symptoms.

These conditions may be a urinary tract infection, appendicitis, having an ectopic pregnancy or
an abscess in the ovaries. These methods are all sufficient to find the right diagnose, however,
a definite diagnose is spoken out once the torsion is visible during surgery, which is then
necessary to correct this ovarian torsion.

What treatment options are there?

As mentioned, correctional surgery is necessary to bring the ovaries in their normal position or
in other cases the fallopian tube. In more severe cases, the affected organ needs to be
completely removed. The surgical procedure that is used may be a laparoscopy or a
laparotomy. The laparoscopy uses an instrument to make a small incision in the lower
abdomen.

This helps the physician to see the inner organ that may be affected. A second incision is
necessary to be able to gain access to the ovary. Once this access is gained, the doctor will use
a tool to untwist the twisted organ. The procedure is done under general anesthesia and is in
cases of pregnant women the only, more secure treatment option.

A laparotomy gains direct access to the ovaries through one incision, which is, therefore, larger
than the ones done during a laparoscopy, and the twisted organ is manually untwisted by the
operating doctor. This surgery is done under general anesthesia as well. In cases, in which the
condition was untreated for a longer period of time and the blockage of the blood flow leads to
the death of the surrounding tissue, it will also be removed during this procedure.

The removal of the dead tissue is done either using an oophorectomy or

salpingo-oophorectomy​. The oophorectomy is a laparoscopic procedure, in which the tissue is
removed when it's not viable anymore. A salpingo-oophorectomy is also a laparoscopic
procedure, where the tissue surrounding the organ as well as the fallopian tube is removed.
These procedures carry risks with them that are also known in other surgeries, such as
infections, blood clotting or complications due to the anesthesia.
After surgery, it is important to watch out for any sudden symptoms and if already at home, seek
medical help as soon as these symptoms start to present. Some of the reactions to anesthesia
might be vomiting and nausea, a sore throat or damage to the larynx, damage of the teeth and
in severe cases a cardiovascular collapse or respiratory depression. A respiratory depression
means that the person is not breathing normally and getting only low levels of oxygen to the
blood. If it's left untreated, a respiratory depression can lead to life-threatening consequences
like coma and even death.

Medication is also prescribed to ease the pain and discomfort. The pain medication that is
prescribed depends on the severity of pain and even stronger painkillers such as oxycodone
might be necessary. Hormonal supplements may also be used after the surgery, such as birth
control pills, as these are known to prevent the condition from reoccurring.

It is shown to help, as birth control pills work towards preventing cysts from forming. But a
gynecologist in Brooklyn​criticizes this method of prevention as it misses the right type of follow
up, which may determine whether the hormonal supplements are actually working or not. It is,
therefore, the patient's own responsibility to have a gynecological exam regularly, something
that is important for all women, even if they've never had any gynecological condition.

Are there any complications?

The complications of an ovarian torsion all depend on how fast a person reacts to the symptoms
and of course, the ability to seek medical help as soon as possible. If the ovarian torsion is
detected before any tissue died, the recovery is more than positive. But, even in cases where
the tissue is dead or the organ needs to be removed completely, such as one ovary, conception
is still possible. This disease doesn't affect infertility at all.