Small functional cysts that cause few symptoms are monitored for several months to ensure that they disappear without treatment. Benign cystic teratoma dermoid cyst is the most common ovarian tumor in women in the second and third decade of life 9 and as a rule is benign. Ultrasoundguided transabdominal ovarian cyst aspiration and body repositioning to allow for spontaneous detorsion. Recurrence of ovarian torsion in a multiple pregnancy. Sixtyfour percent of torsions occur on the right side 10. Usually associated with a mass cyst causing rotation obstruction also pid, hydrosalpinx, tubal ligation or adhesions. The larger the cyst, the more likely that ovarian torsion will occur.
The search was conducted by combining the textwords ovarian torsion, adnexal torsion, adolescents and oophoropexy. Ovarian torsion ovarian torsion is defined by white and stella as a total or partial rotation of the adnexae around its vascular axis 2005, p. Given the history of intermittent abdominal pain and the imaging findings, concern arose for intermittent ovarian torsion. Ovarian torsion is a condition that occurs when an ovary twists around the ligaments that hold it in place. It accounts for approximately 23% of all acute surgical emergencies, and is the fifth reason for gynecological emergencies. Often accompanies torsion of adjacent ovary often with a cyst but may be isolated to tube epidemiology. Dermoid cysts may also rupture, releasing contents and triggering an inflammatory cascade that often results in peritonitis. We recently treated a 14yearold female patient with clah and ovarian cyst torsion.
Pain severity many patients with twisted ovaries note that the pain makes it difficult to laugh, talk, walk, breathe, or be touched in the abdomen. Ovarian torsion may also be diagnosed on ct or mri, although ultrasound should be the primary imaging modality if torsion is the leading diagnosis. Adnexal torsion is one of the few gynaecological surgical emergencies. During surgery, torsion was detected in her left adnexa. The most important risk factor for ovarian torsion is ovarian mass. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. Ovarian torsion also termed as adnexal torsion refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. Subtle anatomic etiologies, such as an elongated uteroovarian ligament and robust ovarian volume, are commonly underappreciated and may contribute to idiopathic recurrent unilateral torsion in adults. Description ovarian torsion occurs infrequently only in females. Pregnancy is a risk factor for torsion odds ratio, 18. Rupture and torsion are major damages which may lead to abdominal pain and. As consistent with various studies, in our study also teratoma 22. The authors present a case of spontaneous resolving fetal ovarian cyst. At day 3, the surgery was performed and the diagnosis was of ovarian cyst with twisted.
Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle causing obstruction to venous outflow and arterial inflow. Causes and management of ovarian cysts zina abdulkareem al zahidy ibn sina national college abstract an ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Dermoid cysts or mature cystic teratoma are the most common type of ovarian germ cell tumor. If ovarian torsion is suspected, timely intervention with diagnostic laparoscopy is indicated to. This may result in vomiting or feeling faint most ovarian cysts are related to ovulation, being. While the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of malignancy, the vast majority of these lesions are benign. This article presents 12 cases of pathologically confirmed ovarian torsion diagnosed on ct or mri. The risk of torsion increases when pelvic masses exceed 5 cm 7. As the ovary twists, it will first compromise lymphatic drainage, leading to. This is a 32yearoldwoman, g2p1, referred at 34 weeks of gestation with a fetus with ovarian cyst torsion on the left side. Left ovary normal size and follicular pattern and flow. Benign ovarian cysts in reproductiveage women undergoing. The follicular ovarian cyst is the most common kind of ovarian cyst. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard.
Jun 21, 2012 ovarian torsion may also be diagnosed on ct or mri, although ultrasound should be the primary imaging modality if torsion is the leading diagnosis. The main feature of torsion is ovarian enlargement due to venouslymphatic engorgement, edema and hemorrhage. Secondary signs include free pelvic fluid, an underlying ovarian lesion, reduced or absent vascularity and a twisted dilated tubular structure corresponding to the vascular pedicle. Dermoid cyst is the most common germ cell tumor of the ovary containing various tissue elements. 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. Symptoms typically include pelvic pain on one side. Elevated ca 199 level may be related to ovarian torsion and.
In can occur in women of all ages, but most women that experience this are younger. Five year retrospective case series of adnexal torsion. Combining clinical acumen, appropriate tests and detailed consideration may be. The presence of an internal daughter cyst was confirmed fig.
Apr 02, 2020 most torsion cases occur in premenopausal females of childbearing age, but up to 17% of cases affect prepubertal and postmenopausal women. The first case of torsion was diagnosed in 1891 by kuestner. Imaging features of ovarian torsion on ct and mri are then pre sented with illustrative case examples. You may also be more likely to develop ovarian torsion. Most cases of the ovarian torsion can be diagnosed on usg. Right ovary edematous, peripheral small follicles, no flow. Brucellainfected ovarian dermoid cyst causing initial seguchi m, kohno c, inukai k,tobayama s.
Salmonella treatment failure in a patient with acute brucellosis. Since torsion is not uncommon, surgical management was often advised with a view of making a definitive diagnosis during the detorsion procedure and remove the cyst while preserv. A twised ovary requires immediate surgery 100% of the time and a ruptured cyst often does not. Jaspan, do facoog chairman the department of obstetrics and gynecology the einstein health care network, philadelphia, pa. We report here a 14yearold adolescent with painless torsion of the ovary including dermoid cyst and with abnormal elevated ca 199 serum levels. Sep 20, 2017 ovarian torsion can occur without the presence of a cyst, however. Gynecologic ultrasonography is the imaging modality of choice.
The condition occurs following twisting of the ovary on the main vascular pedicle infundibulopelvic ligament ipl containing the ovarian artery and vein, which results in impedance of venous outflow with continued arterial inflow, and eventually leads. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and. We hereby report a case of huge cyst in a 15year old girl having severe abdominal pain which was diagnosed as torsion in ovarian dermoid cyst. Torsion of malignant ovarian masses in this population is rare 9 6. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. A study at an obstetrics and gynaecology department found that preoperative diagnosis of ovarian torsion was confirmed in only 46% of people. Ovarian torsion definition of ovarian torsion by medical. How common is torsion in patients with ovarian cysts and what. Calledfunctional cysts, these occur when the normal follicle that matured to release an egg does not shrink after the egg is released ovulation. Adnexal torsion mostly occurs in the child bearing group, but is not. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas 8. Physical examination o nonspecific, unilateral pelvic pain o tender adnexal mass.
It is also strongly associated with ovarian stimulation. Ct is less specific for torsion and carries the additional burden of radiation exposure, while mri is not often readily available in the emergency department setting. Pdf update on the management of ovarian torsion in children and. Torsion of the ovary, tube or both is estimated to be responsible for only a small number of. A retrospective study revealed a torsion rate of 14. The size of the mass is positively correlated with the risk of ovarian torsion. Ovarian torsion represents a true surgical emergency. Ovarian torsion ultrasound discussed by radiologist duration. Resolution of the ovarian torsion, as well as preservation of the pregnancy without surgical intervention.
Fever is uncommon, and usually lowgrade if present. Torsion of uterine adnexa is an important cause of acute abdominal pain. Ovarian torsion or mass are two important considerations given this appearance. Ovarian torsion is the fifth most common gynecological emergency condition and for that, delayed diagnosis is not uncommon leading to disastrous results as ovarian infarction and necrosis. An ovarian cyst is a collection of fluid in a sac that is in or on an ovary.
It occurs commonly in reproductive age group, more on the right side 60% and often presents with acute lower abdominal pain lasting for few hours and up to 24 h, accounting for 2. Torsion of a large ovarian dermoid cyst in the second. With ovarian torsion, the blood supply to the ovary can be blocked and permanently hurt the ovary. While classically the pain is sudden in onset, this is not always the case. Torsion of ovarian masses is quite common and isolated torsion of the fallopian tube has also been reported in the literature. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. The treatment of ovarian cysts depends on a womans age, the presence or absence of symptoms, any coexisting conditions related to ovarian cysts, and the appearance of the cyst on the sonogram. Ultrasound is the preferred diagnostic test, but as we discuss later, the presence of blood flow detected by ultrasound does not rule out ovarian torsion.
Unilateral recurrent ovarian torsion in adults is unusual following treatment of common underlying risk factors e. Adnexal torsion twisting of the vascular pedicle of an ovary, ovarian cyst. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. An ovarian cyst is a fluidfilled sac in or on the surface of an ovary. Ovarian cyst, torsion cases, lectures, articles, cmes. Ovarian torsion ncus north carolina ultrasound society. Ovarian torsion comprises approximately 3% of all gynecologic surgical emergencies, and occurs predominately in women of childbearing age. 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.
Cyst can also rupture leading to peritonitis, sepsis, and adhesions. Aug 16, 2016 within the cyst was a daughter cyst, without significant bloodflow fig. Objectives after participating in this conference, you should have an increased knowledge of, and be more competent to. Complications may include infection, bleeding, or infertility risk factors include ovarian cysts, ovarian.
Physiologic cyst maternal hormonal stimulation inutero infantsprepubertal. These indices combine clinical and radiologic predictors of adnexal torsion eg, vomiting. This is a rare complication, but it must be heeded during laparoscopic and open surgical removal. The ovary, and often the fallopian tube as well adnexal torsion become twisted around their vascular pedicle. It is basically a sac inside the ovary filled with fluids. Ovarian torsion adnexal torsion diagnosis and treatment. Ovarian torsion adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. In cases where torsion happens without a cyst, its usually younger girls, explained gupta. Ovarian torsion is an uncommon cause of acute abdominal pain in females, but it is a gynecologic emergency diagnostic delay can result in loss of the ovary.
For example, a cyst or ovarian mass can cause the ovary to become lopsided, making it unstable. Ovarian cysts and ovarian cancer what are ovarian cysts. These symptoms can be intermittent or sustained, are highly variable and nonspecific. Risk of torsion is related to size of mass or cyst if known. Occurs in women of all ages 23 involve right tube etiology. A, there is a heterogeneous structure within the right lower quadrant that measures 6. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. It may be complicated by torsion, rupture, chemical peritonitis and malignant change but is rarely. 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. Ovarian pathologies often remain silent, however they may come up with abdominal pain, ovarian torsion, haemorrhage, and ovarian cyst rupture which can lead to acute abdomen. An ovarian cyst is a fluidfilled sac within the ovary. Occasionally they may produce bloating, lower abdominal pain, or lower back pain.
Laparoscopic uteroovarian ligament truncation and uterosacral. Pelvic ultrasonography can provide information on ovarian cysts. Ovarian torsion is a medical condition where the ovary rotates to such an extent that it causes occlusion of the ovarian artery andor vein. As seen in this case, combined surgical procedures may be. An update on the diagnosis and management of ovarian torsion emmanuel damigos ptychio latrikes mbbs,a jemma johns mbbs md mrcog,b, jackie ross mbbs frcog c ast5 in obstetrics and gynaecology, friarage hospital, south tees hospitals trust, northallerton, north yorkshire dl6 1jg, uk bconsultant gynaecologist, kings college hospital, denmark hill, london se5 9rs, uk. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Ovarian torsion can occur without the presence of a cyst, however. This twisting can cut off blood flow to the ovary and fallopian tube. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the emergency department ed such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as. Evaluation and management of ruptured ovarian cyst view in chinese similarly with a sudden onset of pelvic pain. When fallopian tube also twists with the ovary it is known as adnexal torsion.
South eastern melbourne phn ovarian cyst pathway 2 red flags suspicion of malignancy torsion background about ovarian cyst common types. Within the cyst was a daughter cyst, without significant bloodflow fig. Ruptured cyst patients note a moment of severe pain which often passes after a few hours. The primary risk factor for ovarian torsion is an ovarian mass and is most common if the ovary is 5 cm or larger. Physical examination may reveal lower abdominal tenderness. Ovarian torsion ot is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Adnexal torsion is commonly unilateral, with a slight. Nov 10, 2017 torsion can occur if the ovary is unstable. Ovarian torsion is a common complication of which ultrasonographic diagnosis is confusing. A history of prior ovarian cyst or mass, prior ovarian torsion, or current pregnancy ie, corpus luteum cyst should increase your suspicion for torsion. Jul 19, 2019 the most important risk factor for ovarian torsion is ovarian mass. An update on the diagnosis and management of ovarian torsion. Ovarian torsion occurs as a result of other medical conditions such as structural abnormalities of the ovary and tube, tumors, cysts etc.
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