Why is this happening
The ovary is suspended by ligaments and normally has a certain mobility. When it increases, the fulcrum shifts, and the organ begins to behave like a weight on a string: with a sudden movement, turn, physical activity or sexual intercourse, it can rotate around the ligament. Most often, the cause of enlargement is a cyst measuring more than five centimeters. The risk increases after stimulation of ovulation, during pregnancy, when the ovary is displaced by the growing uterus, as well as in girls and adolescents with long ligaments, in whom torsion sometimes occurs even with a normal ovary.
- Ovarian cyst, especially larger than 5 cm
- Stimulation of ovulation and hyperstimulation syndrome
- Pregnancy
- Long ligaments in girls and adolescents
- Sudden movements and physical activity
- Past torsion
How to recognize
The typical onset is sudden, severe pain in the lower abdomen on one side, which can radiate to the lower back, groin and hip. The pain is often accompanied by nausea and vomiting, which often leads to the mistaken idea of poisoning. Sometimes the pain waxes and wanes: this is due to partial untwisting and re-torsion. The temperature is usually normal or slightly elevated, the abdomen is painful when pressed on the affected side. In girls and adolescents, the picture is often mistaken for appendicitis, so examination by both a surgeon and a gynecologist is important.
- Sudden unilateral pain in the lower abdomen
- Nausea and vomiting
- Pain radiates to the lower back and hip
- Wave-like course of pain
- Pain on pressure
- Often confused with appendicitis and poisoning
Diagnostics
The main method is ultrasound of the pelvic organs, preferably transvaginal access in adult women and transabdominal access in girls. Characterized by an enlarged edematous ovary, a displacement of its location, and free fluid in the pelvis. Doppler ultrasound shows decreased or absent blood flow, but preserved blood flow does not rule out torsion because the ovary has a dual blood supply. Be sure to do a pregnancy test and a general blood test to rule out ectopic pregnancy and inflammation. If there is reasonable suspicion, the operation is performed without waiting for an ideal ultrasound picture.
- Ultrasound of the uterus and ovaries
- Dopplerography of pelvic vessels
- Pregnancy test
- Complete blood count and CRP
- Examination by a gynecologist and surgeon
- Diagnostic laparoscopy if in doubt
Treatment
Treatment is only surgical and urgent. The operation is performed laparoscopically: the ovary is untwisted, blood flow is restored and its color changes are observed; if a cyst is present, it is removed. The modern approach is to preserve the organ even with severe swelling and cyanosis, because ovarian function is restored in many cases. Removal is carried out only if the tissue is clearly non-viable. To reduce the risk of re-torsion, the ovary is sometimes immobilized. After the operation, the woman is observed, and a control ultrasound is prescribed for cysts.
- Emergency laparoscopy
- Unwinding the ovary and restoring blood flow
- Removal of a cyst if present
- Organ preservation whenever possible
- Ovarian fixation at high risk of recurrence
- Control ultrasound after surgery
Why can't you wait?
Every hour of delay reduces the chance of saving the ovary. Taking painkillers and antispasmodics temporarily reduces pain, creates a false impression of improvement and leads to loss of time, and heat on the abdomen increases swelling. Another thing is also dangerous: under the mask of torsion, an ectopic pregnancy, rupture of a cyst with bleeding, and appendicitis can be hidden - conditions that also require surgery. Therefore, in case of sudden severe pain in the lower abdomen, you should call 103 for help and do not eat, drink or take medications until the examination.
- Call 103 for help
- Do not take painkillers and antispasmodics
- Do not apply a heating pad to your stomach
- Do not eat or drink until the examination
- Report the date of your last menstrual period
- Take the results of previous ultrasounds with you
