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Ovarian Torsion


Presentation

  • The objective of this article is to present a case of pediatric ovarian torsion and to review its epidemiology, diagnosis, and treatment. A 3-year-old girl presented to the ED with vomiting, fever, anorexia, and abdominal pain.[ncbi.nlm.nih.gov]
  • We present a case of ovarian torsion in an adolescent female who presented with abdominal pain and marked abdominal distension, which was initially suggestive of a gravid abdomen.[ncbi.nlm.nih.gov]
  • Acute ovarian torsion is an uncommon yet important diagnostic consideration in any female pediatric patient presenting with acute abdominal pain. A 2-month-old infant presented to the emergency department with a several-day history of constipation.[ncbi.nlm.nih.gov]
  • The objective of this article is to present a case of OT in early pregnancy and to review its epidemiology, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • We discuss the clinical presentation of this unusual tumour, though often asymptomatic, can rarely present with severe abdominal pain from complications like torsion with rupture, leading to massive intra-abdominal bleeding.[ncbi.nlm.nih.gov]
Severe Pain
  • Twisting causes sudden, severe pain and often vomiting. Doctors use an ultrasound device inserted into the vagina (transvaginal ultrasonography) to confirm the diagnosis. Surgery is done immediately to untwist the ovary or to remove it.[msdmanuals.com]
  • Patient usually presents with acute severe pain abdomen and pelvic examination may reveal a tender cystic mass separate from the uterus. The risk of ovarian torsion rises by 5 fold during pregnancy. Incidence is 5 per 10,000 pregnancies[ 1 ].[casesjournal.biomedcentral.com]
  • When present, it is often associated with severe pain. Etiology and pathophysiology Ovarian torsion is the total or partial rotation of the adnexa around its vascular axis.[mdmag.com]
  • In patients with prior ovarian torsion, 11% were likely to recur, and of those, women with normal anatomy are at greater risk. [5,6] Clinical Presentation The classic presentation of ovarian torsion includes acute onset of moderate to severe pain with[emdocs.net]
Soft Tissue Mass
  • Evaluation with plain radiographs demonstrated a subtle yet persistent soft tissue mass in the right pelvis.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Abdominal pain is one of the most common chief complaints of patients presenting to emergency departments, and emergency physicians (EPs) often evaluate patients with right lower quadrant abdominal pain.[ncbi.nlm.nih.gov]
  • The process causes abdominal pain and will result in ovarian tissue loss if not diagnosed and managed expeditiously.[ncbi.nlm.nih.gov]
  • A 3-year-old girl presented to the ED with vomiting, fever, anorexia, and abdominal pain.[ncbi.nlm.nih.gov]
  • This case evaluates a patient with abdominal pain who presented with a pelvic mass and imaging studies suspicious for malignancy. A 21-year-old, gravida 0, para 0, was admitted after presenting to the outpatient with abdominal pain.[ncbi.nlm.nih.gov]
  • Abstract We report a case of pregnancy luteoma, which had undergone torsion in a 33-year-old Indian woman, who presented with severe abdominal pain and decreasing haemoglobin levels at 33 weeks gestation.[ncbi.nlm.nih.gov]
Lower Abdominal Pain
  • : Given the higher risk of malignancy in post-menopausal women, ovarian mass-related torsion is an uncommon but important cause of acute-onset lower abdominal pain.[ncbi.nlm.nih.gov]
  • Ovarian cysts Lower abdominal pain with adnexal fullness on exam. Imaging or laparoscopy may be needed to distinguish from ovarian torsion. Ultrasound shows ovarian cysts and lacks features suggestive of torsion.[online.epocrates.com]
  • We report the case of a 20-year-old white woman who presented with sudden onset of severe lower abdominal pain and nausea. Similar episodes of pain were experienced in the previous few months and diagnosed as a case of bilateral ovarian cyst.[ncbi.nlm.nih.gov]
  • The patient was transferred by ambulance for a six-hour history of severe lower abdominal pain.[ncbi.nlm.nih.gov]
  • Abstract Adnexal torsion is an uncommon cause of severe lower abdominal pain in women and is often difficult to distinguish from other acute abdominal conditions.[ncbi.nlm.nih.gov]
Severe Abdominal Pain
  • Abstract We report a case of pregnancy luteoma, which had undergone torsion in a 33-year-old Indian woman, who presented with severe abdominal pain and decreasing haemoglobin levels at 33 weeks gestation.[ncbi.nlm.nih.gov]
  • Comments: This salpingo-oophorectomy specimen is from an adult female who presented with severe abdominal pain. Ultrasound examination revealed multicystic ovarian lesion which was removed at laparotomy.[webpathology.com]
  • If this were to happen, you would have severe abdominal pain and you might feel like throwing up or even feel like passing out. If you have any of these symptoms, you should see your HCP immediately or go to the closest hospital emergency room.[youngwomenshealth.org]
  • pain that comes on quickly .[en.wikipedia.org]
Left Lower Quadrant Pain
  • They are more likely to present with fever and diffuse pain, rather than focused right or left lower quadrant pain. The most common presenting symptom is pelvic pain followed by the history of or a palpable adnexal mass on physical exam .[emdocs.net]
Cafe-Au-Lait Spots
  • Physical exam should pay careful attention to the patient's tanner stage, the abdominal exam for palpable masses, tenderness and/or rebound, the skin exam for cafe-au-lait spots, and, if the patient is old enough and the exam is tolerated, a pelvic exam[pedclerk.bsd.uchicago.edu]
Adnexal Mass
  • Important questions regarding medical history include the presence of adnexal mass, gynecologic or obstetric diseases, pregnancy, ongoing infertility treatment, and prior adnexal mass.[emdocs.net]
  • Diagnosis can usually be made on the basis of the characteristic clinical presentation in conjunction with ultrasound evidence of a unilaterally enlarged adnexal mass.[casesjournal.biomedcentral.com]
  • However, surgeons must note that extensive necrotic tissues in adnexal masses may result in the misdiagnosis of malignancy in frozen section technique.[jmrh.mums.ac.ir]
  • She was found to have a bilateral ovarian torsion caused by adnexal mass. She was treated by laparoscopic detorsion, left salpingo-oophorectomy, and right cystectomy.[ncbi.nlm.nih.gov]
  • Ultrasonography showed a right adnexal mass, probably ovarian in origin, with suspicious intratumoral bleed. The pain was treated symptomatically, and the symptoms improved. A successful induction of labour was then performed at 36 weeks gestation.[ncbi.nlm.nih.gov]
Adnexal Tenderness
  • Pelvic inflammatory disease Sexually active female with lower abdominal pain, cervical motion tenderness, and adnexal tenderness. Abnormal vaginal and cervical discharge may be noted, as well as a temperature 101 F ( 38 C).[online.epocrates.com]
  • On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Fever is uncommon, and usually low-grade if present. Diagnostic Testing The most dangerous condition in the differential for adnexal torsion is an ectopic pregnancy.[cdemcurriculum.com]
  • There is adnexal tenderness. A raised white cell count is common. The result of vascular compromise secondary to ovarian torsion is hemorrhagic infarction and necrosis, that can occur as rapidly as within hours of torsion onset.[radiopaedia.org]
  • The most common presenting symptom/sign was lower abdominal pains/adnexal tenderness (100%) and none presented with anemia or deranged blood chemistry. Most (66%) had the cyst on the right.[tjogonline.com]
Imperforate Hymen
  • Molar Pregnancy PID Tubo-ovarian Abscess Ovarian Cysts Follicular Cyst Corpus Luteum Cyst Polycystic Ovarian Syndrome Obstructive Genital Lesions Imperforate Hymen Noncommunicating Uterine Horn Endometriosis Associated Chocolate Cyst of Endometriosis[pedclerk.bsd.uchicago.edu]

Workup

  • Abdominal Loin pain hematuria syndrome Proctitis —infection or inflammation of the anus or rectum Colitis —infection or inflammation of the colon Appendicitis —infection or inflammation of the bowel Diagnosis [ edit ] Females [ edit ] The diagnostic workup[en.wikipedia.org]
  • Her subsequent workup suggested AT necessitating a laparoscopic evaluation where right adnexectomy was carried out due to hemorrhagic and necrotic changes.[scitechnol.com]
  • […] to and treatment by gynecologic oncologists has been shown to improve survival rates in women with ovarian cancer. 14-16 Cysts with an Indeterminate Likelihood of Malignancy For women with cysts with an intermediate likelihood of malignancy, further workup[clevelandclinicmeded.com]
  • Ovarian hyperstimulation occurs more often with invasive moles and choriocarcinoma than complete molar pregnancies. [13] Risk of cancer [ edit ] A widely recognised method of estimating the risk of malignant ovarian cancer based on initial workup is the[en.wikipedia.org]
Chlamydia Trachomatis
  • Cervical cultures may show Neisseria gonorrhoeae or Chlamydia trachomatis , the most common causes of PID. Ultrasound may show tubo-ovarian abscess.[online.epocrates.com]

Treatment

  • Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment.[ncbi.nlm.nih.gov]
  • Surgery remains the standard method for definitive diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Ovarian transposition has proven to be a safe method for preserving ovarian function in young premenopausal women who require pelvic irradiation for treatment of early stage malignancies.[ncbi.nlm.nih.gov]
  • Traditionally, ultrasonography and laparoscopy facilitated early diagnosis and treatment of this condition. This case report highlights the usefulness of color Doppler ultrasonography in the diagnosis of ovarian torsion.[ncbi.nlm.nih.gov]
  • Conservative treatment of ovarian torsion via ultrasound-guided transabdominal cyst aspiration and body repositioning represents a reasonable alternative to surgical intervention in the pregnant patient.[ncbi.nlm.nih.gov]

Prognosis

  • […] long-standing infarcted ovary may have a more complex appearance with cystic or hemorrhagic degeneration Doppler findings in torsion are widely variable 3 little or no intra-ovarian venous flow (common) absent arterial flow (less common, sign of poor prognosis[radiopaedia.org]
  • Fetal ovarian cysts management and ovarian prognosis: a report of 82 cases. J. Pediatr. Surg. 2009;44:868; author reply 868-9. Guthrie BD, Adler MD, Powell EC.[pemplaybook.org]
  • Although ovarian torsion in very young children is rare, a case of ovarian cyst torsion was reported in a 2-year-old. [17] Prognosis With early diagnosis and appropriate treatment, the prognosis of ovarian torsion is excellent.[emedicine.medscape.com]

Etiology

  • We report the successful management of a prenatally diagnosed ovarian cyst in a newborn female and provide operative evidence for the presumptive etiology of the cyst.[ncbi.nlm.nih.gov]
  • The bilateral posterior peritoneal defects that housed the adnexa were likely of congenital etiology.[ncbi.nlm.nih.gov]
  • Abstract Ovarian torsions in adolescence are rarity, particularly bilateral, with mostly unknown etiology. Enlargement of the ovary contributes to torsion.[ncbi.nlm.nih.gov]
  • The etiological factors were unclear, but the authors suggest that the increase in ovarian volume was due to transient hypergonadotropic feedback.[ncbi.nlm.nih.gov]
  • Etiology (cause): Sometimes a mass or cyst in the ovary can cause twisting. If the stalk of the ovary is long, it may also lead to torsion. Signs and Symptoms (“What symptoms will my child have?”)[eapsa.org]

Epidemiology

  • The objective of this article is to present a case of pediatric ovarian torsion and to review its epidemiology, diagnosis, and treatment. A 3-year-old girl presented to the ED with vomiting, fever, anorexia, and abdominal pain.[ncbi.nlm.nih.gov]
  • In this article, case discussions will serve as a platform for discussing the epidemiology and clinical manifestations of pediatric OT, as well as reviewing the latest evidence related to the diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Although all emergency physicians are aware of ovarian torsion, there are several myths regarding its epidemiology, diagnosis, and treatment. This article attempts to review some of these myths to improve emergency diagnosis and evaluation.[ncbi.nlm.nih.gov]
  • The objective of this article is to present a case of OT in early pregnancy and to review its epidemiology, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • Epidemiology: Ovarian torsion is the fifth most common emergency of the female reproductive organs. Etiology (cause): Sometimes a mass or cyst in the ovary can cause twisting. If the stalk of the ovary is long, it may also lead to torsion.[eapsa.org]
Sex distribution
Age distribution

Pathophysiology

  • The underlying pathophysiology involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal oedema, internal haemorrhage and infarction with the subsequent sequelae.[ncbi.nlm.nih.gov]
  • Epidemiology and Pathophysiology Ovarian torsion is the partial or complete twisting of an ovary around its ligamental support, often leading to an occlusion of its blood supply and associated with the sudden onset of abdominal pain and, if untreated,[pedclerk.bsd.uchicago.edu]
  • […] of reproductive age, it can occur at any age. [2] Signs and symptoms [ edit ] Patients with ovarian torsion often present with sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting . [6] Pathophysiology[en.wikipedia.org]

Prevention

  • Oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a recurrent torsion.[ncbi.nlm.nih.gov]
  • Several methods of prevention using surgical plication have been proposed, which require varying degrees of technical expertise and can result in altered reproductive anatomy.[ncbi.nlm.nih.gov]
  • Mild symptoms and low clinical suspicion, in addition to risks associated with pregnancy prevented early laparoscopic examination, though torsion was considered.[ncbi.nlm.nih.gov]
  • Early diagnosis of ovarian torsion can help prevent irreversible damage to the adnexal structures in women desiring to maintain fertility. The patient was transferred by ambulance for a six-hour history of severe lower abdominal pain.[ncbi.nlm.nih.gov]
  • Adnexal torsion can present as a surgical emergency and requires a prompt and definitive diagnosis to prevent permanent damage to the adnexal structures.[sonoworld.com]

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