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 majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women[ 2 ]. [casesjournal.biomedcentral.com]

• 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]

  Mild pain in your belly can last for several weeks, but if you have moderate to severe pain that makes it very hard for you to walk, you vomit, or you feel like passing out, see your HCP right away or go to the closest emergency room. [youngwomenshealth.org]

  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]

  Discussion Ovarian torsion is an uncommon cause of acute abdominal pain in nonpregnant women but is more common during pregnancy. When present, it is often associated with severe pain. [mdmag.com]

• Shivering

  Griffin D, Shiver SA. Unusual presentation of acute ovarian torsion in an adolescent. Am J Emerg Med. 2008 May. 26(4):520.e1-3. [Medline]. Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. Ovarian cyst torsion in a toddler. [emedicine.medscape.com]

  Physical examination may reveal fever and tenderness at the costovertebral angle on the affected side. [11] Pyelonephritis that has progressed to urosepsis may be accompanied by signs of septic shock, including rapid breathing, decreased blood pressure, shivering [en.wikipedia.org]

• 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]

• Nausea

  A middle-aged female presented with a 5-day history of cramping abdominal pain and nausea and vomiting. Abdominal wall guarding and rebound tenderness was noted on examination. [ncbi.nlm.nih.gov]

  Listen for key features on history: sudden onset of unilateral pelvic pain, sometimes radiating to the groin, often associated with nausea and vomiting. [cdemcurriculum.com]

  Other symptoms may include nausea. Complications may include infection, bleeding, or infertility.Risk factors include ovarian cysts, ovarian enlargement, ovarian tumors, pregnancy, fertility treatment, and prior tubal ligation. [en.wikipedia.org]

• 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]

• Severe Abdominal Pain

  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]

  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]

  Your health care provider (HCP) will want you to let them know if you have abdominal or belly pain. [youngwomenshealth.org]

  Typical appendicitis includes several hours of generalized abdominal pain that begins in the region of the umbilicus with associated anorexia, nausea, or vomiting. [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]

• Hydrops Fetalis

  Nine days previously, she had had a stillbirth caused by hydrops fetalis at 24 weeks' gestation. The characteristic findings observed on magnetic resonance imaging (MRI) led to the diagnosis of HL complicated by torsion of the enlarged left ovary. [ncbi.nlm.nih.gov]

• Thigh Pain

  We report an atypical case of ovarian torsion, an uncommon cause of abdominal pain in a very young girl. She presented with intermittent episodes of groin and thigh pain over a 10-week period. [ncbi.nlm.nih.gov]

• 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]

  View Article PubMed Google Scholar Duic Z, Kukura V, Ciglar S, et al: Adnexal masses in pregnancy: a review of eight cases undergoing surgical management. Eur J Gynaecol Oncol. 2002, 23: 133-134. PubMed Google Scholar Hibbard LT: Adnexal torsion. [casesjournal.biomedcentral.com]

  Among 44 postmenopausal patients with acute pelvic masses, 10 cases with adnexal torsion were selected. The exclusion criteria were adnexal masses without torsion, non-menopausal status and inadequate data. [jmrh.mums.ac.ir]

  The affected ovary may show a heterogeneous echotexture and may be seen as a complex adnexal mass with septations and debris, as a cystic mass or as a solid mass with peripheral cysts. 3. [sonoworld.com]

  Pelvic examination revealed a 16-week sized uterus, with a closed cervix, and a tender 10-cm left adnexal mass. Laboratory results were normal. [mdmag.com]

• Adnexal Tenderness

  Physical examination may reveal lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. Fever is uncommon, and usually low-grade if present. [cdemcurriculum.com]

  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]

  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]

• Cervical Motion Tenderness

  Cervical motion tenderness, a unilateral tender adnexal mass, and peritoneal signs are usually present. [merckmanuals.com]

  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]

  Look for corroborating evidence on pelvic exam: adnexal tenderness on the same side as the pain and less commonly an adnexal mass. Purulent cervical discharge and cervical motion tenderness point more towards PID with a tubo-ovarian abscess. [cdemcurriculum.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]

• Genital Lesions

  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]

Her subsequent workup suggested AT necessitating a laparoscopic evaluation where right adnexectomy was carried out due to hemorrhagic and necrotic changes. [scitechnol.com]

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]

[…] 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]

• Ischemic Changes

  Ultrasonography failed to detect the peduncle changes. At surgery, the right adnexa was twisted 180 degrees in a clockwise direction with no findings suggestive of gangrenous change, hemorrhagic infarction or ischemic change. [ncbi.nlm.nih.gov]

  It refers to a complete or partial rotation of the adnexal supporting organ, resulting in ischemic changes in the ovary. [tcmjmed.com]

Ovarian torsion in pregnancy is increasing in frequency due to the growing prevalence of ovarian stimulation treatment. [ncbi.nlm.nih.gov]

[…] 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]

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]

References: [1] [2] Ovarian torsion Etiology Physical activity (e.g., when exercising) The primary risk factor is ovarian enlargement (e.g., pregnancy, tumors, cysts). [amboss.com]

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]

Definition / general "Twisting" of fallopian tube that blocks blood flow, causing ischemia and associated edema and pain Often accompanies torsion of adjacent ovary (often with a cyst) but may be isolated to tube Epidemiology Occurs in women of all ages [pathologyoutlines.com]

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]

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]

Oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a recurrent torsion. [ncbi.nlm.nih.gov]

The complete absence of flow should be confirmed by power Doppler to prevent erroneous interpretation. 3. In cases of partial/incomplete torsion, intra-ovarian flow may be demonstrated. [sonoworld.com]