Epidemiology
Etiology
- Ovarian enlargement is the most important risk factor; common causes include:
- Ovarian cysts
- Ovarian tumors
- Ovarian hyperstimulation syndrome
- Pregnancy
- Strenuous physical activity
Pathophysiology
Twisting of the ovary and the fallopian tube around the infundibulopelvic ligament and ovarian ligament
Infundibulopelvic ligament contains ovarian vessels
Clinical features
Diagnostics
- Initial Test: Pelvic Ultrasound with Color Doppler (TVUS).
- Findings: Enlarged, edematous ovary, heterogeneous stroma, peripherally displaced follicles (“string of pearls”).
- Whirlpool sign: Twisted vascular pedicle.
- Decreased or absent Doppler blood flow (Note: Presence of flow does NOT rule out torsion due to dual blood supply from ovarian and uterine arteries).
- Key Labs:
- β-hCG: Rule out ectopic pregnancy (must perform first in reproductive age).
- CBC: Leukocytosis indicates tissue necrosis/ischemia.
- UA: Rule out nephrolithiasis and UTI.
- Confirmatory / Gold Standard: Direct visualization during surgical exploration (Laparoscopy).
- Crucial: High clinical suspicion warrants urgent surgical evaluation even if Doppler US is normal.
Treatment
<% tp.file.cursor() %>