What is ovarian torsion?

Ovarian torsion is one of the most common gynaecologic surgical emergencies that occurs when the ovary twists on its ligamentous supports, resulting in blood obstruction. While torsion can affect females of any age, it is most prevalent in women of reproductive age. Adnexal torsion is a term used when the fallopian tube twists along with the ovary.

What are the risk factors for ovarian torsion?

The risk factors for ovarian torsion are:

• Ovarian mass that is 5 cm in diameter or larger. Torsion can occur in ovaries of any size, although this figure represents an average. Generally, the risk of torsion increases with the size of the ovary.
• Ovulation inducement for infertility treatment can result in large ovarian follicular cysts and, in some cases, massive ovarian enlargement due to hyperstimulation.
• History of ovarian torsion.

What are the symptoms of ovarian torsion?

Symptoms of ovarian torsion may include:

• Pelvic pain (sudden onset, moderate to severe pelvic pain that may be sharp, dull, stabbing, crampy or colicky in nature)
• Nausea with or without vomiting
• Fever

How is ovarian torsion diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

The following tests can be used to diagnose ovarian torsion:

• Imaging studies: Transvaginal and pelvic ultrasound with Doppler.
• Blood tests.
• Definitive diagnosis is established by directly observing a rotated ovary during surgery. Typically, a laparoscopic approach is used.

How is ovarian torsion treated?

Premenopausal patients with a non-malignant (non-cancerous) twisted ovary:

• It is usually recommended to attempt to untwist the ovary and preserve it (detorsion and ovarian conservation) rather than removing it (salpingo-oophorectomy).
• If there is a benign cyst on the ovary, the surgeon may remove the cyst (cystectomy) during the detorsion procedure.

Patients with severely damaged ovaries or suspicious of ovarian cancer:

• If the ovary is clearly dead (necrotic) or is concerned that it might be cancerous, the preferred approach is to remove both the ovary and the fallopian tube (salpingo-oophorectomy). This is also the recommended procedure for postmenopausal patients.

Premenarchal patients with ovarian torsion and a normal ovary:

• Along with detorsion, oophoropexy may be done to reduce the risk of future torsion. If a cyst or mass is present, the surgeon may perform detorsion and cystectomy without oophoropexy.

What happens if ovarian torsion is left untreated?

Ovarian torsion, if left untreated, can result in the loss of blood supply to the affected ovary and fallopian tube. This lack of blood flow can lead to tissue damage, infarction (tissue death), and loss of function in these organs.

Make an appointment at Pantai Hospitals

If you or someone you know is experiencing sudden, severe lower abdominal or pelvic pain, taking immediate action is crucial. Ovarian torsion is an emergency that requires prompt attention to prevent potential complications. 

A dedicated and expert team of Obstetricians and Gynaecologists at Pantai Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding your reproductive health.

For health screening appointments, please contact the Health Screening Centre at your nearest Pantai Hospital.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.