Ovarian torsion is a medical emergency involving the twisting of an ovary on its supporting ligaments. This twisting can also affect the adjacent fallopian tube. The condition cuts off the blood supply to the affected reproductive organs, requiring immediate medical attention.
What is Ovarian Torsion?
Ovarian torsion occurs when the ovary, and sometimes the adjacent fallopian tube, rotates around the ligaments that hold them in place within the pelvis. This rotation constricts the blood vessels, impeding the flow of blood to the ovarian tissue. Initially, the venous outflow is obstructed, leading to congestion and swelling of the ovary. If the twisting persists, arterial blood flow becomes compromised, which can lead to tissue damage.
Without prompt treatment, the lack of blood supply can cause ovarian tissue to die, potentially leading to the loss of the affected ovary. This condition is considered a surgical emergency. Prompt intervention is crucial to prevent irreversible tissue damage and preserve ovarian function.
Understanding Recurrence
Ovarian torsion can indeed happen more than once. While specific recurrence rates vary, studies indicate a range, with some reporting figures up to 28% for women in their reproductive years. In pregnant individuals, the risk of a second episode may be higher, potentially ranging from 19.5% to 37.5%. Those without an underlying ovarian mass during their initial torsion might experience a recurrence rate as high as 63%.
Several factors increase the likelihood of a second ovarian torsion. A history of a previous ovarian torsion is one of the strongest predictors for recurrence. Underlying ovarian masses, such as cysts or benign tumors, especially those larger than 5 centimeters, make the ovary more prone to twisting due to their size and weight. Anatomical variations, like unusually long ovarian ligaments, can also contribute to the ovary’s instability and susceptibility to twisting.
Certain medical procedures and conditions are also associated with an increased risk of recurrence. Fertility treatments that stimulate the ovaries to produce more eggs can enlarge the ovaries and lead to the development of cysts, thereby increasing the chance of torsion. Pregnancy also presents an elevated risk, partly due to hormonal changes that relax ligaments and the formation of corpus luteum cysts. Polycystic ovary syndrome (PCOS), characterized by enlarged ovaries with multiple small cysts, may also increase susceptibility to recurrent torsion.
Recognizing Symptoms and Seeking Care
Symptoms of ovarian torsion often appear suddenly and are severe. A primary symptom is acute, intense pelvic pain, usually on one side of the lower abdomen. This pain may be sharp, stabbing, or crampy, sometimes radiating to the back or thigh. The pain can also be intermittent, occurring for days or weeks if the ovary twists and untwists.
Individuals often experience nausea and vomiting accompanying the pain. Sometimes, a low-grade fever or abnormal bleeding might also be present. If these symptoms arise, especially with a history of ovarian torsion, immediate medical evaluation, diagnosis, and intervention are crucial to untwist the ovary, restore blood flow, and preserve its function.
Strategies for Prevention
Strategies can reduce the risk of ovarian torsion recurrence. For individuals with known ovarian masses, especially larger cysts, regular monitoring is advised. Oral contraceptives can suppress ovarian cyst formation, lowering the risk of torsion.
Surgical interventions may be considered, especially after a previous torsion episode. Oophoropexy is a procedure where the ovary is surgically fixed to the pelvic sidewall or uterus to prevent re-twisting. If a problematic cyst or mass is identified, its surgical removal (cystectomy) can decrease recurrence. The specific prevention plan is individualized, based on the patient’s medical history and underlying factors contributing to the torsion.