If ovarian torsion is diagnosed and treated quickly, the chances of a successful recovery are quite high. If the ovaries are not clearly visualized with vaginal or abdominal ultrasound, magnetic resonance imaging (MRI) can be used to avoid the risk of ionizing radiation. University hospital. PCA morphine. However, reestablishing ovarian circulation by untwisting the ovarian pedicle has recently been shown to result in viable ovarian tissue on the affected side, with no systemic complications reported to date.9,14,15 Conservative treatment appears to be warranted to preserve fertility, even for adnexa that initially appear nonviable and purple or black in color.16,17. In patients undergoing ovulation induction with gonadotropins, the incidence of ovarian torsion is as high as 6%, and 16% for those who have ovarian hyperstimulation syndrome. Pregnancy, pelvic surgery, and enlargement of the ovaries are factors which may cause ovarian torsion. . Due to this reason, in most of the cases, the diagnosis is made late, causing severe damage to the ovary. Our patient had received ovulation induction prior to pregnancy and there was an excessive response (16 oocytes retrieved), but she was not complicated by ovarian hyperstimulation. NLM After untwisting the ovarian pedicle, the ovary returned to its normal color and showed no signs of hemorrhage or necrosis. The risk of any surgery to the pregnancy will depend on the gestational age. Treatment options are limited to surgery, either by laparoscopy or laparotomy, but the former becomes more difficult in the second trimester. Quant Imaging Med Surg. HHS The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies. . Since these symptoms are similar to those of a urinary tract infection, kidney stones, appendicitis, ovarian abscess, and ectopic pregnancy, it becomes difficult for the doctor to diagnose the ovarian torsion. Corpus luteum cysts or ovarian hyperstimulation were considered as the main risk factors in that period. Fall in blood pressure and heart rate is another common response to visceral and deep somatic nociception.7, Ultrasound is the diagnostic modality of choice and will most often reveal a unilateral ovarian enlargement that appears solid, cystic, or complex, with or without fluid collections in the pouch of Douglas. In the first trimester, when ovarian torsion most often occurs in pregnancy, the risk of fetal loss is the smallest with modern anesthetic techniques.10 Surgery during the second or third trimester is associated with the risk of premature labor. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women . The decision to proceed to surgery during pregnancy is somewhat complex, since the well-being of both mother and fetus must be taken into account. Clinical present a tion. Adnexal torsion in menotropin-induced pregnancies. 13. If a dermoid is accidentally ruptured, every effort should be made to avoid spilling the very irritating sebaceous contents into the peritoneal cavity. have an increased risk of ovarian torsion of normally appearing ovaries, compared to women in the reproductive age who also have normal-appearing ovaries. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. In all cases, definitive diagnosis must await careful examination of permanent sections. Ovarian cysts are three times more common in ovarian torsion cohorts than in the general population. Hurd WW, Smith AJ, Gauvin JM, et al. Hess LW, Peaceman A, O'Brien WF, et al. Retrospective, historical cohort study. VTE after ovarian torsion-detorsion in pregnancy is an infrequent event and is more likely to occur in the first and second trimester. Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. The cyst was excised in a usual fashion (Figure 2). Ovarian torsion, a major complication of OHSS, is estimated to occur in 12-25% of pregnant women. The remainder of her pregnancy was unremarkable, and she delivered a healthy infant vaginally at term. Ovarian torsion occurs far more commonly during pregnancy than in the non-pregnant state. nancy have been mostly reported previously in isolated case reports and small case series (3–6), and there appears METHODS to be limited information on the subject. Ahot bath did not relieve the symptoms. COVID-19 is an emerging, rapidly evolving situation. Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case. Regional anesthesia should be used whenever possible to decrease postoperative pain and the subsequent release of catecholamines, which can stimulate uterine contractility.11 Continued epidural infusion of narcotics for up to 72 hours is an excellent way to minimize postoperative pain.12. The left side is thought to barely have space because of the sigmoid colon. 2. Surgical intervention for maternal ovarian torsion in pregnancy. Complications may include infection, bleeding, or infertility. The incidence of ovarian torsion varies in pregnancy. In the presence of an ovarian cyst, a simple cystectomy can be performed in the absence of overt malignancy. 26. Color flow Doppler was not available. 2009 by American Society for Reproductive Medicine.) Evidence suggests that ovarian cysts are very common in the asymptomatic pregnant cohorts; however, they spontaneously resolve as the pregnancy progresses. Ovarian cysts and torsion in assisted reproduction and pregnancy. Initial Actions and Primary Survey. Vergote I, De Brabanter J, Fyles A, et al. Torsion of ovarian tumors occurred predominantly in the reproductive age group. . Your risk of developing an ovarian cyst is heightened by: • Hormonal problems. The hypotension evoked by visceral nociception is mediated by delta opioid receptors in the periaqueductal gray. adnexal mass; ovarian torsion; pelvic ultrasonography; pregnancy. As the woman is likely to present with nonspecific symptoms of lower abdominal pain, nausea, and vomiting, ovarian torsion can often be misdiagnosed as appendicitis or preterm labour. Because the mass extended above the umbilicus, laparotomy was performed instead of laparoscopy. eCollection 2020 Jan-Mar. 2004;1019:237-245. Pregnant women who conceive as a result of controlled ovarian hyperstimulation are at greater risk for the development of ovarian torsion 2, 3. Note that the affected ovary contains the corpus luteum, and this is an established risk factor for torsion in early pregnancy. In the nonpregnant patient and during the first trimester of pregnancy, ovarian torsion can usually be approached laparoscopically.15 Although untwisting the ovarian pedicle is relatively simple, ovarian cystectomy requires more advanced laparoscopic skills. 15. Other risk factors of ovarian torsion include: Woman suffering from polycystic ovarian syndrome Have had a surgery for closing fallopian tubes (tubal litigation) Ovarian torsion occurs most frequently in women during their reproductive years, but it does sometimes happen in prepubescent girls. Patients with actue inferior MIs should be monitored closely for preload because RV … In an acute setting, ultrasound is a useful adjuvant to rule out ovarian torsion. Her vital signs were remarkable for a blood pressure of 90/55 mm Hg and a pulse of 88 beats/min. Adnexal cyst seen with twists in its pedicle (torsion) Management of ovarian torsion in in vitro fertilization pregnancy 28. Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART) for which hospital admission is required in severe cases to prevent life-threatening complications or for treatment of ovarian torsion. Cohen SB, Oelsner G, Seidman DS, et al. She was placed on progesterone therapy upon hospital discharge and eventually delivered a healthy term infant. Ovarian torsion may also result in decreasing or stopping blood flow to the ovary. Physical examination showed she was diaphoretic. Would you like email updates of new search results? 9. 4 Its most common cause in pregnancy is a corpus luteum cyst, which usually regresses spontaneously by the second trimester. One study showed a diagnostic accuracy of ultrasonography as 74.6%, with abnormal ovarian blood flow and presence of free fluid as the most diagnostic. This can happen due to the formation of ovarian cysts. Pregnancy is also a risk factor for torsion. 5 Ovarian torsion, therefore, occurs most frequently in the first trimester, occasionally in the second, and rarely in the third. Because of the serious potential consequences Risk Factors, Symptoms and Treatment of Ovarian Torsion in for maternal and neonatal health, the possibility of heterotopic pregnancy Premenarchal Girls: The 12-Year Experience of One Center should be considered with high risk pregnancies. Diagnosis of adnexial torsion is difficult during pregancy (1). If this occurs, prolonged peritoneal irrigation with warmed saline will prevent peritonitis. 2001;75:85-86. 19-21 The risk of torsion appears to decrease with increasing gestation, 21 is unusual after 20 weeks 22 and becomes harder to diagnose. Because of the serious potential consequences Risk Factors, Symptoms and Treatment of Ovarian Torsion in for maternal and neonatal health, the possibility of heterotopic pregnancy Premenarchal Girls: The 12-Year Experience of One Center should be considered with high risk pregnancies. People who undergo ART have a much greater risk of experiencing ovarian torsion than those who do not. The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion-detorsion scenario. Turk J Emerg Med. 1990;76:403-406. Chapron C, Capella-Allouc S, Dubuisson JB. All rights reserved. Ovarian torsion is relatively uncommon in the second trimester of pregnancy. Immediate obstetric consultation was initiated. Diagnose with ultrasound and Doppler. She reported no vaginal bleeding or discharge, nausea, vomiting, fever, diarrhea, or constipation. ART increases the risk of ovarian torsion. . Hibbard LT. Adnexal torsion. The diagnosis depends mainly on the clinical manifestation, D-dimer level and imaging tests such as compression ultrasonography and computed tomography pulmonary angiogram. . . “It’s like a ball on a string. Key Words: Ovarian torsion, multiple pregnancy, ovarian stimulation, ultrasound-guided transabdominal cyst aspiration Ovarian torsion is responsible for %3% of all gynecologic emergen-cies (1–6). Zweizig S, Perron J, Grubb D, et al. The patient described her pain as nonradiating, sharp, and 10 out of 10 in severity. Treatment of adnexal torsion using operative laparoscopy. Whether there are differences in the ultrasonic features and histological diagnosis of ovarian torsion among pregnant and non-pregnant women is still unclear, but a better characterization of ovarian torsion may be helpful … Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. When present, it is often associated with severe pain. Blunt dissection is used to separate the cyst from the ovarian tissue. This study was conducted to review the clinical manifestations, and to compare the outcome between laparoscopy and laparotomy in … The presence of arterial flow within the ovary suggest either an incomplete torsion, or a torsion … Key Words: Maternal ovarian torsion, pregnancy, ultrasound Maternal ovarian torsion in pregnancy is a very rare compli- Ovarian torsion. The majority of cysts are functional. 7. The thin ovarian capsule is carefully incised, usually with a scalpel. | Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. Etiology of closurerelated adhesion formation after wedge resection of the rabbit ovary. Cocaine blocks extraneuronal uptake of norepinephrine by the pregnant human uterus. Approximately 20% of the cases occur during pregnancy 1. This can cause severe pain, nausea, and abdominal tenderness. Ovarian torsion is when an ovary twists on its attachment to other structures, such that blood flow is decreased. 1 Torsion more commonly occurs on the right rather than the left with an incidence of 3:2. Missed diagnosis of OT could lead not only to ovarian necrosis and sepsis, but also threaten the pregnancy. Ovarian torsion involves torsion of the ovarian tissue on its pedicle leading to reduced venous return, stromal edema, internal hemorrhage, and necrosis. The patient was not on ovarian stimulation treatments. Objective: Diagnosing OT in early pregnancy can be challenging. 12. 2016 Dec;8(1):16. doi: 10.1186/s13089-016-0049-5. 2011 Dec;50(4):458-62. doi: 10.1016/j.tjog.2011.10.010. The time of decision and laparoscopy is that of the risk of necrosis of the adnexa and, therefore, of the ovarian prognosis. The ovary does not require precise reconstruction as was thought in the past. . The patient recovered from her surgery without problems and was discharged on the third postoperative day. Symptoms typically include pelvic pain on one side. Electrosurgery can be used on the internal ovarian surfaces for hemostasis but should not be used near the cyst wall to minimize the risk of cyst rupture. | 1993;168:1791-1795. Epub 2008 Nov 5. Ovarian torsion is when an ovary twists around its own ligaments. n ovarian torsion in our hospital from January 2012 to June 2018. Up to 22% of ovarian torsions occur in pregnancy. Risk factors for ovarian torsion are pregnancy, ovulation induction during fertility treatment, and ovarian masses (especially if >5cm). Torsion of a ‘normal’ ovary is a rare event, mostly occurring in childhood. Background: Ovarian torsion (OT) is one of the most common gynecologic surgical emergencies. While classically the pain is sudden in onset, this is not always the case. Laboratory results were normal. The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies. Ovarian pregnancy torsion. Euvolemic hypoosmolar hyponatraemia may be due to hypothyroidism, adrenal insufficiency or SIADH. doi: 10.1016/j.fertnstert.2009.06.029. Ovarian torsion, also sometimes termed adnexal torsion or tubo-ovarian torsion, refers to rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle.. Torsion of the normal fallopian tube in pregnancy. We report a very rare case of bilateral ovarian torsion complicating SOHSS in a singleton pregnancy, which was successfully managed by laparoscopic detorsion. 1988;158:1029-1034. Unlike in our patient, ovarian torsion occurs more often in the right adnexa, presumably because the sigmoid colon limits the mobility of the left ovary.1 Almost without exception, torsion occurs when the ovary is enlarged secondary to cysts or neoplasms. Ovarian cysts are 3 times more common in ovarian torsion cohorts than in the general population, and evidence suggests that ovarian cysts are very common in asymptomatic pregnant women but spontaneously resolve as the pregnancy progresses. Epub 2018 Jul 18. 51% of the torsions occur in tumours measuring 6 – 8cm and 60% of torsions occur between 10 and 17 weeks. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Laparoscopic detorsion allows sparing of the twisted ischemic adnexa. Risks of torsion and malignancy are not directly proportional to increasing mass size in pregnant women. 1993;38:465-468. After ovarian stimulation, the incidence of AT in pregnancy rises to 6%, reaching up to 16% in cases of ovarian hyperstimulation syndrome [4, 5]. Malignant tumors occur in less than 6% of cases.2 Serous cystadenofibromas, as in our patient, are relatively common, accounting for approximately 8% of ovarian neoplasms.3, The incidence of ovarian torsion rises 5-fold during pregnancy to approximately 5 per 10,000 pregnancies.4 Its most common cause in pregnancy is a corpus luteum cyst, which usually regresses spontaneously by the second trimester.5 Ovarian torsion, therefore, occurs most frequently in the first trimester, occasionally in the second, and rarely in the third.6, Ovarian torsion can sometimes be difficult to diagnose in pregnancy. While it can rarely occur with a normal ovary, the majority of cases are associated with some type of ovarian pathology (e.g., tumor, cyst, hyperstimulation syndrome secondary to infertility treatments). However, some authors reported cases of ovarian torsion in second or third trimester and suggested that persisting ovarian cysts as the main risk factor  ,  . 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