Ovarian torsion
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Ovarian torsion
Pathology
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Ovarian torsion
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A 32-year-old woman comes to the emergency room with nausea, vomiting, and severe abdominal pain. The pain began 6 hours ago and has become more severe over the last 2 hours. Past medical history includes seasonal depression and placement of a progestin-releasing IUD a month ago. Her last menstrual period was two weeks ago. Temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 90/75 mmHg. Abdominal examination reveals tenderness in the left lower quadrant. Bimanual examination reveals a tender, palpable left adnexal mass and visible IUD strings at the vaginal orifice. The urine pregnancy test is negative. The total leukocyte count is 8000/mm3. A transabdominal ultrasound reveals a hyperechoic adnexal mass with the decreased arterial flow. An explorative laparotomy is performed. The infundibulopelvic ligament is ligated during the procedure, and the pathological specimen is removed. Which of the following is the most likely diagnosis?
Summary
Ovarian torsion refers to the rotation of the ovary at its pedicle, to such a degree as to occlude the ovarian blood supply or drainage, which can potentially damage the ovary. Patients with ovarian torsion often present with sudden onset of sharp and usually unilateral lower abdominal pain, accompanied by nausea and vomiting.
Ovarian torsion is a medical emergency and requires immediate treatment. It is typically diagnosed through a physical exam and imaging tests such as an ultrasound. Treatment may include surgery to untwist the ovary and restore its blood supply. In some cases, the ovary may need to be removed if it has been damaged due to ischemia.