Journal of Fertilization: In Vitro - IVF-Worldwide, Reproductive Medicine, Genetics & Stem Cell Biol
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Ovarian Torsion: A Slight Overview

Zeev Shoham^{* *}Correspondence: Zeev Shoham, Director of the Reproductive and Endocrinology Unit Kaplan Medical Center, Israel, Email:

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Introduction

Ovarian torsion also termed as the adnexal torsion. It is the fifth most common medical emergency of the female reproductive organs. It is a condition that occurs when an ovary twists around the ligaments that hold it in place. Sometimes, the fallopian tube may also become twisted. This twisting cuts off the blood flow to the ovary and fallopian tube. It causes severe pain as the ovary does not receive enough blood. If the blood restriction continues for too long, it can lead to tissue death, resulting in loss of an ovary. Ovarian torsion usually affects only one ovary.

Signs and Symptoms

In ovarian torsion symptoms arise suddenly and intensely. Main symptoms are:

1. Severe, sudden pain in the lower abdomen

2. Cramping

3. Nausea, vomiting, loss of appetite

4. Very heavy vaginal bleeding

5. Fever

6. Changes in the timing of menstruation

7. Change in bowel movements

8. More frequent urination

9. Weight gain

However, diagnosis of ovarian torsion can be challenging as the symptoms are similar to those of appendicitis, gastroenteritis, kidney stones, a urinary tract infection, pregnancy.

Diagnosis

It is essential to seek Doctors advice if there are any of the above symptoms

1. A trans-vaginal ultrasound, which involves inserting a small ultrasound probe into the vagina.

2. An abdominal ultrasound, which uses an ultrasound probe on the outside of the abdomen.

3. Other imaging tests, such as a CT scan or MRI scan.

4. A complete blood count test, or CBC, which can measure the number of white blood cells in the body.

Causes

1. Torsion can occur if the ovary is unstable. E.g. a cyst or mass in the ovary can displace it. The extra mass on the ovary can cause it to twist and rotate around its supporting ligaments.

2. Ovarian ligament, connecting the ovary to the uterus, if it is longer than usual. It can make ovarian torsion more likely.

3. Assisted reproductive technologies (ART), such as inducing ovulation, can be another factor for increasing of ovarian torsion.

4. In the first trimester, some women may have corpus luteum cysts which causes the ovary to twist.

5. Higher hormone levels during pregnancy also can relax tissues within the body, including the ligaments that hold the ovaries in situ. If the ligaments aren't taut, they'll be more susceptible to twisting.

6. Girls between 20-40 ages are more likely to experience ovarian torsion.

Treatment

Medication

There is no such medication that can untwist the ovary. However, pain medications such as narcotics may be given if there is a lot of pain.

Surgery

It is the only way to untwist an ovary. Doctors recommend surgery as quickly as possible.

There are two surgical procedures to untwist your ovary

Laparoscopy: It involves making small, keyhole-like incisions in the abdomen. Surgeon will insert several medical instruments, and camera (which enables to view internal organs), into the abdomen and pelvis and attempt to untwist the ovary.

Laparotomy: Sometimes, if a doctor is unable to see the ovary well enough, they may need to perform an open procedure. In open procedure a large incision is made under the navel to expose the ovary and untwist it.

If ovarian torsion restricts blood flow for long time, then ovarian tissue may die, and a surgeon had to remove the ovary.

If ovarian tissue is no longer alive, laparoscopic procedure is used to remove the ovary, it is termed as Oophorectomy.

If both the ovarian and fallopian tissue is no longer alive, laparoscopic procedure is used to remove both of them; it is termed as Salpingo-Oophorectomy. This may also be recommended to prevent recurrence in women who are postmenopausal.