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Khalid Naji

on 18 February 2013

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Transcript of Copy of blank

Ovarian torsion

Khalid A. Naji
Medical intern Pathophysiology Ovarian torsion classically occurs unilaterally in a pathologically enlarged
ovary The process can involve the ovary alone
but more commonly affects both the ovary and the oviduct (adnexal torsion) 60% of torsion occurs
on the right side Multiple factors
-developmental abnormalities
-enlarged corpus luteum cyst
-ovarian tumor
-hx of surgery Frequency 2.7% of cases of
acute gynecologic
complaints The fifth most common
gynecologic surgical
emergency usually in women
between
20 and 39 years Mortality/Morbidity delayed diagnosis
ovarian salvage
early diagnosis
lead to death Signs & symptoms • Acute appendicitis
• Diverticulitis
• Mesenteric ischemia
• Endometriosis
• Acute PID
• Ectopic pregnancy
• Pregnancy with UTI
• Ovarian tumor
• Tubal ovarian abscess
• Ureteral calculi Lab studies • A pregnancy test
• General laboratory studies are
not helpful in verifying a diagnosis
of ovarian torsion

The use of a complete blood count to evaluate
for leukocytosis and anemia is nonspecific and
unlikely to support or exclude the diagnosis Imaging Studies US
• Ultrasonography is the primary modality of
imaging for patients with suspected
ovarian torsion
• Ovarian enlargement secondary to
impaired venous and lymphatic drainage is
the most common sonographic finding in
ovarian torsion CT
• Computed tomography may demonstrate
an enlarged ovary and adnexal masses
but is unable to evaluate the presence or
absence of blood flow to the involved
ovary
• However, CT may be useful in ruling out
other possible causes of lower abdominal
pain in cases of diagnostic uncertainty Procedures
• Laparoscopy can be used for both
confirmation of the diagnosis and
treatment
• Culdocentesis is a nonspecific test that is
unlikely to confirm or exclude torsion and
is not recommended in the diagnostic
workup TREATMENT ? • Prehospital Care
• assessing vital signs
• establishing an intravenous line
• Treat nausea and vomiting
• For the patient with a concerning history,
physical examination, or ultrasonographic
findings suspicious for torsion • Conservative management is favored
early in the course of disease and consists
of laparoscopy with uncoiling of the torsed
ovary and possible oophoropexy.
• Since recurrence of torsion is rare except
in profoundly enlarged ovaries (ie,
polycystic ovaries), some suggest that
fixation of the ovary to the pelvic wall is
unwarranted • Salpingo-oophorectomy may be indicated
if severe vascular compromise, peritonitis,
or tissue necrosis is clearly evident • However, since the size, color, and edema
of the ovary may not accurately reflect the
amount of tissue injury, multiple studies
now support early conservative
management with a success rate of 88%
or greater • Recently, laparoscopic triplication of the
utero-ovarian ligament has been
performed to prevent recurrent torsion in
young patients in attempt to shorten the
excessively long ligament Complications THANK U


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