Ovarian torsion: 10-year perspective

Melissa White, Julian Stella
Emergency Medicine Australasia: EMA 2005, 17 (3): 231-7

OBJECTIVE: To define the presenting symptoms and clinical progress of surgically proven cases of ovarian torsion presenting to a tertiary women's hospital.

METHODS: A retrospective case review of surgically proven ovarian torsion at The Royal Women's Hospital, Melbourne between 8 May 1990 and 8 May 2000.

RESULTS: Fifty-two cases were identified. Median age at presentation was 33.5 years (interquartile range [IQR]: 28.7-39.3). Known risk factors at presentation were found in 16 (30.8%, 95% CI: 26.9-34.6%) cases including 6/49 (12.2%, 95% CI 11.1-12.4%) with ovarian hyperstimulation syndrome. The main clinical features included: sudden pain (20/23, 87%, 95% CI 75-98.9%), nausea/vomiting (23/39, 59%, 95% CI 49.9-68.1%) and palpable abdominal mass (23/37, 62.2%, 95% CI 52.4-71.9%). Median symptom duration was 3 days (IQR: 1-7.25). Median time to diagnosis was 22 h (IQR: 7.8-55.0). The diagnosis was mostly made at surgery (36, 69.2%, 95% CI 60.5-77.9%) with clinically suspicion in 10 (19.2%, 95% CI 17.2-21.3%) and sonographic suspicion/confirmation in six (11.5%, 95% CI 10.5-12.5%) cases. Ultrasound was performed in 31 (59.6%, 95% CI 51.7-67.6%) cases. Underlying pathologies included: ovarian cysts (27, 51.9%, 95% CI 44.9-59.0%) and tumours (16, 30.8%, 95% CI 26.9-34.6%)--mostly benign. Ovarian preservation occurred in 16 (30.8%, 95% CI 26.9-34.6%) cases with no demonstrable association to patient age, time to diagnosis or known risk factors.

CONCLUSION: The diagnosis of ovarian torsion remains challenging. Clinical characteristics lack sensitivity and specificity and ultrasound diagnosis is not definitive. Laparoscopy remains the investigation of choice. Despite delays in diagnosis this study demonstrates relatively high ovarian salvage rates compared with most published data.

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