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Ovarian cyst and tumors
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Bryan J. Dicken, Deborah F. Billmire
Ovarian torsion may occur with a normal ovary, ovarian cyst, or ovarian tumor. US frequently demonstrates multiple small peripherally located, uniform cysts in the involved ovary. This appearance arises secondary to displaced follicles, due to venous congestion and edema. Color Doppler may reveal absence of arterial flow. A twisted pedicle may also be seen. In cases involving simple cysts, management of the cyst with ovarian preservation is the goal of therapy. Since it is not possible to differentiate benign from malignant lesions in the acute setting of torsion, the principles of ovarian preservation are still valid. If a neoplasm is present, management should be as directed in the section on ovarian neoplasm below. In the absence of evidence of neoplasm, it is preferable to untwist the ovary, and consider oophoropexy to allow resolution of inflammation and edema. This can be accomplished by detorsion, then fixation of the ovary with absorbable suture through the tunica of the ovarian pole to the adjacent utero-ovarian ligament, or to the psoas tendon (Figure 81.5). Care must be exercised to identify the ureter prior to suture fixation. Patients should be followed by close postoperative surveillance of the ovary with US in 6–8 weeks.
Adnexal/Ovarian Torsion
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Hajra Takala, Mona Omar, Ayman Al-Hendy
The ovaries are ovoid nonfixed organs that are located within the broad ligament on either side (lateral) of the uterus. This position is maintained by the infundibulopelvic ligaments, also called suspensory ligaments (a fold of peritoneum extending from the mesovarium to the pelvic wall), of the ovary, which suspend the ovary superolateral to the lateral pelvic wall. A mesovarium is a fold of the peritoneum, continuous with the outer surface of the ovaries. The suspensory ligament of the ovary contains the ovarian artery, ovarian vein, ovarian nerve plexus, and lymphatic vessels. The other side (medial pole) of the ovary is supported and connected to the uterus by the utero-ovarian (UO) ligament, also known as the ovarian ligament or the proper ovarian ligament [1–3].
A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
A final consideration of acute ovarian cyst pain is the possibility of torsion. Torsion is a surgical emergency that occurs when the ovary and/or fallopian tube, enlarged due to fluid accumulation such as in the form of a cyst, twists on its ligamentous supports such that its blood supply is compromised. Torsion can occur in women of any age, and even in premenarchal girls with normal-sized ovaries.52 However, size of the ovary is considered the primary risk factor, and even asymptomatic masses above 5 cm will garner the gynecologic surgeon’s attention for intervention to prevent torsion. Torsion typically presents with the patient complaining of the worst pain of her life, often with nausea and vomiting, and findings of an acute abdomen. Ultrasound may demonstrate a mass with absence of blood flow by doppler interrogation. Torsion more often occurs on the right side, due to a longer utero-ovarian ligament on the right and the cushioning presence of the sigmoid colon on the left. Treatment for torsion is surgical.
Urinary retention in an 8-year-old: are we missing adnexal torsion?
Published in Journal of Obstetrics and Gynaecology, 2021
Adnexal torsion can present with vague and unusual symptoms in children. Only one other case of ovarian torsion causing urinary retention has been reported in the literature; this is possibly due to the disturbance of the autonomic nervous system (Schuster et al. 2003). A recent systematic review (Kives et al. 2017) gives the following recommendations:To make a prompt diagnosis and referral to a surgeon.Ultrasound and colour flow Doppler are the imaging of choice.A laparoscopy is the preferred surgical approach.That a conservative surgical treatment of detorsion, with or without cystectomy, should be performed. This is even in cases of a blue-black ovary.Oophoropexy can be considered in cases with a congenitally long ovarian ligament, a repeat torsion, or when no obvious cause is found.The risk of malignancy at the time of torsion is very low.
Adnexal incidentalomas on multidetector CT: how to manage and characterise
Published in Journal of Obstetrics and Gynaecology, 2020
A. C. Tsili, M. I. Argyropoulou
There are two main ligaments that attach to the ovary, the suspensory ligament and the ovarian ligament. The suspensory ligament of the ovary is a fold of peritoneum extending out from the ovary to the pelvic sidewall, and transmitting the ovarian vein and artery. The visualisation of the suspensory ligament leading to a pelvic mass is a sign highly indicative of the ovarian origin of a mass. This ligament may be detected at CT as a short and narrow, linear or fan-shaped soft-tissue band that widens as it approaches the ovary (Figures 3(a) and 4). The ovarian ligament is a fibrous structure, connecting the ovary to the lateral surface of the uterus. This ligament is occasionally seen at CT as a short and narrow soft-tissue band between the uterus and ovary (Saksouk and Johnson 2004; Forstner 2019).
Losartan ameliorates ovarian ischaemia/reperfusion injury in rats: an experimental study
Published in Journal of Obstetrics and Gynaecology, 2020
Ismet Hortu, Orkun Ilgen, Cagdas Sahin, Ali Akdemir, Gurkan Yigitturk, Oytun Erbas
Ovarian torsion is one of the most prominent gynaecological emergencies with a frequency of 2.7–7.4% depending on the series and occurs most commonly during the reproductive years, with the average patient being in her mid-20s (Sasaki and Miller 2014). It is defined as the twisting of the ovary and/or tube around its own vascular axis. Patients with adnexal torsion present with acute, severe, unilateral lower abdominal and/or pelvic pain, and nausea in addition to vomiting. Hence, detorsion of the ovary is surgically implemented to maintain its proper blood supply (Soltani et al. 2017). Ovulation induction, ovarian and/or paratubal cysts, hyperlaxity of the infundibulopelvic or utero-ovarian ligaments have been considered as risk factors of this emergent condition. When diagnosed early, the adnexa can be unwound. However, the diagnosis is often delayed due to the inconsistent presenting symptoms and signs as well as intermittent pain. When the diagnosis is delayed, the adnexa becomes congested, ischaemic, haemorrhagic, and necrotic. Misdiagnosis or delay in treatment can have permanent sequel including loss of an ovary which affects future fertility, peritonitis, pelvic thrombophlebitis, and even death (Shokri et al. 2018).