Gastrointestinal and Genitourinary Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
The often non-specific presentation of ovarian torsion can make diagnosis difficult, and as a result the most appropriate form of imaging may not always be clear. However, in cases where ovarian torsion is suspected, ultrasound is the initial imaging modality of choice. A transabdominal scan should be adequate to establish the diagnosis with a well distended urinary bladder, but in more difficult cases a transvaginal scan may be necessary. CT imaging may be performed, although the findings are more non-specific and it is not recommended in the first instance. (See Table 2.31.)
Clinical specialties
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Kerry, aged 44, presents to the emergency department with severe left lower quadrant pain. List two gynaecological causes of acute left lower abdominal pain. (2)Name two investigations for assessing your answers to 1. (2)What are the clinical features of ovarian torsion, and how does it arise? (2)A solid cystic mass is found on the left ovary, with calcified structures that look similar to teeth. What is the diagnosis? (1)How does the answer you gave in the above question arise? (1)Kerry undergoes a laparoscopic cystectomy, and her pain settles with analgesia after 2 days. However, she is worried about ovarian cancer. What can you tell her, given she has the answer you gave in 4? (1)Name two risk factors for ovarian cancer. (2)What genetic mutations may increase the risk of ovarian cancer? (1)Tumour markers can be used to monitor response to ovarian cancer treatment. Give an example of a tumour marker used in ovarian cancer. (1)
Test Paper 3
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Ovarian torsion is most common in prepubertal girls and may be caused by ovarian enlargement (for example owing to neoplastic causes, of which benign cystic teratoma is the most common) or abnormally increased adnexal mobility. It is more common on the right than the left, which is postulated to occur because of a protective effect of the sigmoid colon on the left side. On ultrasound, the most reliable positive finding is asymmetry between the volumes of the right and left ovaries. Arterial Doppler waveform is usually but not always absent, as there is blood supply from both the ovarian and uterine arteries.
The effect of rutin on ovarian ischemia-reperfusion injury in a rat model
Published in Gynecological Endocrinology, 2018
Cenk Nayki, Umit Nayki, Ferda Keskin Cimen, Mehmet Kulhan, Omer Erkan Yapca, Nezahat Kurt, Aslı Bilgin Ozbek
Ovarian torsion is a gynecological emergency in women, especially in first three decades of life that leads to a serious reduction in blood flow of the ovaries and following tissue damage [1]. Therefore, ovarian torsion must be diagnosed and treated surgically as soon as possible to prevent potential necrosis leading to infertility. In the surgical treatment, detorsion might be considered to restore the ovarian blood supply. However, reperfusion of the ischemic tissue might leads to more serious damage to the tissue than the damage caused by ischemia [2]. This process is known as ischemia-reperfusion (I/R) injury [3]. Several factors such as activation of neutrophils and trombocytes, release of reactive oxygen species (ROS) and cytokines, and inflammation are considered to have role in the pathogenesis of this I/R injury [4].
The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model
Published in Journal of Obstetrics and Gynaecology, 2022
Sema Süzen Çaypınar, Sema Karakaş, Cihan Kaya, Damlanur Sakız, Salim Sezer, Murat Ekin
Adnexal torsion is a common gynecological emergency in reproductive-age women, with a reported incidence of 2.7% (Hibbard 1985). Torsion of the adnexal structures can result in massive parenchymal congestion, infarcts, and haemorrhagic necrosis after arterial and venous blockade (Vijayalakshmi et al. 2014). The diagnosis of ovarian torsion could be obscure due to non-specific symptoms such as nausea, vomiting, and abdominal pain. Nevertheless, the early diagnosis is essential since it may cause detrimental effects on ovarian reserve (Bayer and Wiskind 1994). The recommended management is the detorsion of the adnexal pedicle in patients with fertility desire (Kaya et al. 2014). However, detorsion alone may increase the risk of thrombosis, infection, and leaving an undiagnosed malignancy (te Velde et al. 1998; Ozler et al. 2013).
When is it too late? Ovarian preservation and duration of symptoms in ovarian torsion
Published in Journal of Obstetrics and Gynaecology, 2022
Katherine Adams, Emma Ballard, Akwasi Amoako, Akram Khalil, David Baartz, Kevin Chu, Keisuke Tanaka
Eighty-six women were identified as having surgically proven ovarian torsion in the 10-year study period (Table 1). All women were admitted via the emergency department. The mean age was 36.1 years (SD 14.2), with a range between 18 and 78 years. Seventy patients (81%) were pre-menopausal with twenty-five (34.7%) being nulligravida. Nine patients (10.5%) were pregnant at the time of diagnosis with a mean gestation of 13 weeks, and 2 patients (2.3%) were within 6 weeks postpartum. Thirty-seven patients (43.0%) had a history of previous abdominal surgery. One or more risk factors for ovarian torsion were identified in thirty-seven patients (43.0%), including previous ovarian torsion, previous ovarian cyst, polycystic ovarian syndrome and endometriosis. There were no cases of ovarian hyperstimulation syndrome.