Twisted Ovary:
Symptoms and RISKS

The term "twisted ovary" describes an ovary which has twisted on itself, cutting off its own blood supply. It usually involves the Fallopian tube and ovary but it may involve the ovary alone. It can occur in women of all ages, but approximately 70-75% of cases occur in women under 30 years old. About 20% of all reported cases of twisted ovary are in pregnant women. Ovarian torsion usually arises in only one ovary at a time. But it can occur in both normal or enlarged ovaries and fallopian tubes, and occasionally develops in both.

The ovary has a twofold arterial and venous blood supply. The arterial supply is derived from the ovarian arteries that branch from the abdominal aorta, as well as from the adnexal branches of the uterine artery. The venous system parallels the arterial, with the exceptions that the left ovarian vein empties into the left renal vein and that the right ovarian vein courses into the inferior vena cava. In case of twisted ovaries there is reduced venous return from the ovary as a result of stromal edema, hyperstimulation, or a mass. Quick and confident diagnosis is required to save the adnexal structures from infarction. Ultrasonography with color Doppler analysis is the method of choice for the evaluation of adnexal torsion because it can show morphologic and physiologic changes in the ovary. Definitive diagnosis is generally made by laparoscopy. 

The signs and symptoms associated with twisted ovary are variable and nonspecific. Most patients present with severe lower abdominal and pelvic pain, nausea, and vomiting. The differential diagnosis could include appendicitis, gastroenteritis, ectopic pregnancy, pelvic inflammatory disease, and ruptured corpus luteum. Among adolescents, hemorrhagic ovarian cysts must also be considered. Laboratory tests are not helpful, because most signs and symptoms of ovarian torsion can be associated with leukocytosis. Ovarian torsion may also be a rare complication of IVF treatment. The overall risk is about 0.2%.

If not treated early enough the twisted ovary may die (gangrene). Treatment is surgery to untwist the ovary and even removing it sometimes. Laparoscopy is the gold standard for making the diagnosis and may allow treatment. If diagnosis is delayed, the torsion can worsen and cut off arterial blood flow into and venous blood flow out of the ovary. This results in necrosis (death) of the ovarian tissue. Delayed diagnosis can also result in problems when trying to conceive due to infertility.