Ovarian torsion: Difference between revisions
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===Pathophysiology=== | ===Pathophysiology=== | ||
* | *Cysts greater than 4cm more likely to torse<ref>M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282</ref> | ||
*dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis | *The ovaries have a dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis | ||
**sonographer should document dual arterial and venous waveforms | **sonographer should document dual arterial and venous waveforms | ||
Revision as of 10:18, 6 November 2015
Background
- Occurs in females of all ages (most common in reproductive age women)
- Ovarian cysts (usually > 5 mm) and neoplasms account for 94% of cases in adults
- Account for only 50% in children (much more likely to torse normal ovaries)
Pathophysiology
- Cysts greater than 4cm more likely to torse[1]
- The ovaries have a dual ovation blood supply so even if flow negative but significant pain still consider as diagnosis
- sonographer should document dual arterial and venous waveforms
Clinical Features
- Nausea/vomiting (70%)
- Sudden and sharp pain in the lower abdomen (59%)
- can be intermittent
- Fever (<2%)
Differential Diagnosis
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Diagnosis
- Ultrasound (sensitivity 46-70%)
- Diminished or absent blood flow in the ovarian vessels (presence of flow does not r/o)
- Ovarian mass > 2.5-3 cm
- Enlarged ovarian volume
- Loss of echogenicity
- Edema
- Free fluid
- CT may be used to r/o other possible causes of lower abdominal pain; also exclude presence of pelvic mass
- Gold standard: direct visualization!
Treatment
- Emergent OB/GYN consult in ED
See Also
References
- ↑ M.L. Brandt et al. Surgical indications in antenatally diagnosed ovarian cysts J Pediatr Surg, 26 (1991), pp. 276–282