Torsion initially compromises the lowpressure venous and lymphatic. Since the anatomy and function of the ovary vary considerably at different stages in a womans life, these aspects will be considered during adulthood, childhood, and. An update on the diagnosis and management of ovarian torsion emmanuel damigos ptychio latrikes mbbs,a jemma johns mbbs md mrcog,b, jackie ross mbbs frcog c ast5 in obstetrics and gynaecology, friarage hospital, south tees hospitals trust, northallerton, north yorkshire dl6 1jg, uk bconsultant gynaecologist, kings college hospital, denmark hill, london se5 9rs, uk. Ovarian torsion definition ovarian torsion is the twisting of an ovary on its ligamentous supports and can result in a compromised blood supply. There is an excellent agreement between ultrasound and histopathology diagnosis in diagnosing adnexal masses with kappa value 0. Concomitant ovarian and tubal torsion has been shown to occur in up to 67% of cases of adnexal torsion 10,11. Notably, the ovarian pedicle was twisted twice around its axis.
Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. Histopathology revealed no underlying ovarian lesion. Ovarian serous cystadenoma, torsion, salpingitis and. Ninetyseven cases of torsion of the pedicle were found at 1,101 consecutive operations for ovarian tumor performed at the mount sinai hospital between 1924 and 1935. Torsion of a normal ovary in the third trimester of. It is associated with blood supply compromise and ischemic injury in the ovary which occurs following reduced venous return. The genital tract makes up the rest of the female reproductive system. Evaluation of adnexal masses correlation of clinical. Gametogenesis in the female is referred to as oogenesis. Up to 80% of the cases of ovarian torsion are associated with a history of an ovarian mass or cyst. Adnexal torsion occurs more frequently in the first and early second trimesters than in the third trimester 2. In the present study, ovarian functions after the torsion process, and medical ozone administration were evaluated. Ovaries also have an endocrine function they release oestrogen and progesterone.
We report torsion of a normalsized ovary in the third trimester of pregnancy, most probably the first case report of its kind in the englishlanguage literature. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Therapeutic effects of medical ozone in the functions and. Therefore, timely diagnosis is critical to prevent. Evaluating ovarian preservation after ovarian torsion using. Ovary, fallopian tube and primary peritoneal carcinoma histopathology reporting guide version 1.
Torsion of ovarian tumors occurred predominantly in the reproductive age group. The potential for ovary conservation in suspected ovarian torsion should be greater if the tumor is nonmalignant, the time from the onset of abdominal pain to operation is short, and the crp. The uterus is a muscular organ, and its mucosal lining undergoes hormone dependent changes. Her histopathology report showed a benign serous cystadenoma. Choose from 298 different sets of ovary histology flashcards on quizlet. Pdf ovarian torsion is a rare but emergency condition in women. Ovarian serous cystadenoma, torsion, salpingitis and schistosomiasis in a nigerian. In can occur in women of all ages, but most women that experience this are younger. Histopathology, ischemia, montelukast, ovary, oxidative stress, rat, reperfusion ovarian torsion is the twisting of the ovary andor tube on its ligamentous support 1. It is a commonly held belief that if blood flow can be shown in an ovary that ovarian torsion can be excluded. Histopathological and biochemical assessment of a novel diagnostic method for ovarian torsion article pdf available in biotechnic and histochemistry october 2019 with 52 reads. Torsion of the pedicle in ovarian tumors jama surgery.
Ovarian torsion adnexal torsion refers to rotation of the ovary and a portion of the fallopian tube on its supplying vascular pedicle. An update on the diagnosis and management of ovarian torsion. The ovary is the organ where gametogenesis oogenesis occurs. Malignant transformation, torsion and rupture in a mature cystic teratoma of the ovary, a case report section. Usually associated with a mass cyst causing rotation obstruction also pid, hydrosalpinx, tubal ligation or adhesions. In this case we report a 23 yearold primigravida with 30 weeks presenting with torsion of the ovarian cyst. Pdf histopathological and biochemical assessment of a.
The majority of the cases presented in pregnant 22. Confusion may also occur due to overlap in appearances with. Pathology of the ovary, fallopian tube and peritoneum introduces the topic with a discussion of the anatomy, development, histology and normal function of the ovary, followed by chapters on nonneoplastic disorders of the ovary. Ovary, fallopian tube and primary peritoneal carcinoma. Extension of mesovarium forming germinal epithelium, overlying tunica albuginea parts. With the provisional diagnosis of adnexal torsion, the patient was taken to surgery. However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to ct or mri the latter in pregnant or young patients as the first imaging study. Case report of ovarian torsion mimicking ovarian cancer as. Luteinization of stromal cells may be prominent in some cases and there are clearly areas of close interrelationship and overlap between these conditions. According to the literature, there are only a few experimental studies that investigate the effects of ir injury on the hormonal functions and morphological views of the ovary.
Clinical history is useful but often can overlap for both entities at presentation. Adnexal torsion refers to the total or partial twist of the ovary around its vascular axis and can result in vascular compression and necrosis. Ovarian torsion occurs when the ovary and its vascular pedicle twists in its suspensory ligament, which is the structure that attaches the ovary to the pelvic sidewall. Untreated ovarian torsion can lead to the loss of ovary and infertility 1, 4. This chapter deals with the normal macroscopic, microscopic, and ultrastructural morphology of the human ovary, and its hormonal function. The mass found on laparoscopy can best be explained by torsion, autoamputation, and reimplantation of the ovary containing the mature cystic teratoma into the posterior culdesac.
The ovary is where oogenesis occurs ovaries are stimulated by gonadotrophin from the anterior pituitary. Pearls and pitfalls in diagnosis of ovarian torsion. Ovulation is the release of an oocyte and occurs every 2830 days. Torsion, autoamputation, and reimplantation of viable. More completely, it is defined as adnexal torsion when the twisting includes the fallopian tube. Fibrinoid vascular necrosis can be seen in both entities. Discussion pediatric ovarian torsion is an infrequent diagnosis and it often mimics acute appendicitis 1. Neonatal ovarian cysts can clinically cause pain, vomiting, fever, irritability, and abdominal distention. Description ovarian torsion occurs infrequently only in females. The presence of flow at color doppler imaging does not allow exclusion of torsion but instead suggests that the ovary may be viable, especially if.
The major presenting symptom was pain but an abdominal mass was palpable in 79. Its unclear how often ovarian torsion occurs, but doctors agree that its an uncommon diagnosis. Obstruction to the arterial inflow, venous outflow, and lymphatic drainage can cause hemorrhagic necrosis within. Pdf evaluating ovarian preservation after ovarian torsion using. Nonneoplastic proliferations of the ovarian stroma occur in a range of conditions, including polycystic ovary syndrome, stromal hyperplasia, massive oedema and fibromatosis. The size of the mass is positively correlated with the risk of ovarian torsion. Surgery immediately to salvage torsed ovary o oophoropexy. The most important risk factor for ovarian torsion is ovarian mass. In general, when ovarian torsion develops, venous blood flow to the ovary is first blocked, followed by. Occurs in women of all ages 23 involve right tube etiology.
Key content torsion of the ovary, tube or both is estimated to be responsible for. Ovarian torsion society for academic emergency medicine. Sonographic diagnosis of ovarian torsion ucsf emergency. Mri of ovarian torsion european journal of radiology. While classically the pain is sudden in onset, this is not always the case. Ovarian torsion ucsf emergency medicine ultrasound. Postulated causes include markedly mobile fallopian tubes or mesosalpinx, elongated pelvic ligaments, fallopian tube spasm, strenuous exercise, or abrupt changes in intraabdominal pressure. Adnexal torsion in the third trimester of pregnancy. Symptoms typically include pelvic pain on one side. The histopathology confirmed an extensively hemorrhagic fallopian tube and ovary with partial necrosis. Ovarian torsion definition of ovarian torsion by medical. Clinical indices and histological changes over time in. Comparison of biochemical parameter levels of all experimental groups.
The inflammatory cells with testicular torsion are frequently lymphohistiocytic instead of the mixed inflammatory cells of a polyarteritis nodosa. Ovarian torsion is defined as a partial or complete twisting of the ovary around its vascular pedicle and ligamentous supports. The contents consisted of old, organised blood clots. It is uncommon for a normalsized ovary to undergo torsion in advanced gestation. Definition ovarian torsion is the twisting of the ovary due to the influence of another condition or disease. Torsion of the pedicle is a serious and most common complication of ovarian tumor. Ovarian torsion is a gynecologic emergency whose ultrasound features have been well described 112. In this study, the 2 incidences of ovarian torsion encountered in pediatric age. The average diameter of ovarian masses in patients with ovarian torsion was found to be around 9. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment. Casecontrol study comparing the sensitivity and specificity of. She presented to the antenatal clinic with acute pain abdomen. Torsion of a normal ovary is unusual but is more common in adolescents. Adnexal torsion is a term that is inclusive of either the ovary, fallopian tube, or both.
Torsion usually occurs in ovaries with functional cysts or tumors. Ovarian torsion is a gynecologic syndrome that constitutes a surgical emergency affecting both children 2 and adolescent women. Ovarian torsion is an uncommon cause of acute abdominal pain in females, but it is a gynecologic emergency diagnostic delay can result in loss of the ovary. Ovarian torsion ot is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Midsurgical examination confirmed the diagnosis of.
If not treated quickly, it can result in loss of an ovary. Adnexal torsion in advanced pregnancy is an uncommon emergency. The most important factors for a diagnosis of ovarian torsion on ultrasound are the size and grayscale appearance and the clinical presentation. Protective effects of montelukast on ischemiareperfusion. Complications may include infection, bleeding, or infertility risk factors include ovarian cysts, ovarian. It is a medical emergency requiring immediate surgical intervention to prevent ovarian necrosis. The ovary, and often the fallopian tube as well adnexal torsion become twisted around their vascular pedicle. Pathology of the ovary, fallopian tube and peritoneum.
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