Ovarian torsion is a clinical emergency in which an ovary with or without the fallopian tubes twists along its axis, leading to partial or complete obstruction of its blood supply. It is also called an adnexal or tubo-ovarian torsion, especially if the fallopian tube is also involved. The ovaries twist along the suspensory ligament of the ovary and the utero-ovarian ligament, which support the ovaries and secure them to the inner pelvic walls and uterus, respectively. It most commonly occurs in women of reproductive age and when the ovary is larger than 5 cm. The torsion cuts off the ovarian blood supply, leading to pooling of blood, edema, and severe pain. As a clinical emergency, it needs to be treated promptly with surgical intervention in order to prevent necrosis of the ovaries and other complications.
Last updated: 29 Apr, 2022
Ovarian torsion is the twisting of the ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy along their axis Axis The second cervical vertebra. Vertebral Column: Anatomy. Ovarian torsion may or may not include the fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy and it if does, it is termed adnexal torsion.
Posterior view of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy showing the blood supply of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy and
ovaries
Ovaries
Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes).
Ovaries: Anatomy:
Note the ovarian artery traveling along the ovarian
suspensory ligament
Suspensory ligament
Ovaries: Anatomy, supplying both the
ovaries
Ovaries
Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes).
Ovaries: Anatomy and the lateral portion of the uterine tube. The ovarian artery continues in the
mesosalpinx
Mesosalpinx
Uterus, Cervix, and Fallopian Tubes: Anatomy to anastomose with branches of the
uterine artery
Uterine Artery
A branch arising from the internal iliac artery in females, that supplies blood to the uterus.
Uterus, Cervix, and Fallopian Tubes: Anatomy. (Note: the
round ligament
Round ligament
A fibromuscular band that attaches to the uterus and then passes along the broad ligament, out through the inguinal ring, and into the labium majus.
Uterus, Cervix, and Fallopian Tubes: Anatomy comes off the anterior surface of the
uterus
Uterus
The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina.
Uterus, Cervix, and Fallopian Tubes: Anatomy.)
Superior view of the female pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy depicting the ovaries Ovaries Ovaries are the paired gonads of the female reproductive system that contain haploid gametes known as oocytes. The ovaries are located intraperitoneally in the pelvis, just posterior to the broad ligament, and are connected to the pelvic sidewall and to the uterus by ligaments. These organs function to secrete hormones (estrogen and progesterone) and to produce the female germ cells (oocytes). Ovaries: Anatomy in situ and their supporting ligaments and relation to the uterus Uterus The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The uterus has a thick wall made of smooth muscle (the myometrium) and an inner mucosal layer (the endometrium). The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Uterus, Cervix, and Fallopian Tubes: Anatomy
Image by Lecturio. License: CC BY-NC-SA 4.0Ovarian or adnexal torsion involves the following sequence of events:
Adnexal torsion is suspected based on typical symptoms, supported by imaging with transvaginal ultrasonography or color Doppler Doppler Ultrasonography applying the doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. Ultrasound (Sonography) ultrasonography, and confirmed during immediate exploratory surgery.
Laparoscopy Laparoscopy Laparoscopy is surgical exploration and interventions performed through small incisions with a camera and long instruments. Laparotomy and Laparoscopy/ laparotomy Laparotomy Incision into the side of the abdomen between the ribs and pelvis. Laparotomy and Laparoscopy is the gold standard for the diagnosis of ovarian torsion, as the twisted ovary can be directly visualized by the surgeon.