OVARIAN TORSION: A FIFTEEN-YEAR REVIEW.
Houry D, Abbott JT. Ann Emerg Med 2001 Aug;38(2):156-9.
STUDY OBJECTIVE: Our purpose was to describe the history, physical, and
laboratory findings in women with ovarian torsion (OT).
METHODS: A retrospective chart review was conducted
at 2 urban teaching hospitals. All women admitted from 1984 to 1999 with
surgically proven OT were included in the study.
RESULTS: The 87 women ranged in age from 14 to 82
years (mean 32 years). Twelve were pregnant, 15 were postmenopausal, and 7 were
posthysterectomy. Thirty-five (40%) had prior pelvic surgery; 18 of these (21%
of the total) had undergone tubal ligation. Twenty-two (25%) women had a
history of an ovarian cyst. Sixty-five (75%) patients were seen in the
emergency department. Pain characteristics were variable: the onset was sudden
in 51 (59%); "sharp" or stabbing in 61 (70%); and radiated to the
flank, back, or groin in 44 (51%) patients. Only 3 had peritoneal signs at
presentation. The majority of patients (70%) had nausea or vomiting. Fever was
rare (2 patients). OT was considered in the admitting differential diagnosis in
41 (47%) patients. An enlarged ovary (>5 cm) was found in 77 (89%) patients
at surgery. Only 26 patients had surgery within 24 hours. In 8 (9%) patients,
detorsion was possible; of these, 3 had surgery within 24 hours.
CONCLUSION: The diagnosis of OT is often missed and
ovarian salvage is rare. Pain characteristics are variable and objective
findings are uncommon in OT.