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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 465-467

Ovarian torsion: Ultrasonography and color doppler imaging


Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission08-Apr-2020
Date of Decision05-May-2020
Date of Acceptance25-Jul-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Suresh Phatak
Department of Radio.Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_100_20

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  Abstract 


Young women with abdominal pain usually localized to a lower quadrant. We must first consider ovarian torsion as the cause and should be able to differentiate it from other conditions, such as appendicitis, cholecystitis, pelvic inflammatory disease, urinary collecting system calculi, and ruptured benign adnexal cysts. The ovarian torsion if identified in early-stage ovary can be saved.

Keywords: Acute abdomen, color Doppler sonography, ovarian masses, ovarian torsion


How to cite this article:
Tapadia S, Phatak S, Singh V. Ovarian torsion: Ultrasonography and color doppler imaging. J Datta Meghe Inst Med Sci Univ 2020;15:465-7

How to cite this URL:
Tapadia S, Phatak S, Singh V. Ovarian torsion: Ultrasonography and color doppler imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Feb 25];15:465-7. Available from: http://www.journaldmims.com/text.asp?2020/15/3/465/308534




  Introduction Top


In females, adnexal torsion is reported to be the fifth most common gynecologic emergency condition.[1] It is an acute surgical emergency occurring in women of reproductive age group, occasionally in newborn and prepubertal patient, and rarely in the postmenopausal patient. The most common conditions to be considered for a woman with acute abdominal pain include pelvic inflammatory disease with abscess, ectopic pregnancy, hemorrhage from a functional ovarian cyst, and adnexal or ovarian torsion.[2] There is usually a concurrent benign ovarian cyst or mass noted in the premenopausal adults. Adnexal torsion is accompanied with pregnancy in 20% of the cases, with the right ovary being the most commonly affected; only in 10% of the cases, bilateral involvement has been noted. In women of postmenopausal age, it is almost always seen with ovarian neoplasm. Usually, in children, ovarian torsion may occur in the absence of ovarian disease and has been attributed to excessive mobility of the adnexa. In 10% of the cases, the contralateral ovary is also torsed.[3]

In torsion, the ovary or ipsilateral  Fallopian tube More Details, or both, twists with the vascular pedicle as the axis which results in arterial and venous compromise. Usually, the ovarian cyst is the leading point of the torsion. If torsion is not diagnosed and treated immediately, it is likely to be followed by hemorrhagic infarction. Early diagnosis can be treated by conservative management, which may spare the ovary in young women.[4]


  Case Report Top


A 29-year-old hemodynamically stable female patient was brought to the emergency department with severe acute abdominal pain for 4 h and three episodes of vomiting with normal bowel and bladder habits. She was on her 2nd day of the menstrual cycle, so it was assumed to be uterine cramps. She was advised ultrasonography (USG) with color Doppler for further evaluation. On USG – there was evidence of bulky left ovary measuring 12.1 cm × 6.5 cm with a large cyst of size 5.7 cm × 5.5 cm within. Multiple small peripheral follicles were also present [Figure 1] and [Figure 2]. The left ovary showed no flow on color Doppler [Figure 3]. The uterus appeared to be normal. There was also evidence of free fluid in the pouch of Douglas. The right ovary was not visible as it was operated for chocolate cyst earlier. She underwent an emergency laparotomy which confirmed diagnosis of left torsed ovary [[Figure 4] - operative specimen].
Figure 1: Gray scale ultrasound image showing evidence of enlarged left ovary measuring 12.1 cm × 6.5 cm

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Figure 2: Gray scale ultrasound image showing enlarged left ovary with a cyst measuring 5.7 cm × 5.5 cm and multiple peripheral follicles

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Figure 3: Color Doppler image showing no vascularity being picked up by the vascular pedicle of the left ovary

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Figure 4: Following complete hysterectomy – white arrow showing hemorrhagic gangrenous left ovary, black arrow showing the twisted pedicle of the left ovary

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  Discussion Top


The most common sonographic finding in ovarian torsion is the enlargement of effected ovaries, free fluid in the cul de sac, a complex mass with septations and debris, homogeneous low-level echoes (“ground glass”) within the affected ovary, and small peripheral cystic structures within the torsed ovary.[5] Depiction of ovarian vascularity and flow is very important in such cases as it provides us with the details of vascular compromise and helps us differentiate between complete and incomplete torsion. In the earliest phases of torsion, venous flow is obstructed, and arterial flow has a “spiky” pattern. In later stages, both arterial and venous flow within the ovary is absent even though flow in the twisted pedicle can be observed.[6]

Variability in the degree of vascular compromise as well as collateral vasculature and the rapidity of achieving detorsion may all play a role in preserving the ovary and its function during this ischemic insult.[7],[8],[9],[10],[11],[12]


  Conclusion Top


USG with color Doppler acts as the first-line investigation for accurate and fast diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Albayram F, Hamper UM. Ovarian and adnexal torsion: Spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20:1083-9.  Back to cited text no. 1
    
2.
Burnett LS. Gynecologic causes of the acute abdomen. Surg Clin North Am 1988;68:385-98.  Back to cited text no. 2
    
3.
Akata D. Ovarian torsion and its mimics. Ultrasound Clinics 2008;3:451-60.  Back to cited text no. 3
    
4.
Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: Depiction of twisted vascular pedicle. J Ultrasound Med 1998;17:83-9.  Back to cited text no. 4
    
5.
Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med 2008;27:7-13.  Back to cited text no. 5
    
6.
Fleischer AC, Brader KR. Sonographic depiction of ovarian vascularity and flow: Current improvements and future applications. J Ultrasound Med 2001;20:241-50.  Back to cited text no. 6
    
7.
Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010;202:536.e1-6.  Back to cited text no. 7
    
8.
Laishram S, Gupta V, Bhake A, Wankhede A, Agrawal D. To Assess the Utility of Proliferative Marker Ki-67 in Surface Epithelial Ovarian Tumor. J Datta Meghe Inst Med Sci Univ 2019;14:6-10. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_71_18. [Last accessed on 2020 Feb 18].  Back to cited text no. 8
    
9.
Gadge A, Acharya N, Shukla S, Phatak S. Comparative Study of Transvaginal Sonography and Hysteroscopy for the Detection of Endometrial Lesions in Women with Abnormal Uterine Bleeding in Perimenopausal Age Group. J SAFOG 2018;10:155-60. Available from: https://doi.org/10.5005/jp-journals-10006-1580. [Last accessed on 2020 Feb 18].  Back to cited text no. 9
    
10.
Sadavarte TP, Bansal NO, Banode P, Padmawar M. Role of High Resolution ultrasonography and Color Doppler in Evaluating and Distinguishing the Type of Inguinal hernia. Int J Curr Res Acad Rev 2020;12:135-40. Available from: https://doi.org/10.31782/IJCRR.2020.135140. [Last accessed on 2020 Feb 18].  Back to cited text no. 10
    
11.
Dakhode S, Gaidhane A, Choudhari S, Muntode P, Wagh V, Zahiruddin QS. Determinants for accessing emergency obstetric care services at peripheral health facilities in a block of wardha district, maharashtra: A qualitative study. J Datta Meghe Inst Med Sci Univ 2020;15:1-6.  Back to cited text no. 11
  [Full text]  
12.
Abbafati C, Machado DB, Cislaghi B, Salman OM, Karanikolos M, McKee M, et al. Five insights from the Global Burden of Disease Study 2019. Lancet 2020;396:1135-59.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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