Ovarian torsion

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Classification according to ICD-10
N83.5 Torsion of the ovary
ICD-10 online (WHO version 2019)

A ovarian torsion or ovarian stem rotation refers to the rotation of the ovary (ovary) about its mounting. The resulting closure of the venous drainage leads to hemorrhagic infarction and thus to the formation of necrosis . Ovarian torsion occurs in cystically altered, enlarged ovaries (ovaries) and is very painful.

Clinic and diagnostics

The medical history and clinical picture as well as sonography are the most important diagnostic instruments. The main symptom is the one-sided, colicky pain. In addition to pain, the patients usually also suffer from nausea, vomiting, sweating and tachycardia . If the ovary is necrotic, the inflammation parameters in the blood, such as white blood cells ( leukocytosis ) or CRP, may also be increased. The sonographic evidence of an ovarian cyst corroborates the clinical suspicion. In children, transabdominal sonography is used with the filled urinary bladder as an acoustic window; in adults, transvaginal ultrasound is used.

The blood flow to the ovary can be checked using Doppler sonography . The lack of or insufficient blood flow suggests necrosis of the ovary as a result of torsion. However, the Doppler sonographic evidence of vascularization of the ovary does not rule out a torsion. The final confirmation of the diagnosis is made by the laparoscopy .

In terms of differential diagnosis, ectopic pregnancy or a cyst rupture must be considered. Also, appendicitis , pelvic inflammatory disease or endometriosis must be considered.

therapy

Treatment consists of rapid Retorquierung the ovary by laparoscopy . The surgical treatment must be carried out within hours. Otherwise there is a risk of the affected ovary dying off. This can subsequently lead to infertility .

literature

  • C. Yaman, T. Ebner, K. Jesacher: Three-dimensional power Doppler in the diagnosis of ovarian torsion. In: Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. Volume 20, Number 5, November 2002, pp. 513-515, ISSN  0960-7692 . doi : 10.1046 / j.1469-0705.2002.00834.x . PMID 12423493 .
  • R. Mashiach, N. Melamed, et al. a .: Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. In: Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine. Volume 30, Number 9, September 2011, pp. 1205-1210, ISSN  1550-9613 . PMID 21876091 .
  • V. Hofmann, KH Deeg, PF Hoyer: Ultrasound diagnostics in pediatrics and pediatric surgery. Textbook and atlas. Thieme 2005, ISBN 3-13-100953-5 .

Individual evidence

  1. ↑ A. Strauss, L. Sanders et al. a .: Gynecological emergencies . In: The emergency doctor . tape 29 , 2013, p. 221 .