Ovarian torsion: a fifteen-year review

Our purpose was to describe the history, physical, and laboratory findings in women with ovarian torsion (OT).

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.

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.

The diagnosis of OT is often missed and ovarian salvage is rare. Pain characteristics are variable and objective findings are uncommon in OT.