371 Ovarian Torsion versus Ruptured Ovarian Cyst: Emergency Department Presentation and Outcomes

Abstract

As the fifth most common gynecologic surgical emergency, ovarian torsion is a diagnosis that emergency physicians need to consider, as early diagnosis is key to restore blood flow to the ovary and avoid permanent damage. Ruptured ovarian cysts can present similarly with sharp, sudden onset of pelvic pain. This can result in difficulty distinguishing between ovarian torsion and ruptured ovarian cyst on history and physical exam. This study will evaluate similarities and differences in clinical presentation or outcomes of patients presenting to ED with ovarian torsion or ruptured ovarian cyst. This five-year retrospective study at two community teaching EDs includes all patients with a chief complaint of abdominal pain and a primary final discharge diagnosis of ovarian torsion or ruptured ovarian cyst. Excluded are pregnant patients and patients with no imaging studies in the ED. Descriptive statistics are reported as medians or percentage and statistical testing done with either Mann-Whitney or Fisher Exact as appropriate. Significance was set at p=0.05. 91 cases meet inclusion/exclusion criteria; 26 (28.6%) had ovarian torsion while 65 (71.4%) had ruptured ovarian cyst. The initial vital signs were all unremarkable. No one was febrile, the highest heart rate was 105 and there was only one hypotension (84/53). 78.0% (71/91) had ultrasound studies while in the ED, 53.8% (49/91) had CT abdominal scans, and 33.0% (30/91) had both done while in the ED. Patients with ovarian torsion were significantly older (34.5 years versus 27.0; p<0.001). However, there were no differences in time from pain onset, days from last menstrual period, history of vaginal bleeding, or prior history of ovarian cysts. All of the torsion patients were admitted to the hospital and 88.3% had surgery, while 13.8% of ruptured cysts were admitted and 9.2% had surgery. In this five-year retrospective study, aside from slight age differences, there were no differences in the clinical presentation of patients with ovarian torsion or ovarian cyst rupture. However, 88.3% of patients with torsion required emergent surgical intervention while only 13.8% of ruptured ovarian cyst required surgical intervention. As there are no distinguishing characteristics between ovarian torsion and cyst rupture, suspected patients should have expeditious and appropriate imaging studies while in the ED.