Abstract
Objective: Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. Methods: A retrospective observational study was conducted at the Ob/Gyn department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n = 62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. Results: Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score >6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (p = 0.039) and pain score (p = 0.008). Conclusion: The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.
Highlights
Ovarian torsion refers to the twisting of the ovary on its ligamentous supports, which often results in an impedance of its blood supply
All female patients (n = 62) older than 11 years of age who presented with acute pelvic pain with highly suspected ovarian torsion from January 2000 through December 2009 and for whom surgeries were performed within less than 6 hours of the ultrasound assessment were included
The majority of the cases were suggestive of ovarian torsion, as determined by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%)
Summary
Ovarian torsion refers to the twisting of the ovary on its ligamentous supports, which often results in an impedance of its blood supply. This condition is the fifth most common gynecological emergency and affects females of all ages [1]. Whereas anatomic factors usually account for ovarian torsion in adults, normal ovaries have been demonstrated in over 50% of ovarian torsion cases in children under the age of 15 years [5]. Torsion has been described following laparoscopic hysterectomy, suggesting that even release of the fulcrum, on which the ovaries usually twist, does not protect against torsion [6]. The right ovary is more likely than the left to undergo torsion, suggesting that the sigmoid colon may help to prevent torsion [8]
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