Ovarian torsion and cyst accidents: whirlpool sign, time-critical detorsion, cyst rupture and haemorrhagic cyst, with IOTA assessment

It is 02:00 and a 24-year-old wakes with sudden, gripping right-sided pelvic pain and vomits. The pregnancy test is negative. The ultrasound shows an enlarged ovary with a coiled pedicle and reduced venous flow. Your decision is the ovary, and it is measured in minutes, not hours. Torsion is the fifth most common gynaecologic emergency — and question examiner is really asking is whether you will operate on clinical suspicion or wait for a "perfect" scan.^[1][3]

Overview and definition

Adnexal (ovarian) torsion is the twisting of the ovary, and usually the fallopian tube, on its ligamentous supports — the round ligament, the infundibulopelvic ligament and the utero-ovarian ligament. The twist compromises first venous and lymphatic return, then arterial inflow, progressing from congestion and oedema to ischaemia and, if not relieved, to infarction. The cyst accidents — rupture and haemorrhage — are separate events that complicate a pre-existing adnexal mass.^[1][3]

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References12ShowHide

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