Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ... Goldberg Y, Bardicef M, Lissak A, et al. Ovarian torsion. Ovarian enlargement is common with ovulation induction and therefore predisposes the patient to torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Gray scale US combined with Doppler US is the method of choice for imaging of lower abdominal and pelvic pain in female patients. Ovarian torsion is "a situation in which the ovary twists on its own blood supply," Karen Wang, M.D., assistant professor of gynecology and obstetrics at Johns Hopkins University, tells SELF. Unilateral pelvic pain in a girl is ovarian torsion until proven otherwise. Ovarian torsion accounts for up to 2.7% of all cases of acute abdominal pain. [17] Ovaries with torsion can frequently be anterior to the uterus. It is sometimes seen in pregnancy and may also be associated with sudden increases in intra-abdominal pressure that can occur with coughing or hiccupping. Prior abdominal surgeries and ovarian hyperstimulation syndromes are also known causes. Major advantages of US are that it is radiation-free, cost-effective, and has easy availability. In a retrospective review of 87 cases of torsion, Houry et al. METHODS During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian torsion is a gynecological emergency and is caused by the twisting of the ovary and fallopian tube on the vascular pedicle. Ovarian torsion, premenarchal girls, laparoscopic detorsion Introduction. Often the pain is severe and abrupt, but trying to tease this out is often not fruitful. Acute pelvic pain is the leading reason for emergency visits to gynecology departments [1]. Abdominal tenderness was present in 64.1%.On abdominal ultrasound, an enlarged ovary was identified in 28.9% 11) . Methods: During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. ?12].However, in women presenting with acute pelvic pain, bowel or urologic causes represent the more common causes and will often lead to CT or MRI (the latter in pregnant or young patients) as the first imaging study. In torsion, the ovary typically appears hypoechoic secondary to edema from obstructed lymphatic or venous flow. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ... Owing to the lack of ionizing radiation, widespread availability, and lack of need for sedation, gray scale, with color Doppler ultrasound examination is often the initial imaging obtained when there is suspicion of gynecologic pathology. Priya Raj had abdominal pain from ovarian torsions for months, but doctors mistook it for other ailments before she was diagnosed in the ER during COVID-19. Ovarian torsion is the twisting of the ovary on its vascular pedicle that can lead to vascular compromise and necrosis. OBJECTIVE To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. Ovarian torsion is when an ovary twists back and forth, causing intense pain in the pelvic area that comes and goes, explained Dr. Adeeti Gupta, a board-certified OB-GYN in New York. Patients present with acute lower abdominal pain and concomitant nausea, vomiting. In another study, of 32 premenarchal patients with ovarian torsion, the main presenting symptoms were abdominal pain (92.3%) and nausea and vomiting (84.6%). This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. Sonographic findings associated with ovarian torsion include a rounded and enlarged ovary on the ipsilateral side with pain. Ovarian torsion is a common concern in girls presenting to emergency care with pelvic or abdominal pain. While it can rarely occur with a normal ovary, the majority of cases are associated with some type of ovarian pathology (e.g., tumor, cyst, hyperstimulation syndrome secondary to infertility treatments). Pinto AB, Ratts VS, Williams DB, et al. Ovarian torsion is the fifth most common gynecologic surgical emergency, with prevalence rates of 2.7% to 3%. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. It is the fifth most common cause of gynaecological surgical emergencies [1]. We measured plasma D-dimer levels 2 h after the operation because various studies have shown that D-dimer increases within minutes after the onset of ischemia and remains elevated for 6–12 h ( Acosta et al. Acute pelvic pain is the leading reason for emergency visits to gynecology departments [1]. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian torsion can occur prenatally and … Here, we discuss the major diagnostic considerations of acute pelvic pain and an enlarged ovary. [1] Ovarian torsion is the partial or complete rotation of the ovary on the axis between the utero-ovarian and infundibulopelvic ligaments. found that 70% of patients reported “sharp or stabbing” pain. 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