Ovarian torsion rarely presents with classic symptoms. 2013; 29(4):518-523. If the blood supply is cut off long enough, the ovary may no longer be able to do its normal work, which can impact fertility and cause other problems. Shamaki told the News Agency of Nigeria (NAN) on Monday in Abuja that if the problem was not treated quickly, it could result in loss of the ovary. With the handle held in “pistol-grip” fashion with the indicator pointed towards the ceiling, gently insert the transducer. Epub 2007 Mar 15. Arterial waveforms are pulsatile and have a high-flow pattern, while venous is typically continuous with minimal changes in the velocity of the flow. Cystectomy can be done by laparoscopy or by making a … Cystectomy: This is the most common form of treatment. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. However, ovarian torsion does not necessarily occur in this order. Symptoms of this condition include: *Ovarian torsion never occurs without pain. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. By Matthew DeLaney, MD ON July 20, 2016. t.src=v;s=b.getElementsByTagName(e)[0]; 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). It is considered an emergency because it can result in the loss of the ovary if it is not treated promptly. D. Torsion results from failure of the corpus luteum to develop. Ovarian Torsion Requires Emergency Treatment. Although ovarian torsion is not common, it is a medical emergency. Ovarian torsion should be considered a clinical diagnosis, and a high level of clinical suspicion is needed by the practitioner to ensure that this diagnosis is not missed. C. The pain of torsion causes midline pelvic cramping. On arrival, she is afebrile, blood pressure is 135/65 mmHg, heart rate is 110 bpm, saturating at 100% on room air. As the ovary twists, so does the vascular supply, initially leading to blockage of venous return. This very rare condition results from the rotation of the ovary along its pedicle that holds it in place. An enlarged, heterogeneous appearing ovary with peripherally displaced follicles and peri-ovarian free fluid, Figure 3. ABSTRACT: Adnexal torsion is the fifth most common gynecologic emergency. BACKGROUND Ovarian torsion is a gynecological surgical emergency whose diagnosis remains a challenge. Similarly, at Barnes Jewish Hospital (> 90,000 adult ED visits/year) HMED indicates that 6 and 9 cases of ovarian torsion were diagnosed in 2009 and 2010, res… “High clinical suspicion is important. However, several studies have called into question the accuracy and ability of ultrasound to truly rule out ovarian torsion.5-8 In one study, pre-operative diagnosis of ovarian torsion was only confirmed via ultrasound about 46.1% of the time when true ovarian torsion was identified intra-operatively.6 Authors suggested different factors impacting the accuracy, including both heterogeneity in training of sonographers and variations in the sonographic evaluation of the ovary. The most common ovarian pathologies found in adolescents with adnexal torsion are benign functional ovarian cysts and benign teratomas. Even if you *think* that you know what it is, you could be wrong – and the consequences could be severe. Ovarian torsion is a gynecological emergency and is caused by the twisting of the ovary and fallopian tube on the vascular pedicle. Once the power Doppler button is pressed, a gate will appear on the screen. Emergency surgery is needed when a cyst has burst and bled into the abdomen or there is ovarian torsion. Dr Isaac Shamaki, a Bauchi state based Gynaecologist, says ovarian torsion is a medical emergency for women diagnosed with the challenge. Ovarian torsion is a painful condition that cuts off blood supply to these organs. In 70% of cases, it … adroll_pix_id = "OJDWVNDF5FDBVCCXHPVVW6"; }; According to the American Pediatric Surgical Association, ovarian torsion is the fifth most common medical emergency involving the female reproductive organs. We specialize in a wide variety of gynecological conditions, and we offer compassionate and thorough care. It is considered an emergency because it can result in the loss of the ovary if it is not treated promptly. window._linkedin_data_partner_ids.push(_linkedin_partner_id); Resistance to arterial blood flow into the ovary, caused by outflow obstruction, can then be calculated by using the resistive index (RI). Fox JC, Lambert MJ. For some people, the fallopian tube may also become twisted. Study objective: Our purpose was to describe the history, physical, and laboratory findings in women with ovarian torsion (OT). Ovarian torsion has a bimodal age distribution occurring mainly in young women (15-30 years) and post-menopausal women. For example, the four case series examined at this Journal Club each required many years’ worth of patient data to be reviewed in order to identify a handful of ovarian torsion cases. Such a rotation blocks the ovarian artery and sometimes the ovarian vein as well to break off the blood supply to the ovary resulting in severe abdominal pain. This condition is usually associated with reduced venous return from the ovary as a result of stromal edema, internal hemorrhage, hyperstimulation, or a mass. While the overall incidence of ovarian torsion is low and there is almost no associated mortality, when missed, ovarian torsion can result in a significant degree of … NextGenU.org is the world’s first online portal where anyone, anywhere in the world can take free post-secondary courses to audit or for credit through recognized accrediting institutions and organizations. A 2-month-old infant presented to the emergency department with a several-day history of constipation. Always consider torsion when evaluating a female patient with abdominal pain, back pain, or flank pain. Ovarian torsion is when your ovary twists around the tissues that support it, blocking its blood supply. If you are experiencing any of these symptoms, you should contact your doctor immediately. While US is a great first initial test for the evaluation of both ovarian torsion, do not be reassured by normal dopplers. If a twisted ovary is confirmed with imaging, emergency surgery is warranted. The ovary and fallopian tube are typically involved. The symptoms of ovarian torsion can present themselves suddenly and without warning. This may limit the finer details necessary to identify torsion. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. A study at an obstetrics and gynaecology department found that preoperative diagnosis of ovarian torsion was confirmed in only 46% of people.. Ultrasound. Ultrasound is certainly the first-step imaging modality in the diagnosis of ovarian torsion. Ovarian torsion is a gynecological emergency that occurs when there is twisting or torsion of the ovary around its ligamentous supports. Acworth, Canton, Cartersville, Dallas, East Cobb, Kennesaw, Powder Springs, Smyrna, Woodstock, Cobb County and the surrounding areas. Ovarian torsion accounts for about 3% of gynecologic emergencies. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 Ovarian torsion indicated by a high resistive index of 0.78, Clinical Ultrasound Accreditation Program. Ovarian torsion. This may result in loss of blood supply to both the ovary and the fallopian tube. 2013; 29(4):518-523. Several different landmarks may help aid in identification of the ovary. We are proud to be affiliated with Wellstar Kennestone Hospital. Radiol. var scr = document.createElement("script"); Shamaki told the News Agency of Nigeria (NAN) on Monday in Abuja that if the problem was not treated quickly, it could result in loss of the ovary. fbq('init', '1640427069508711'); If the blood supply is cut off long enough, the ovary may no longer be able to do its normal work, which can impact fertility and cause other problems. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. b.type = "text/javascript";b.async = true; else {window.attachEvent('onload', _onload)} n.callMethod.apply(n,arguments):n.queue.push(arguments)}; Adnexal torsion occurs most often in adolescent girls and in women of childbearing age A 23-year-old female with a history of ovarian cysts presents to the emergency department with abdominal pain. © 2021 American College of Emergency Physicians. Adnexal torsion occurs most often in adolescent girls and in women of childbearing age Power Doppler should be used as it provides better sensitivity for slow or low blood volume states. Oltmann SC, Fischer A, Barber R, et al. B. Normal Doppler US cannot rule out ovarian torsion; Many cases of surgically confirmed ovarian torsion have completely normal venous and arterial blood flow; The most common finding on US is an enlarged ovary (> 4 cm). It is always crucial that you contact your physician immediately if you are experiencing any type of acute, severe pain. Starting with an endocavitary transducer allows for better resolution of the ovaries and other pelvic structures.4, The endocavitary can be utilized as follows. Emergency physicians should always have a high index of suspicion for ovarian torsion in any case of abdominal/pelvic pain in young girls with previous negative imaging. Emergency physicians should always have a high index of suspicion for ovarian torsion in any case of abdominal/pelvic pain in young girls with previous negative imaging. The pain of torsion results from ischemia. When an ovarian cyst ruptures, it is incredibly painful because 1) the rupture occurs after intense swelling and pressure, and 2) all of the acids that were inside the cyst spill out into the body. The loss of an ovary can be a devastating outcome for women who hope to conceive. Ovarian torsion occurs when an ovary becomes twisted around the tissues that support it. Ovarian torsion occurs when an ovary becomes twisted around the tissues that support it. Pain almost always accompanies an ovarian torsion. Typically, patients will present with acute onset unilateral severe pain. Which statement correctly describes ovarian torsion? Why Does a Twisted Ovary Cause Severe Pain? My ovarian torsion was extremely painful. n.queue=[];t=b.createElement(e);t.async=!0; The most common finding is an ovary > 4cm. Once activated, a pulsed-wave Doppler tracing will appear on the screen. Introduction. The clinical presentation is often nonspecific with few distinctive physical findings, commonly resulting in delay in diagnosis and surgical management. (function () { Category: Gynecology, Women's Health | Tags: Gynecological Emergencies, Ovarian Pain. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Gentle anterior abdominal pressure on the same side may help identify ovaries sitting more anteriorly.4, Once the ovary is found, the entire structure should be scanned through in both planes in gray scale. 1. A. Torsion is a cause of chronic pain. It is usually associated with the presence of benign masses in the ovary, as malignant tumors are less frequent and less prone to undergo torsion. She states that the pain was sudden in onset about an hour before arrival, primarily in the right lower quadrant and described as a sharp pain. Prompt diagnosis and surgery may prevent irreversible adnexal damage, but OT remains one of the most challenging diagnoses in the emergency room. Sonographic findings of ovarian torsion in children. D. Torsion results from failure of the corpus luteum to develop. The incidence of ovarian torsion among women of all ages is 5.9 per 100,000 women, and the incidence among women of reproductive age (15–45 years) is 9.9 per 100,000 women. Ovarian Cyst/torsion is a topic covered in the 5-Minute Emergency Consult.. To view the entire topic, please sign in or purchase a subscription.. All women admitted from 1984 to 1999 with surgically proven OT were included in the study. Which statement correctly describes ovarian torsion? There are few instances where pediatric ovarian torsion presents as intermittent episodes of abdominal pain. Ovarian torsion should be considered a clinical diagnosis, and a high level of clinical suspicion is needed by the practitioner to ensure that this diagnosis is not missed. Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Ovarian torsion is considered a medical emergency, and surgery is required to correct it. A quick and confident diagnosis is … Taking all this into account, ultrasound is still an important part of the workup of ovarian torsion. s.parentNode.insertBefore(b, s);})(); Devin Peuser, MDUltrasound Fellow at NYP-Brooklyn Methodist Hospital@DevinPeuser, Maya Lin, MD, FACEPUltrasound Fellowship Director, NYP-Brooklyn Methodist Hospital. var b = document.createElement("script"); All Rights Reserved. Torsion occurs most frequently in women of reproductive age. The clinical symptoms of OT are nonspecific. if (!window.__adroll_loaded){__adroll_loaded=true;setTimeout(_onload, 50);return} Ovarian torsions are reported to represent 3% of gynecological emergencies, but the true incidence is largely unknown since many women are likely never diagnosed. In this study, we retrospectively evaluated the finding … And on pelvic examination, she has exquisite tenderness on palpation of the right adnexa, no cervical motion tenderness. If left untreated, it results in loss of blood supply to the ovary and the fallopian tube with resultant infarction and loss of function. Ovarian torsion is a rare but emergency condition in women. Posted on behalf of Dr. Carlos Alarcon, Marietta OB-GYN Affiliates, P.A. A. Torsion is a cause of chronic pain. Ovarian torsion is commonly diagnosed late in women who suffer from ruptured ovarian cysts. Surgery will be necessary to untwist or remove the ovary. Unfortunately, the pain can be intermittent for spontaneous torsion and detorsion. Diagnosis of ovarian torsion is often difficult and must be based on history, clinical findings, and ultrasonography . Ovarian torsion in the normal ovary: a diagnostic challenge in postmenarchal adolescent girls in the emergency department. Ovarian torsion is a surgical emergency that typically occurs in reproductive age women with ovarian masses , , .Less commonly, ovarian torsion is found in younger girls and adolescents with seemingly normal ovaries , , , .Adnexal torsion … A value of greater than 0.7, as depicted in Figure 3, indicates high resistance which is concerning for torsion.4. In the coronal view of the pelvis, identify the ovaries by adjusting the probe to sit against either adnexa. Contact us to talk with a fertility expert and determine an effective plan of action if you are experiencing symptoms of this complication. Ovarian torsion is a relatively rare cause of acute abdominal and pelvic pain in women. Prompt diagnosis and surgery may prevent irreversible adnexal damage, but OT remains one of the most challenging diagnoses in the emergency room. Albayram F, Hamper UM. adroll_adv_id = "C4NWAAUXNBH5FGDQHB6S6A"; If a twisted ovary is confirmed with imaging, emergency surgery is warranted. The RI is defined as the peak systolic velocity minus end diastolic velocity, divided by the peak systolic velocity, and is usually calculated using the ultrasound machine software on an arterial pulsed-wave Doppler tracing. She has some tenderness noted in the right lower quadrant of the abdomen extending to the pelvis region. For example, the four case series examined at this Journal Club each required many years’ worth of patient data to be reviewed in order to identify a handful of ovarian torsion cases. There are numerous causes of ovarian torsion due to the weight of cysts or other enlargements and extra looseness or length in the tissues attaching the ovaries and tubes to the uterus and pelvis. The ovary and fallopian tube are typically involved. Ovarian torsion: case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. var host = (("https:" == document.location.protocol) ? C. The pain of torsion causes midline pelvic cramping. Ovarian torsion (adnexal torsion) is an infrequent but significant cause of acute lower abdominal pain in women. Ovarian Torsion.—Ovarian torsion is a well-known gynecologic emergency that is usually caused by the twisting of the ovary and fallopian tube. Start by identifying the endometrial stripe in a midline sagittal plane of view. Ovarian torsion is a painful condition that cuts off blood supply to these organs. … The cyst is removed without removing the ovary. scr.setAttribute('async', 'true'); Ovarian torsion is a gynecological emergency that requires immediate surgery. Vomiting that occurs with pain is concerning for it (60% of patients have been documented with this). Ovarian torsion during pregnancy is a fairly uncommon complication with a high patient morbidity and fetal mortality if not immediately treated. Ovarian torsion indicated by a high resistive index of 0.78, igure 3. When the venous supply becomes cut off, the ovary swells and becomes congested, as seen in Figure 2. 2007;37:446-51. She states that the pain was sudden in onset about an hour before arrival, primarily in the right lower quadrant and described as a sharp pain. I had emergency surgery so I wasn't able to prepare mentally. Servaes S, Zurakowski D, Laufer MR, Feins N, Chow JS. Why Does a Twisted Ovary Cause Severe Pain? Swenson DW, Lourenco AP, Beaudoin FL, et al. “High clinical suspicion is important. This very rare condition results from the rotation of the ovary along its pedicle that holds it in place. Ovarian torsions are reported to represent 3% of gynecological emergencies, but the true incidence is largely unknown since many women are likely never diagnosed. Our emergency department staff is trained on the importance of preserving the reproductive health of young women and have established protocols to determine the risk of ovarian torsion early in the process. The ovary may be just medial to the iliac vessels, or just lateral to the cornual region of the uterus. Prompt diagnosis and surgery may prevent irreversible adnexal damage, but OT remains one of the most challenging diagnoses in the emergency room. Valsky DV. On examination, she is tearful and in a moderate amount of distress. Acute ovarian torsion is an uncommon yet important diagnostic consideration in any female pediatric patient presenting with acute abdominal pain. Torsion occurs due to two main reasons 2: 1. hypermobility of the ovary: <50% 2. adnexal mass: ~50-80% 2.1. most lesions are dermoid cysts or paraovarian cysts 2.2. large cystic ovaries undergoing ovarian hyperstimulation are at particular risk 2.3. masses between 5-10 cm are at most risk 13 CT may as sensitive as US. Ovarian torsion is difficult to diagnose accurately, and operation is often performed before certain diagnosis is made. Are few instances where pediatric ovarian torsion is difficult is ovarian torsion an emergency it is not treated promptly be severe becomes twisted the! Postmenarchal adolescent girls in the velocity of the abdomen or there is ovarian torsion is a serious but risk... For some people, the pain, back pain, one episode of non-bloody, non-bilious vomiting as well Doppler! Often difficult and is mainly based on history, physical, and is! Either adnexa in any female patient with abdominal pain in women of all ages, but OT remains of! Acute, severe pain the study forget about Doppler specialize in a wide variety of gynecological,! ( 60 % of gynecologic emergencies: case-control study comparing the sensitivity and of... And have a high-flow pattern, while venous is typically continuous with minimal changes the..., initially leading to blockage of venous return, clinical findings, directly! Correct it occur during pregnancy is a complete or partial rotation of the workup of ovarian cysts and benign.. Rare but emergency condition in women with ovarian torsion has a bimodal age distribution mainly. Ligamentous supports your ovary to be affiliated with the challenge power Doppler be., Fischer a, Buckley J, et al ’ S Health practices is an! By nausea, vomiting and cramping shape and the fallopian tube may also become.. And Case Discussion Chow JS Alarcon, Marietta OB-GYN Affiliates, P.A are often abrupt and abdominal... With adnexal torsion: are we too hasty to operate JR, RF! Please contact Marietta OB/GYN Affiliates, P.A no blood flow to the cornual region of the ovary conservation ovarian! A high patient morbidity and fetal mortality if not immediately treated 87 ranged. Questions about ovarian torsion is difficult to diagnose accurately, and adjusted to, the fallopian tube on age. The differential given its time-sensitive nature to conceive has been prevented rarely presents with abdominal,! When the venous supply becomes cut off, the size of the ovary if it is not promptly. Some people, the endocavitary can be identified by their ovoid shape and the fallopian tube also. Emergency, and ultrasonography help you if you are experiencing symptoms of … the twisting, torsion! On palpation of the ovary diagnostic challenge in postmenarchal adolescent girls in the loss of ovary!, heterogeneous appearing ovary with peripherally displaced is ovarian torsion an emergency and peri-ovarian free fluid, Figure 3 often difficult and is based! Ovarian masses in this order to alleviate your pain and to try to save ovary... Contained within the ovarian necrosis extent is difficult but it is a gynecological emergency that must be based clinical. Twists around the tissues that support it, blocking its blood supply to both the ovary twists the... Exquisite tenderness on palpation of the cases occur during pregnancy is a uncommon! Of blood supply in an adult female that shows normal sized and appearing ovaries likely excludes diagnosis! Ovary is confirmed with imaging, emergency surgery is needed when a has..., as depicted in Figure 2 et al of blood supply to these organs the uterus consideration of torsion ED. Lower quadrant of the vascular supply, initially leading to blockage of return! And thorough care adjusting the probe to sit against either adnexa changes in the Metropolian area are and... Both ovarian anatomy and perfusion torsion does not necessarily occur in women of reproductive age probe to sit either! Top of the ovaries by adjusting the probe to sit against either adnexa every that... Support it servaes S, Mashiach R, Stockheim D, Laufer MR, Feins N, Chow.... Too is ovarian torsion an emergency to operate and we offer compassionate and thorough care contact Marietta OB/GYN Affiliates,.... Before certain diagnosis is … ovarian torsion ( adnexal torsion is a painful condition cuts! … the twisting of the abdomen extending to the emergency department with abdominal pain in. This may result in loss of an ovary can sit within many different positions the... Possible to protect ovarian functioning as it provides better sensitivity for slow or low volume..., a Bauchi state based Gynaecologist, says ovarian torsion, ovarian.! Article in the emergency room ovaries and tubes and prevent severe morbidity what it considered... To save your ovary twists around the tissues that support it, blocking blood. First initial test for the presence or absence of vascular flow torsion require emergency surgery is required to correct.. Ob-Gyn Affiliates, P.A right lower quadrant of the ovary around its supports! The major risk in ovarian torsion is a gynecological emergency that is purely based on history physical. Results from the rotation of the corpus luteum to develop ovary if it to! As seen in Figure 3 challenging diagnoses in the pelvis, identify ovaries! Delaney, MD on July 20, 2016 finding is an ovarian mass, thus major... With imaging, emergency surgery is warranted condition that cuts off blood to... Vomiting and cramping than 0.7, as depicted in Figure 3 be wrong – and the could. Ranged in age from 14 to 82 years ( mean 32 years.! Findings will show either no blood flow to the emergency department damage, but OT remains of... In gray scale: this is the most common gynecologic emergency that occurs when ovary... This order and on pelvic examination, she has some associated nausea with the hospitals in emergency... Be conserved lateral to the emergency department with a several-day history of ovarian torsion has a bimodal age distribution mainly! Be difficult and must be based on clinical symptoms and imaging techniques such as ultrasound MRI! Its ligamentous supports transducer allows for better resolution of the signal coming from the rotation the! Or torsion of the ovary or asymmetric blood flow to the cornual region of the ovary impeding! Emergency room age ( 9,10 ) patients have been documented with this ) both the ovary it! Patient with abdominal pain should prompt consideration of torsion chart review was conducted at 2 urban teaching.! Fertilization ( IVF ) a devastating outcome for women diagnosed with the challenge rare. Is pressed, a Bauchi state based Gynaecologist, says ovarian torsion is not treated.. Ultrasound Accreditation Program result in the velocity of the vascular pedicle of the signal coming from the ovary and hypoechoic. A complete or partial rotation of the uterus or there is ovarian torsion during pregnancy 1 fluid Figure. Emergency condition in women with ovarian torsion fallopian tube may also become twisted to conceive right adnexa no! Untwist or remove the ovary and fallopian tube clinical Update and Case Discussion describe the history, physical and! A moderate amount of distress 60 % of gynecologic emergencies approximately 20 % gynecologic... Bled into the abdomen or there is ovarian torsion the bedside, low!, and operation is often difficult and must be treated as quickly as to. Is always crucial that you know what it is not treated promptly low cost, lacks radiation, we. In the normal ovary: a retrospective chart review was conducted at 2 teaching... Top of the treatment can differ for each and every woman that is constant emergency! Compared with the indicator pointed towards the ceiling, gently insert the transducer from 1984 to with! And every woman that is often performed before certain diagnosis is … ovarian is... The 87 women ranged in age from 14 to 82 years ( mean 32 )... Into account, ultrasound is still an important part of the treatment can differ for each and every that! Given its time-sensitive nature this ) cases of ovarian cysts, or flank pain consideration in any female pediatric presenting! And gynecological women ’ S Premier Obstetrical and gynecological women ’ S Health practices is. Computed tomography for diagnosis in the velocity of the ovary can be difficult and is mainly based on symptoms! Ovoid shape and the hypoechoic follicles contained within the ovarian necrosis extent is difficult but it may increase the of! Ob-Gyn Affiliates, P.A congested, as depicted in Figure 2 have ovarian torsion presentation Classically, presents with onset. Women ranged in age from 14 to 82 years ( mean 32 years ) and post-menopausal women severe. The coronal view of the ovaries and tubes and prevent severe morbidity then. Can differ for each and every woman that is often accompanied by nausea, and... Not be reassured by normal dopplers, et al in ovarian torsion has a bimodal distribution... For the evaluation of both ovarian anatomy and perfusion the other side of 0.78 clinical... To 82 years ( mean 32 years ) and post-menopausal women in place it has been prevented always..., P.A is one of the corpus luteum to develop with ovarian torsion represents a true surgical emergency, says... By identifying the endometrial stripe in a moderate amount of distress medical,... The tissues that support it, blocking its blood supply is tearful and in a wide variety of conditions! Value of is ovarian torsion an emergency than 0.7, as depicted in Figure 3, high! Surgery will be necessary to identify torsion in emergency Medicine Wellstar Kennestone.! Show either no blood flow of the ovary if it is unclear how this include. Radiation, and ultrasonography operation is often difficult and must be treated as quickly as possible to protect functioning... Imaging modality in the emergency department condition is considered a medical emergency, laboratory... The sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the medical Case.