Ovarian torsion: A fifteen-year review

Study objective: Our purpose was to describe the history, physical, and laboratory findings in women with ovarian torsion (OT). Methods: A retrospective chart review was conducted at 2 urban teaching hospitals. All women admitted from 1984 to 1999 with surgically proven OT were included in the study. Results: The 87 women ranged in age from 14 to 82 years (mean 32 years). Twelve were pregnant, 15 were postmenopausal, and 7 were posthysterectomy. Thirty-five (40%) had prior pelvic surgery; 18 of these (21% of the total) had undergone tubal ligation. Twenty-two (25%) women had a history of an ovarian cyst. Sixty-five (75%) patients were seen in the emergency department. Pain characteristics were variable: the onset was sudden in 51 (59%); "sharp" or stabbing in 61 (70%); and radiated to the flank, back, or groin in 44 (51%) patients Only 3 had peritoneal signs at presentation. The majority of patients (70%) had nausea or vomiting. Fever was rare (2 patients). OT was considered in the admitting differential diagnosis in 41 (47%) patients. An enlarged ovary (>5 cm) was found in 77 (89%) patients at surgery. Only 26 patients had surgery within 24 hours. In 8 (9%) patients, detorsion was possible; of these, 3 had surgery within 24 hours. Conclusion: The diagnosis of OT is often missed and ovarian salvage is rare. Pain characteristics are variable and objective findings are uncommon in OT.