Ovarian torsion refers to the complete or partial rotation of the ovary on its ligamentous supports, often resulting in impedance of its blood supply. It is one of the most common gynecologic emergencies and may affect females of all ages . The fallopian tube often twists along with the ovary; when this occurs, it is referred to as adnexal torsion. Prompt diagnosis is important to preserve ovarian and/or tubal function and to prevent other associated morbidity. However, making the diagnosis can be challenging because the symptoms are relatively nonspecific.
Isolated torsion of the fallopian tube is less common, but may also occur and adversely impact tubal function . Tubal torsion may occur either in the mid-portion of the tube itself or around the ligamentous supports of the tube.
Torsion of paratubal or paraovarian cysts may also occur [3,4].
This topic will focus mainly on ovarian torsion, but isolated fallopian tube torsion and torsion of paratubal or paraovarian cysts will also be reviewed. An overview of the approach to an adnexal mass and to acute pelvic pain is discussed separately. (See "Approach to the patient with an adnexal mass" and "Evaluation of acute pelvic pain in women".)
The ovary is suspended by the infundibulopelvic ligament (also referred to as the suspensory ligament of the ovary), and is not fixed, but may be positioned lateral and/or posterior to the uterus, depending upon the position of the patient. The infundibulopelvic ligament is a fold of the broad ligament that is attached laterally to the pelvic sidewall. The ovarian vessels, which originate in the upper abdomen, travel through the infundibulopelvic ligaments. Other support structures of the ovary include the utero-ovarian ligament, which attaches the ovary to the uterus, and the broad ligament, one area of which is the mesovarium.