Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia.
Adnexal torsion is uncommon, occurring most often during reproductive years. It usually indicates an ovarian abnormality. Risk factors include the following:
Benign tumors are more likely to cause torsion than malignant ones. Torsion of normal adnexa, which is rare, is more common among children than adults.
Typically, one ovary is involved, but sometimes the fallopian tube is also involved. Adnexal torsion can cause peritonitis.
Torsion causes sudden, severe pelvic pain and sometimes nausea and vomiting. For days or occasionally weeks before the sudden pain, women may have intermittent, colicky pain, presumably resulting from intermittent torsion that spontaneously resolves. Cervical motion tenderness, a unilateral tender adnexal mass, and peritoneal signs are usually present.
Adnexal torsion is suspected based on typical symptoms and unexplained peritoneal signs plus severe cervical motion tenderness or an adnexal mass, particularly when criteria for pelvic inflammatory disease are not met or when symptoms are unilateral. Diagnosis is usually confirmed by color Doppler transvaginal ultrasonography.
If torsion is suspected or confirmed by ultrasonography, laparoscopy or laparotomy is done immediately to attempt to salvage the ovary and fallopian tube by untwisting them. Salpingo-oophorectomy is required for nonviable or necrotic tissue. If an ovarian cyst or mass is present, cystectomy or oophorectomy is done.
Last full review/revision December 2008 by S. Gene McNeeley, MD
Content last modified September 2013