Merck Manual

Please confirm that you are a health care professional

honeypot link

Adnexal Torsion

By

Charlie C. Kilpatrick

, MD, MEd, Baylor College of Medicine

Last full review/revision Mar 2021| Content last modified Mar 2021
Click here for Patient Education

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 for adnexal torsion include the following:

  • Pregnancy

  • Induction of ovulation

  • Ovarian enlargement to > 4 cm (particularly by benign tumors)

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.

Symptoms and Signs of Adnexal Torsion

Adnexal 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.

Diagnosis of Adnexal Torsion

  • Clinical evaluation

  • Exploratory surgery to confirm

Clinical diagnosis of adnexal torsion is supported by imaging with transvaginal ultrasonography that shows an enlarged ovary or an ovarian mass. Color Doppler ultrasonography that shows decreased or absent blood flow in the ovary provides further support for the diagnosis.

If adnexal torsion is suspected, exploratory surgery is done immediately. The presence of a twisted ovary confirms the diagnosis.

Treatment of Adnexal Torsion

  • Surgery to salvage the ovary

If adnexal torsion is suspected, laparoscopy or laparotomy is done immediately to confirm the diagnosis and 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 and the ovary can be salvaged, cystectomy is done. Otherwise, oophorectomy is required.

Key Points

  • Adnexal torsion, which is uncommon, is more likely to result from benign tumors than from malignant ones.

  • Torsion causes sudden, severe pelvic pain and sometimes nausea and vomiting; it may be preceded by days or occasionally weeks of intermittent, colicky pain, presumably resulting from intermittent torsion.

  • Suspect adnexal torsion based on symptoms and Doppler transvaginal ultrasonography; follow immediately with exploratory surgery to confirm the diagnosis and treat it.

  • If adnexal torsion is diagnosed, immediately attempt to salvage the ovary and fallopian tube by untwisting them via laparoscopy or laparotomy; if nonviable or necrotic tissue or an ovarian cyst or mass is present, surgical removal (salpingo-oophorectomy, cystectomy) is required.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Test your knowledge

Management of Normal Delivery
Options for pain management during normal delivery include regional, local, and general anesthesia. Of these types of anesthesia, which of the following is a safe and simple method for uncomplicated spontaneous vaginal deliveries in women who wish to bear down and push?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP