Children's Hospital Colorado

Pediatric Ovarian Torsion

What is pediatric ovarian torsion?

Ovarian torsion occurs when the supporting structures of the ovary, including its blood supply, become twisted. A twisted ovary can lead to poor blood drainage and cause painful expansion of the tissue. A decrease in blood and oxygen to the ovaries can damage egg cells and the cells that help with puberty and the production of female hormones. Although ovarian torsion can occur at any age, we will be focusing on pediatric ovarian torsion in this article.

Illustration showing how ovarian torsion can twist the ovary and block the flow of blood.

 

What causes pediatric ovarian torsion?

When ovaries are elevated above the uterus, they become less stable, which makes it easier for the ovaries and their support structures to become twisted. The adult uterus is large enough that the ovaries generally remain stable, tucked behind the uterus. Therefore, torsion in adults usually happens when a cyst or mass develops within the ovary, causing it to increase in size and elevate above the uterus. However, the uterus in children and younger adolescents is smaller and the ovaries float above it naturally. As a result, up to half of all torsion cases in girls and young teens happens to those with normal ovaries.

Who gets ovarian torsion?

Ovarian torsion occurs in females, and may happen at any age, from children and adolescents, up through a woman’s reproductive lifespan.

What are the signs and symptoms of ovarian torsion?

Sudden and severe pain in the lower abdomen is the most common symptom of ovarian torsion. The pain tends to come from one side of the lower abdomen or the other, depending on which ovary is twisted. The pain is quite intense and can be accompanied by nausea and vomiting.

What tests are used to diagnose ovarian torsion?

We first perform several tests to rule out more common causes of pelvic pain. To rule out infection as the cause, we perform blood and urine tests. We will also test for sexually transmitted infections if the patient is sexually active. Performing these tests first is one way we can assess the patient without being invasive. In pediatric and adolescent gynecology, we are sensitive to a patient’s comfort and the way we approach exams and diagnoses plays a large part in this.

After ruling out more common causes of pelvic pain, we perform a pelvic ultrasound to assess the ovaries for possible torsion. An ultrasound uses sound waves to produce images of structures inside of the body. The pelvic ultrasound allows the radiologist to see if blood is collecting in the ovary and if blood is flowing properly into and out of the ovary. If signs suggest ovarian torsion, we perform a minimally invasive surgical evaluation using a laparoscopic camera to make a definitive diagnosis.

Why choose us for ovarian torsion evaluation?

Because the symptoms of ovarian torsion are often abrupt and severe, many patients first come to our urgent care or emergency department. 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. Pediatric gynecologists are on call for urgent issues and we have experienced doctors and advanced imaging equipment to help us diagnose and treat the cause of the pain quickly and accurately.

What to expect from a pelvic ultrasound?

Our providers will perform a pelvic ultrasound using an abdominal probe placed on the lower abdomen. Much like an ultrasound when viewing a baby in the womb, we move the probe across the abdomen and pelvis to capture images of the ovaries inside. It takes about 20 minutes to perform and read the test. We will provide a preliminary diagnosis soon after.

How is ovarian torsion treated?

Ensuring the preservation of the ovaries is our main goal when managing ovarian torsion in girls and adolescents. The best way to ensure the ovaries remain safe is to confirm a definitive diagnosis and then untwist the ovaries during the same procedure.

After making the diagnosis, we use the same camera that helped us diagnose the condition to guide us as we carefully untwist the ovary. If the surgeon discovers an ovarian cyst at this time, they will remove it and place the ovary back into its natural position. Even if the torsion appears to have harmed the ovaries, they are left in place because they still have a chance of recovering. The chance of a second torsion in an adolescent is less than 5%. If an ovary twists again, we may suggest an additional surgery to secure the ovary to the back of the uterus or the pelvic sidewall for added stability.

Why choose us for treatment of ovarian torsion?

Here at Children's Colorado, we have five gynecologists who are board-certified in pediatric and adolescent gynecology. Their education and experience mean they can offer the best treatment while maximizing future reproductive potential. Studies have shown a higher rate of ovarian preservation when pediatric gynecologists are involved in the surgical treatment of ovarian torsion.

Helpful resources

If you think you may be experiencing symptoms of ovarian torsion, please call the Pediatric and Adolescent Gynecology at 720-777-2667 to set up an appointment.

The American College of Obstetricians and Gynecologists (ACOG) is a non-profit organization dedicated to the improvement of women’s health and provides additional information on ovarian torsion.

The Journal of Pediatric & Adolescent Gynecology (JPAG) covers all aspects of clinical and basic science research in pediatric and adolescent gynecology and has numerous medical articles about ovarian torsion.

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