Epidemiology

Adnexal torsion is thought to account for approximately 3% of all gynecologic surgical emergencies.[2][3] The highest incidence is in reproductive-age women, with 80% of all cases occurring in females <50 years.[4] The postmenopausal period accounts for 10% of cases of adnexal torsion.[5] Just over half (56%) of patients in a large series of adnexal torsion had an ovarian mass, mostly with benign histology, including dermoid cysts and paraovarian cysts.[5] Anything that enlarges the ovary, such as pregnancy and ovulation induction with gonadotropins, also predisposes women to torsion.[6][7][8][9][10] The risk of ovarian torsion is approximately 5 in 10,000 in pregnancy, with the highest incidence between 6 and 14 weeks of gestation.[11]

In patients undergoing ovulation induction with gonadotropins, the incidence of adnexal torsion is 3% for those who have ovarian hyperstimulation syndrome.[5] In contrast to adults, adnexal torsion in pediatric and adolescent patients involves an ovary without an associated mass or cyst in as many as 46% of cases.[1]

Risk factors

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ovarian neoplasm

Neoplasms account for 46% of anatomic abnormality-related cases.[4]

Predisposes the ovary to swing on its vascular pedicle.

Includes benign neoplasms such as cystic teratomas, and serous and mucinous adenomas. In adults, 1.1% to 2% of all neoplasms are malignant. This percentage is lower in children.[2][12][14][17][20][21] Adnexal masses 6 to 8 cm in size pose greatest risk.[22]

ovarian cyst

Just over half (56%) of patients in a large series of adnexal torsion had an ovarian mass, mostly with benign histology, including dermoid cysts and paraovarian cysts.[5]

Enlarged ovary allows rotation of the ovary around its ligamentous supports.[2][7]

infertility treatment

Ovarian enlargement is common with ovulation induction and therefore predisposes the patient to torsion.[6][7][8][9][10][19]

In patients undergoing ovulation induction with gonadotropins, the incidence of adnexal torsion is 3% for those who have ovarian hyperstimulation syndrome.[5]

prior pelvic surgery

Previous torsion and tubal ligation are commonly associated with ovarian torsion.[19][23]

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paraovarian cyst

May twist on its own pedicle or cause torsion of the adnexa.

hydrosalpinx

Reported at the time of surgery in 2% of cases.[17]

pregnancy

The risk of ovarian torsion is approximately 5 in 10,000 in pregnancy, with the highest incidence between 6 and 14 weeks of gestation.[11]

Displacement of adnexa due to enlarging uterus may predispose the ovary, especially if enlarged, to rotate on its pedicle.[6]

strenuous exercise

Sudden physical movements have been associated with ovarian torsion.

sudden increased abdominal pressure

May be caused by coughing, hiccupping, defecation, and vomiting. May push ovary to rotate on its pedicle.[24]

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