High risk and low prevalence diseases: Ovarian torsion

Introduction: Ovarian torsion is a rare, frequently misdiagnosed condition that carries with it a high rate of morbidity. Objective: This review highlights the pearls and pitfalls of ovarian torsion, including presentation, evaluation, and management in the emergency department (ED) based on current evidence. Discussion: Ovarian torsion is one of the most common gynecological surgical emergencies and occurs with com-plete or partial rotation of the ovary along the supporting ligaments, obstructing vascular flow. Several risk fac-tors include the presence of an ovarian mass or cyst. The most common population affected includes reproductive aged women, though cases also occur in premenarchal females, pregnant women, and postmeno-pausal women. Abdominal or pelvic pain is common but is not always sudden in onset or severe. Nausea and vomiting occur in 70%. Ultrasound can assist with diagnosis, but a normal ultrasound examination cannot ex-clude the diagnosis. Computed tomography with intravenous contrast can assist with diagnosis. Treatment in-cludes emergent gynecologic consultation for surgical detorsion, along with symptomatic therapy in the ED. Conclusions: An understanding of ovarian torsion can assist emergency clinicians in diagnosing and managing this disease. Published by Elsevier Inc.