Predictors of Ovarian Torsion: Clinical and Sonographic Characteristics

Abstract

Objective: Acute pelvic pain is one of the leading reasons for an emergency room visit. Ovarian torsion, in which patients experience pain, is the fifth-most prevalent gynecologic emergency. The condition is difficult to diagnose and requires surgical intervention. This study was performed to assess clinical and sonographic variables and their association with ovarian torsion. Materials and Methods: A retrospective cohort of 73 patients with acute pelvic pain had 35 patients with surgically confirmed ovarian torsion and 38 patients with surgically confirmed not ovarian torsion. Multivariate logistic regression was used to examine predictors according to demographic, medical-condition, medical-history, pain, and ovarian-cyst variables for their potential associations with ovarian torsion. Results: Variables associated with increased ovarian torsion confirmed by surgery were: intermittent pain (odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.23-12.35; p = 0.02); pain lasting less than 8 hours (OR: 6.74; 95% CI: 1.94-23.37; p = 0.003); and ovarian cyst ≥ 5 cm (OR: 8.11; 95% CI: 1.21-54.34; p = 0.03). A simple cyst seen on imaging was associated with decreased ovarian torsion (OR: 0.17; 95% CI: 0.04-0.72; p = 0.02). No demographic, medical-condition, and medical-history variables were associated with ovarian torsion. Conclusion: Intermittent pain, pain lasting less than 8 hours, and ovarian cyst ≥ 5 cm are frequently seen clinical and sonographic indicators of ovarian torsion. Clinicians who see patients presenting with these symptoms with work-ups that strongly indicate ovarian torsion should bring such patients in for surgical treatment.