212: Second Opinion

Think of the schoolyard tetherball--an object at the end of of a rope twisting as it moves. That's not exactly what happens with ovarian torsion, but you get the ideal.  The ovary is suspended by one "rope" (ligament) attached it to the uterus, and at the other end, a ligament headed in the direction of the abdominal sidewall.  Blood vessels and nerves course through these ligaments. An enlarged (i.e., heavy) ovary is more likely to twist. Twisting causes pain and kinks off blood vessels supplying the ovary; the ovary could be lost.

Note the twisted ligament below the ovary

An athletic, 32 yr old emergency room physician, Beth just didn't feel right, so went for a run. When that just worsened the pain, she went to her own ER. A CT (xray) scan, an ultrasound, some blood tests and several hours later, I was called because the only abnormal finding was the ultrasound's failure to confirm blood flow into the ovary--a sign of torsion. Well, not the only abnormal finding, the CT suggested a "large fecal mass," i.e., constipation even though she felt her recent bowel movements regular.

In my ER told me she was feeling better--not uncommon as twisting can come and go, but still encouraging. That plus the normal size of the ovary led me to recommend waiting a few hours and repeating the ultrasound instead of immediately proceeding with surgery. Sometimes surgery can untwist the ovary, sometimes the ovary just has to be removed.

She agreed with me (if she had agreed, I would have been okay with the laparoscopic look-first-then-decide approach).  The second ultrasound, done by different technician and interpreted by a different radiologist, showed normal blood flow to both ovaries.  So she went home with some advice about laxatives.