 Hello and welcome to emergency medicine video. In this segment, we will focus on ovarian torsion. We will discuss the diagnosis and management in the emergency department. Let's begin. Ovarian torsion occurs when the ovary and often the fallopian tubes together become twisted or torted around their vascular supply. From the torsion, a few things happen from the vascular supply. First, the lack of venous outflow causes edema. That causes decreased arterial flow. Eventually, that leads to ischemia and infarction. Therefore, in ovarian torsion, it is an emergency and a must-not-miss diagnosis. Ovarian torsion is thankfully an uncommon diagnosis. The risk of it increases, however, when the ovary has a mass or a cyst that make it asymmetric and therefore more likely to tort. In terms of population, it is more commonly seen in young children due to anatomical abnormalities. It is also more likely seen in pregnancy. In pregnancy, there can be an enlarged corpus luteus cyst. Particularly in the women who are undergoing fertility treatment. How does ovarian torsion present itself? Classically, ovarian torsion present with acute unilateral anoxal pain. It can first be very vague. It can also wax and wane when the ovaries have been twisting and untwisting intermittently. The pain can radiate to the pelvis, flank, or even thigh. Associated symptoms can include nausea, vomiting, or a low-grade fever. Since the pain can often be vague or intermittent, there often is a delay in diagnosis. On examination, patient might have anoxal pain. You might be able to feel an anoxal mass. You should not be seeing any discharge or cervical motion tenderness during the pelvic exam. Those are findings related more to pelvic inflammatory disease or tibial ovarian abscess, which is discussed in another video. How do we make the diagnosis of ovarian torsion? There are no lab tests to rule in or out ovarian torsion. However, we want to ensure that the patient is not pregnant. Since ectopic pregnancy can present very similarly. We would often do CBC and urinalysis to check for other diagnoses. The main state of diagnosis lies in radiology. The ultrasound with Doppler flow measurement is the test for ovarian torsion. The lack of blood flow establishes the diagnosis. They may also sometimes see the ovarian mass, cis or edema on the ultrasound as well. However, the presence of blood flow can still mean ovarian torsion for two reasons. In early torsion, only the venous outflow is obstructed. The arterial supply is not affected yet and therefore can still be seen on the ultrasound and Doppler flow. Number two, if the ovary is torting and detorting, and if you're doing the ultrasound in between the two torting phases, then the images might be normal. Therefore, in cases where there is a high clinical suspicion, even the presence of normal Doppler flow does not rule out the diagnosis. We still want to discuss the case with the consultant. Let's talk a little bit now about treatment. Patients with ovarian torsion often have significant pain. Our treatment therefore will focus on intravenous fluids to maintain their blood pressure and pain medications. Since the viability of the ovary decreases as ischemic time gets longer, our goal, once we think about the diagnosis, is to get the patient to the operating room for detortion of the ovary as soon as possible. In summary, in this segment, we discuss ovarian torsion. The main points are, pain can be vague and intermittent. Ultrasound with Doppler flow is the diagnosis of choice. The presence of Doppler flow can still be an ovarian torsion. If we have a high clinical suspicion, consult the gynecologist early. Thank you for watching.