Abdominal Pain In

Gynecology
Dr Daud Kristianto SpOG
 Ovarian Torsion
(adnexal torsion)
• Twisting of the ovary and/or fallopian tube on its vascular and
ligamentous supports, blocking adequate blood flow to the ovary.
• Ovarian torsion is a surgical emergency. Rapid diagnosis and
intervention are necessary to preserve ovarian function where this
is clinically appropriate and it is important to maintain fertility.
 Risk Factors
• Torsion can occur if the ovary is unstable. ( a cyst or ovarian cyst or mass )
• Strenuous Exercise
• Have PCOS(enlarge ovaries)
• Hydrosalpynx
• have a longer ovarian ligament
• Pregnancy(Corpus Luteum cyst)
• Infertility Workups hormonal treatments (ovarian stimulation)
• Although this can happen at any age, it’s Mostly during reproductive years
 Symptoms
• severe, sudden pain in the lower abdomen
• cramping
• nausea
• vomiting
• These symptoms usually present suddenly and without warning.
• Diarrhoea
• In some cases, pain, cramping, and tenderness in the lower abdomen may come and go for
several weeks. This can occur if the ovary is attempting to twist back into the correct position.
 Physical Exam

• Palpable abdominal/ adnexal mass

• IE: Cervical motion tenderned without bleeding, palpable adnexal mass,
with tenderness
 Diagnose
• CBC
• Urinalysis + pregnancy test
• Transvaginal Ultrasound with collour flow
• CT/ MRI
 Surgical Treatment
Laparotomy/ Laparoscopy
reposition adnexa/ Cystectomy/Salpingectomy/salpingooophorectomy
• Depend on severity of the adnexa
 Medical Treatment
• NSAID
• Opioid Pain Relifer