Twisted ovarian cyst, also known as “ovarian torsion,” occurs when an ovarian cyst twists on its stalk cutting off or restricting blood supply to the cyst, the ovary and at times to the fallopian tubes. The ovaries have two sources of blood supply, venous and arterial, and when torsion occurs to an ovary the blood returning from the ovary through the vein is reduced. Cysts that are larger than 4 centimeters are more likely to twist. A cyst that is accompanied by a tumor has a greater potential of twisting. It usually happens in one ovary at a time though it can affect both ovaries simultaneously. It can occur in women irrespective of age, but it’s more common in women under the age of 30 and at times it happens to pregnant women. In rare cases, a twisted ovarian cyst occurs as a result of complications of IVF treatment.
Symptoms – The symptoms can be vague and similar to that of other medical conditions like appendicitis, ectopic pregnancy and ruptured corpus luteum cyst. These symptoms can include pelvic pain, severe pain in the lower abdomen, nausea and vomiting.
Diagnosis – Twisted ovarian cyst can be diagnosed with laboratory tests but these are not too reliable as the results can be confused with leukocytosis, which is an abnormal increase in the number of white blood cells in the blood as a result of infection. Ultrasound with color Doppler analysis is a preferred method of diagnosis as it shows changes in the nature of an ovary. The best method is laparoscopy which involves making small incisions around the belly button and inserting a laparoscope into the abdomen which will reveal the image of what is going on inside on a screen so it is more definite.
Treatment – A twisted ovarian cyst is treated through surgery, using laparoscopy or laparotomy. Depending on the extent of the torsion, the ovary can be untwisted, but if the twist is too extensive the ovary will have to be removed.
Complications – If a twisted ovarian cyst is not taken care of quickly blood supply into and out of the ovary may be cut off resulting in the death of ovarian tissue, (ovarian necrosis). When ovarian necrosis occurs it affects fertility because dead ovarian tissue cannot produce eggs and without eggs pregnancy, of course, cannot take place. When ovarian necrosis has occurred the ovary will definitely need to be removed. If only one ovary is removed, pregnancy is still possible though it reduces the chances of conception thereby limiting fertility.
Ovarian torsion can also cause blood clotting in the ovarian blood vessels which could result in even further complications.