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Ovarian Cyst/torsion

Ovarian Cyst/torsion is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Ovarian cysts:
    • Generally asymptomatic until complicated by hemorrhage, torsion, rupture, or infection
    • Follicular cysts:
      • Most common
      • Occur from fetal life to menopause
      • Unilocular; diameter 3–8 cm
      • Thin wall predisposes to rupture, which usually causes minimal or no bleeding
      • Rupture during ovulation at midcycle is known as mittelschmerz
    • Corpus luteal cysts:
      • Most significant
      • Diameter 3 cm, but usually <10 cm
      • Rapid bleeding from intracystic hemorrhage causes rupture
      • Rupture is most common just before menses begins
      • Can cause severe intraperitoneal bleeding
      • Gradual bleeding into cyst or ovary distends capsule and may cause pain without rupture
  • Adnexal torsion:
    • 5th most prevalent surgical gynecologic emergency
    • Twisting of vascular pedicle of ovary, fallopian tube, or paratubal cyst
    • Causes adnexal ischemia leading to necrosis
    • Occlusion of lymphatics and venous drainage lead to rapid enlargement of adnexa
    • Greatest risk with cysts 8–12 cm

Risk Factors

Adnexal torsion:
  • Reproductive-age women
  • Ovarian cysts, especially >5 cm
  • Ovarian hyperstimulation
  • Tumors: Serous cystadenoma most common; teratomas
  • Pelvic surgery: Tubal ligation; hysterectomy
  • Pregnancy
  • History of pelvic inflammatory disease

Pregnancy Considerations
Torsion in pregnancy usually occurs in the 1st trimester, and in vitro fertilization or ovarian induction are risk factors.


Pediatric Considerations
15% of adnexal torsions occur in children



ALERT
  • Anticoagulated patients at increased risk of:
    • Hemorrhagic corpus luteal cyst
    • Significant bleed from ruptured cyst, including with ovulation

Etiology

  • Ovarian cyst:
    • Follicular cysts result from nonrupture of mature follicle or failure of atresia of immature follicle
    • Corpus luteal cysts result from unrestrained growth in early pregnancy or from normal intracystic hemorrhage days after ovulation
    • Other cysts:
      • Theca lutein
      • Cystic teratoma
      • Endometrioma (chocolate cyst)
  • Adnexal torsion:
    • Right > left
    • Highest frequency in reproductive women

ALERT
Cysts found in postmenopausal women suggest carcinoma

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Citation

Rosen, Peter, et al., editors. "Ovarian Cyst/torsion." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307658/all/Ovarian_Cyst_torsion.
Ovarian Cyst/torsion. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307658/all/Ovarian_Cyst_torsion. Accessed April 25, 2019.
Ovarian Cyst/torsion. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307658/all/Ovarian_Cyst_torsion
Ovarian Cyst/torsion [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307658/all/Ovarian_Cyst_torsion.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ovarian Cyst/torsion ID - 307658 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307658/all/Ovarian_Cyst_torsion PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -