Torsion of the pedicle of an ovarian or uterine tumor may be either chronic or acute; in the one case developing so slowly as to produce no symptoms or even no effect upon the tumor unless merely to inhibit its growth, for in the adhesions are new sources of nutrition; in the second case developing suddenly and producing a train of symptoms that demand immediate relief. The acute cases alone, then, are to be regarded as emergencies.
Cysts of the ovary, especially those which are spherical, non-adherent, and connected by a long pedicle, are most liable to this accident. Kelly finds two causes for this rotation: an effort of a large cyst to accommodate its convex surface to the concavity of the distended anterior abdominal wall or contractions of the anterior abdominal wall acting upon the part of the tumor nearest the middle line.
The diagnosis of acute torsion is not difficult if an ovarian cyst is known to be present. If such a tumor was previously unsuspected, the certain diagnosis may be impossible, especially if the case is seen late and general peritonitis is developing. Symptoms include severe colicky pain, vomiting, marked constipation, abdominal rigidity, and tension.
Once the diagnosis is made, immediate surgery is necessary to untwist the cyst or remove it entirely. If there are no signs of infection, the abdomen can be closed without drainage.
Torsion of uterine fibroids is less common but may occur in large non-pedunculated fibroids leading to symptoms similar to ovarian torsion.
Torsion of the spermatic cord occurs due to malformations and imperfect descent predisposing to rotations. Trauma, such as a heavy lift or strain, can cause it. Symptoms include pain, nausea, vomiting, constipation, and tympanites. The diagnosis is often difficult but manipulation may untwist the cord; if not, surgery must be performed without delay.
Torsion of the pedicle of the spleen in cases of wandering spleen may develop slowly or suddenly with symptoms similar to general peritonitis or intestinal obstruction. Splenectomy is usually recommended when thrombosis of the splenic vessels, infarcts in the spleen, gangrene, or peritonitis are present.
Torsion of the omentum must be considered when symptoms suggest intestinal obstruction and a hernia or obesity is present. Pain may simulate appendicitis but operation is indicated regardless.
Key Takeaways
- Acute torsions of ovarian cysts, uterine tumors, spermatic cords, and omentum require immediate surgical intervention.
- Symptoms such as severe pain, vomiting, constipation, and abdominal rigidity indicate the need for urgent medical attention.
- Surgical procedures vary based on the type of torsion but generally involve untwisting or removal of affected organs.
Practical Tips
- Maintain a well-stocked emergency kit with surgical instruments to address potential torsions in remote settings.
- Learn basic diagnostic skills for identifying torsion symptoms early and distinguishing them from other conditions like appendicitis.
- Understand the anatomy of reproductive organs and their predisposition to torsion to improve your ability to recognize risk factors.
Warnings & Risks
- Misdiagnosis can lead to severe complications, including gangrene or necrosis of affected organs if surgery is delayed.
- Untreated torsions can rapidly progress to peritonitis, sepsis, and even death, emphasizing the importance of prompt medical intervention.
- In cases where manipulation fails to untwist a spermatic cord, immediate surgical removal may be necessary to prevent testicle loss.
Modern Application
While modern medicine has advanced significantly since 1915, the principles outlined in this chapter remain relevant for emergency situations. Understanding how to diagnose and treat torsions can save lives when professional medical help is unavailable or delayed. However, contemporary readers should consult current medical guidelines and seek proper training before attempting any surgical procedures.
Frequently Asked Questions
Q: What are the primary symptoms of ovarian cyst torsion?
The primary symptoms include severe colicky pain, vomiting, marked constipation, abdominal rigidity, and tension. These symptoms demand immediate relief to prevent further complications.
Q: How is torsion of the spermatic cord typically diagnosed?
Diagnosis can be challenging as it may be confused with strangulated hernia or epididymitis. The presence of a painful tumor in the inguinal region and symptoms like intense pain, nausea, vomiting, and constipation point to torsion.