Introduction to ovarian tumor pedicle torsion

Ovarian cyst pedicle torsion refers to the twisting of the blood vessels supplying the ovarian cyst, which causes ischemia of the ovarian cyst, or even necrosis and rupture, causing severe abdominal pain. It is one of the acute abdominal diseases in gynecology, and about 10% of ovarian cysts have pedicle torsion. It is more common in tumors with long pedicles, medium size, good mobility, and center of gravity biased to one side (such as cystic teratomas, mucinous and serous cystadenomas are most likely to have pedicle torsion), and often occurs when the body position changes suddenly, in early pregnancy or after delivery.

The pedicle of ovarian tumor torsion is composed of the pelvic infundibulum ligament, the ovarian proper ligament and the fallopian tube. After acute torsion occurs, venous return is blocked, the tumor is highly congested or blood vessels rupture, causing the tumor to rapidly increase in size, bleeding in the tumor, and finally arterial blood flow is blocked. The tumor becomes necrotic and turns purple-black, which is easy to rupture and secondary infection.

The torsion of ovarian tumor occurs along the direction of the pedicle, either clockwise or counterclockwise. If the torsion is very mild, it may relax naturally. This explains why some patients have a history of repeated abdominal pain. If the torsion cannot be restored, it will first compress the veins in the tumor pedicle. At this time, the venous blood cannot flow back and the artery continues to supply blood, causing the tumor to become congested, swollen, and even exudate. The tumor is dark purple due to congestion and bleeding. Further torsion of the tumor pedicle can compress arterial blood flow, and finally lead to ischemic necrosis and rupture of the tumor, but this situation is relatively rare.

Typical symptoms are sudden severe pain on one side of the lower abdomen, often accompanied by nausea, vomiting and even shock, which is caused by peritoneal traction and strangulation. Gynecological examination shows that the tumor is tense and tender, most obvious at the pedicle, and there is muscle tension. Sometimes it twists and repositions naturally, and the abdominal pain is relieved.