Delayed diagnosis of ovarian torsion: potential impact on fertility

In recent years, we have dealt with a number of cases involving a delay in diagnosis and treatment of ovarian torsion. One of the primary concerns for clients that are unfortunate enough to encounter this condition is the potential impact on fertility.

Ovarian torsion is a condition that arises when an ovary becomes twisted (ie torted), resulting in a blockage of blood flow. It is a serious medical emergency and requires prompt treatment to prevent permanent damage to, or loss of, the ovary which can, amongst other consequences, adversely impact fertility potential.

This can, of course, be extremely concerning for some clients, particularly those that are yet to have children, or who have not yet completed their family, so it is important to understand the causes, signs, and symptoms, and when to seek urgent medical attention so that a prompt diagnosis can be made and treatment initiated.

Cause

An ovarian torsion typically occurs when a mass or growth like an ovarian cyst or benign tumour places extra weight on the ovary, causing it to shift and twist on its supporting tissues that essentially keep it in place.

Signs and symptoms

The symptoms of ovarian torsion differ in each case, but the most common symptoms of this condition are:

• sudden and intense pelvic or lower abdominal pain, often on one side;
• fever;
• nausea and vomiting;
• abnormal vaginal bleeding or discharge.

Therefore, the most common symptoms of this condition are generally non-specific and overlap with other, more common, conditions such as appendicitis, gastroenteritis, and pelvic inflammatory disease. There is also no single test which can reliably confirm or exclude ovarian torsion, which makes diagnosis even more difficult.

In addition, symptoms can differ from patient to patient, and this variable clinical presentation can also make recognition of this condition challenging. As a result, ovarian torsion is frequently missed or wrongly diagnosed leading to a delay in diagnosis and, crucially, intervention.

Impact on fertility potential

Ovarian torsion can impact on fertility if it is not treated promptly. If this condition is left untreated for an extended period of time, it can ultimately result in tissue death, requiring the ovary to be removed. Whilst it is often still possible to get pregnant with only one functioning ovary, it can affect fertility potential, in terms of the chances of pregnancy, particularly where other factors are at play including age, and other gynaecological conditions etc. Therefore, from a fertility maximisation perspective, it is standard practice to exhaust all efforts to preserve the ovary in women of reproductive age and who aim to have children.

Where an ovary is preserved ie detorted, there is generally very little, if any, impact on fertility. One of the primary concerns of clients who suffer an ovarian torsion, need to have an ovary removed, and wish to have a child or expand their family, is the possibility of the remaining functional ovary becoming torted in the future and also having to be removed, which would ultimately lead to total infertility. Whilst this is rare, it is a completely understandable concern, and further reinforces the need for this condition to be treated promptly.

Varisha Gorasia, an associate in the medical negligence team at Penningtons Manches Cooper, comments: “We are currently dealing with a number of ovarian torsion medical negligence claims. It is clear from acting on these cases that the consequences of a delay in diagnosis and treatment of this condition can be extensive, not just from the perspective of potentially impacting fertility, but also in the sense of requiring more invasive surgery and the associated protracted recovery period.

“In one such ovarian torsion case that we recently settled, our client’s fertility had not been impacted as she was post-menopausal; however, as a result of the negligence she required a laparotomy (as opposed to keyhole surgery) resulting in extensive scarring. She was diagnosed with PTSD as a result of the trauma she experienced due to the ovarian torsion episode. Therefore, it is key that this condition is diagnosed and treated promptly as the consequences can be profound.”