In the family of lower abdomen pain, I ask for acute pelvic pain! If we sometimes have the impression that the list is as long as an arm, let us focus particularly on the adnexal torsions. Generally benign, they appear at the level of ovaries and tubes of the vascular pedicle which supplies them. Review of their causes, their manifestations and, finally, the way in which it is up to us to react.

The crux of the problem

There pelvic area refers to pelvis (the pelvic bone) and covers our intimate organs. In the event of appendix torsion, the patient feels a sharp pain in the lower abdomen, which is such that the sensation is similar to stabbing.

This symptom is a warning signal, since it leaves no room for doubt as to the existence of a problem. The procedure to follow is to consult a gynecologist quickly to establish the diagnosis.

The most common scenario is that of ovarian torsion. This most often carries a cyst, Or very bulky due to taking treatment to aid procreation, or it is a cyst of the corpus luteum during pregnancy.

The suffering ovary is generally recognizable by its shape or size. It is an endovaginal ultrasound which will confirm this, that is to say that a probe is inserted into the patient's vagina to have an internal vision of the impacted organ.

The spiral of ischemia

The danger involved in twisting at this location is a ischemia : by changing position, the ovary, connected to the fallopian tube, pulls it into its adnexal torsion. 

The blocking point that is created induces a domino effect, since the blood circulation is made difficult, that irrigation is no longer being done correctly, and that the organ at the end of the chain threatens to pay the price.

Lesions risk damaging the tissues which have not been drained and, if they are too significant, it will be necessary to carry out removal of the organ, which is fortunately extremely rare.

Ovarian cyst often to blame

Let us specify that a mass present in the ovary frequently causes twist. We are dealing with an ovarian cyst, 70% benign, organic and generally dermoic. An unwanted “guest”, who excels in the art of flying under the radar, since he can be asymptomatic and painless.

When it is a source of torsion, and therefore of pain, it is no longer incognito! This pathology is independent of polycystic ovary syndrome. Sometimes linked to endometriosis, cysts usually trigger before menopause.

Once the gynecologist establishes the diagnosis of a adnexal torsion, the patient must be able to benefit from conservative treatment, in order to put the organs back in place using simple manual untwisting.

To the laparotomy, little practiced, is therefore preferred laparoscopy, called minimally invasive. It is based on several small incisions in the abdomen, so as to introduce “piecemeal” a visualization probe (laparoscopy), as well as the surgical instruments necessary to correct the torsion.

Pregnancy: point of vigilance

When adnexal torsion takes place during pregnancy, the signal which must alert remains identical: that of a sharp pain in the stomach. The watchword remains, logically, to consult without delay. We then talk about corpus luteum cyst, which produces progesterone, the hormone secreted by pregnant women.

At the consultation, the gynecologist performs a vaginal examination which has the immediate effect of reviving the pain. His preoperative examination continues at ultrasound, during which the cyst and sometimes also fluid are detected.

The medical response is the same as for non-pregnant women, that is to say a therapeutic operation by laparoscopy. If it remains difficult to prevent the risks of adnexal torsions, react quickly is the key.

The major fear of women in this area is become infertile. A reproductive organ rendered dysfunctional by a torsion indeed raises the question of infertility. However, let us keep in mind that current medical positioning tends in favor of conservative treatment whenever possible and that, even with only one ovary, fertility is little impaired.

So even though with age it is common for women to feel pain in the lower abdomen, there are other possible explanations. And above all, you should not hesitate to consult a healthcare professional because this is not normal!