ICD-10: N83.5

ICD-10 code N83.5 specifically refers to the condition known as torsion of the ovary, ovarian pedicle, and fallopian tube. This condition is a critical gynecological emergency that requires prompt diagnosis and intervention to prevent complications such as loss of ovarian function or necrosis.

Clinical Description

Definition

Ovarian torsion occurs when an ovary twists around the ligaments that hold it in place, leading to a compromised blood supply. This can also involve the fallopian tube and the surrounding ovarian pedicle, which includes the blood vessels and connective tissue. The torsion can be complete or partial, and the severity of symptoms often correlates with the degree of torsion and the duration of the condition.

Etiology

The exact cause of ovarian torsion is not always clear, but several factors can contribute to its occurrence:
- Anatomical Variations: Some women may have anatomical predispositions, such as a longer ovarian ligament, which increases the risk of torsion.
- Ovarian Cysts or Tumors: The presence of cysts or tumors can add weight to the ovary, making it more susceptible to twisting.
- Reproductive Events: Conditions such as pregnancy or ovulation can also increase the risk due to hormonal changes and increased mobility of the ovaries.

Symptoms

Patients with ovarian torsion typically present with acute abdominal or pelvic pain, which may be unilateral. Other common symptoms include:
- Nausea and vomiting
- Abdominal tenderness
- Fever (in some cases)
- Changes in bowel habits
- Possible palpable adnexal mass on examination

Diagnosis

Diagnosis of ovarian torsion is primarily clinical, supported by imaging studies. Key diagnostic tools include:
- Ultrasound: A pelvic ultrasound with Doppler flow studies is often the first-line imaging modality. It can help assess blood flow to the ovary and identify any associated cysts or masses.
- CT Scan: In some cases, a CT scan of the abdomen and pelvis may be utilized to provide a more comprehensive view of the pelvic organs and confirm the diagnosis.

Treatment

The primary treatment for ovarian torsion is surgical intervention, which may involve:
- Detorsion: Untwisting the affected ovary and restoring blood flow.
- Oophorectomy: In cases where the ovary is necrotic or severely damaged, removal of the affected ovary may be necessary.
- Preventive Measures: In some cases, the surgeon may also perform a procedure to secure the ovary in place to prevent future torsion.

Conclusion

ICD-10 code N83.5 encapsulates a serious condition that necessitates immediate medical attention. Understanding the clinical presentation, diagnostic approach, and treatment options is crucial for healthcare providers to manage this condition effectively and minimize the risk of complications. Prompt recognition and intervention can significantly improve outcomes for patients experiencing ovarian torsion.

Torsion of the ovary, also known as adnexal torsion, is a critical condition that requires prompt diagnosis and intervention. The ICD-10 code N83.5 specifically refers to the torsion of the ovary, ovarian pedicle, and fallopian tube. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is essential for effective management.

Clinical Presentation

Overview

Adnexal torsion typically occurs when the ovary and sometimes the fallopian tube twist around the supporting ligaments, compromising blood flow. This condition can lead to ischemia and necrosis if not treated promptly. It is most commonly seen in women of reproductive age, particularly adolescents and young adults, but can occur at any age.

Signs and Symptoms

The clinical presentation of ovarian torsion can vary, but the following signs and symptoms are commonly reported:

• Acute Onset of Abdominal Pain: Patients often present with sudden, severe unilateral abdominal or pelvic pain. The pain may be sharp and can radiate to the back or thigh[1].
• Nausea and Vomiting: Accompanying gastrointestinal symptoms such as nausea and vomiting are frequently observed due to the acute pain and irritation of the peritoneum[2].
• Abdominal Tenderness: Physical examination typically reveals tenderness in the affected lower quadrant, with possible guarding or rebound tenderness indicating peritoneal irritation[3].
• Adnexal Mass: A palpable adnexal mass may be noted during a pelvic examination, although this is not always present[4].
• Altered Bowel Habits: Some patients may experience changes in bowel habits, including constipation or diarrhea, due to the pain and associated stress response[5].

Patient Characteristics

Certain demographic and clinical characteristics are associated with a higher incidence of ovarian torsion:

• Age: Most commonly affects adolescents and young women, particularly those aged 10 to 30 years[6].
• Menstrual Cycle: Torsion is more prevalent during the luteal phase of the menstrual cycle, possibly due to hormonal influences that increase ovarian size and vascularity[7].
• Previous Ovarian Cysts or Masses: Patients with a history of ovarian cysts or masses may be at increased risk due to the potential for increased mobility of the adnexa[8].
• Pregnancy: Pregnant women are also at risk, particularly in the second and third trimesters, due to anatomical changes and increased ovarian size[9].
• Underlying Conditions: Conditions such as hypermobility syndromes or anatomical abnormalities may predispose individuals to torsion[10].

Diagnosis and Management

Diagnosis of ovarian torsion is primarily clinical, supported by imaging studies such as ultrasound with Doppler flow studies to assess blood flow to the affected ovary. In cases where the diagnosis is uncertain, laparoscopy may be performed for direct visualization and potential intervention.

Treatment

The standard treatment for ovarian torsion is surgical intervention, typically via laparoscopy, to untwist the affected ovary and restore blood flow. In some cases, the affected ovary may need to be removed if necrosis has occurred. Additionally, the surgeon may perform an oophoropexy to prevent recurrence by securing the ovary in its anatomical position[11].

Conclusion

Ovarian torsion is a surgical emergency that requires prompt recognition and treatment to preserve ovarian function. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for healthcare providers. Early intervention can significantly improve outcomes and reduce the risk of complications such as infertility or chronic pain.

References

1. Clinical Concepts for OB/GYN | ICD-10 Clinical Concepts for OB/GYN.
2. Ovarian Torsion | 5-Minute Clinical Consult.
3. Diagnostic features, clinical picture and management of ovarian torsion.
4. Emergency Department Utilization for Adnexal Torsion.
5. Incidence of Adnexal Torsion in the Republic of Korea.
6. Adnexal Torsion in Adolescents – a Retrospective Study.
7. Ovarian torsion | Request PDF.
8. Clinical Concepts for OB/GYN | ICD-10.
9. Ovarian torsion | 5-Minute Clinical Consult.
10. Incidence of Adnexal Torsion in the Republic of Korea.
11. Diagnostic features, clinical picture and management of ovarian torsion.

The ICD-10 code N83.5 specifically refers to the condition known as "Torsion of ovary, ovarian pedicle and fallopian tube." This medical condition occurs when the ovary and its supporting structures become twisted, potentially leading to compromised blood flow and severe pain. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with N83.5.

Alternative Names

1. Ovarian Torsion: This is the most common term used to describe the twisting of the ovary itself, which can also imply involvement of the ovarian pedicle and fallopian tube.

2. Adnexal Torsion: This term encompasses torsion of the ovary and the surrounding structures, including the fallopian tube, and is often used interchangeably with ovarian torsion.

3. Torsion of the Adnexa: Similar to adnexal torsion, this term refers to the twisting of the adnexal structures, which include the ovaries and fallopian tubes.

4. Ovarian Pedicle Torsion: This term specifically highlights the twisting of the ovarian pedicle, which is the supportive structure that contains blood vessels and nerves supplying the ovary.

5. Fallopian Tube Torsion: While less common, this term can be used when the fallopian tube is primarily affected by the torsion, although it is usually associated with ovarian torsion.

Related Terms

1. Acute Abdomen: This term may be used in the context of ovarian torsion, as the condition often presents with acute abdominal pain.

2. Pelvic Pain: A common symptom associated with ovarian torsion, which can help in diagnosing the condition.

3. Ischemia: Refers to the reduced blood flow to the affected ovary and fallopian tube, which can result from torsion.

4. Surgical Emergency: Ovarian torsion is considered a surgical emergency due to the risk of necrosis if not treated promptly.

5. Diagnostic Imaging: Techniques such as ultrasound or CT scans are often employed to diagnose ovarian torsion, making this term relevant in the context of the condition.

6. Laparoscopy: A minimally invasive surgical procedure often used to confirm the diagnosis and potentially untwist the affected structures.

Conclusion

Understanding the alternative names and related terms for ICD-10 code N83.5 is crucial for healthcare professionals involved in diagnosing and treating this condition. Accurate terminology not only aids in effective communication but also enhances the clarity of medical records and treatment plans. If you have further questions or need additional information on this topic, feel free to ask!

The diagnosis of torsion of the ovary, ovarian pedicle, and fallopian tube, classified under ICD-10 code N83.5, involves a combination of clinical evaluation, imaging studies, and specific diagnostic criteria. Below is a detailed overview of the criteria and considerations used in diagnosing this condition.

Clinical Presentation

Symptoms

Patients with ovarian torsion typically present with acute abdominal or pelvic pain. Key symptoms include:

• Sudden Onset of Pain: Often unilateral, the pain may be sharp and severe, sometimes radiating to the back or thigh.
• Nausea and Vomiting: Accompanying gastrointestinal symptoms are common.
• Abdominal Tenderness: Physical examination may reveal tenderness in the lower abdomen.
• Changes in Menstrual Cycle: Some patients may report changes in their menstrual cycle or abnormal vaginal bleeding.

Physical Examination

During the physical examination, healthcare providers look for:

• Adnexal Tenderness: Tenderness upon palpation of the adnexa (the area of the ovaries and fallopian tubes).
• Rebound Tenderness: This may indicate peritoneal irritation.
• Fever: While not always present, fever can suggest an inflammatory process.

Imaging Studies

Ultrasound

Transvaginal ultrasound is the primary imaging modality used to diagnose ovarian torsion. Key features include:

• Enlarged, Edematous Ovary: The affected ovary may appear enlarged and swollen.
• Absence of Venous and Arterial Flow: Doppler ultrasound can assess blood flow; the absence of venous and/or arterial flow is highly indicative of torsion.
• Free Fluid: The presence of free fluid in the pelvis may suggest associated hemorrhage or inflammation.

CT Scan

In some cases, a CT scan of the abdomen and pelvis may be utilized, particularly if the diagnosis is uncertain. Findings may include:

• Enlarged Ovary: Similar to ultrasound findings.
• Peritoneal Fluid: Indicating possible complications.

Laboratory Tests

While laboratory tests are not definitive for diagnosing torsion, they can help rule out other conditions:

• Complete Blood Count (CBC): May show leukocytosis if there is an associated infection or inflammation.
• Pregnancy Test: Important to rule out ectopic pregnancy, which can present similarly.

Differential Diagnosis

It is crucial to differentiate ovarian torsion from other conditions that can cause similar symptoms, such as:

• Ectopic Pregnancy: Often presents with unilateral pain and may require urgent intervention.
• Ovarian Cysts or Tumors: Can cause pain but typically do not present with acute torsion symptoms.
• Pelvic Inflammatory Disease (PID): May present with lower abdominal pain and fever.

Conclusion

The diagnosis of torsion of the ovary, ovarian pedicle, and fallopian tube (ICD-10 code N83.5) relies on a combination of clinical symptoms, physical examination findings, and imaging studies, particularly ultrasound. Prompt diagnosis is critical, as delayed treatment can lead to complications such as ovarian necrosis. If you suspect ovarian torsion, immediate medical evaluation is essential to ensure timely intervention.

Torsion of the ovary, ovarian pedicle, and fallopian tube, classified under ICD-10 code N83.5, is a critical gynecological emergency that requires prompt diagnosis and treatment to prevent complications such as loss of the affected ovary or tube. Here’s a detailed overview of the standard treatment approaches for this condition.

Understanding Ovarian Torsion

Ovarian torsion occurs when the ovary twists around the ligaments that hold it in place, compromising its blood supply. This condition can lead to ischemia and necrosis if not addressed quickly. Symptoms typically include sudden onset of unilateral abdominal or pelvic pain, nausea, vomiting, and sometimes fever. Physical examination may reveal adnexal tenderness and a palpable adnexal mass.

Diagnostic Approaches

Before treatment, accurate diagnosis is essential. Common diagnostic methods include:

• Ultrasound: A pelvic ultrasound, often with Doppler studies, is the first-line imaging modality. It helps assess blood flow to the ovary and can reveal the presence of an enlarged, edematous ovary.
• CT Scan: In some cases, a CT scan may be utilized to rule out other conditions, although it is less commonly used for this specific diagnosis due to radiation exposure concerns in young women.

Standard Treatment Approaches

1. Surgical Intervention

The primary treatment for ovarian torsion is surgical intervention, which can be performed through:

• Laparoscopy: This minimally invasive technique is preferred for its benefits, including reduced recovery time and less postoperative pain. During laparoscopy, the surgeon can untwist the affected ovary and assess its viability. If the ovary is viable, it may be fixed in place (oophoropexy) to prevent recurrence.
• Laparotomy: In cases where laparoscopy is not feasible or if there are complications (e.g., significant hemorrhage), a laparotomy may be performed. This involves a larger incision and allows for direct access to the abdominal cavity.

2. Ovarian Preservation

The goal of surgery is to preserve the affected ovary whenever possible. If the ovary is found to be necrotic, it may need to be removed (oophorectomy). However, if the tissue is still viable, the surgeon will typically perform detorsion and fixation to prevent future episodes.

3. Postoperative Care

Postoperative management includes:

• Pain Management: Adequate analgesia is provided to manage postoperative pain.
• Monitoring: Patients are monitored for signs of complications, such as infection or bleeding.
• Follow-Up: Regular follow-up appointments are essential to ensure proper recovery and to monitor for any recurrence of symptoms.

4. Considerations for Recurrence

Patients with a history of ovarian torsion may be at increased risk for recurrence. Preventive measures, such as oophoropexy during the initial surgery, are often recommended to secure the ovary in its anatomical position.

Conclusion

Ovarian torsion is a surgical emergency that necessitates prompt diagnosis and intervention to preserve ovarian function and prevent complications. The standard treatment approach primarily involves laparoscopic surgery for detorsion and fixation of the ovary. Early recognition and timely surgical management are crucial for optimal outcomes, particularly in adolescent and young women, who are most commonly affected by this condition. Regular follow-up care is also important to monitor for any potential recurrence of torsion.