ICD-10: N83.53

Torsion of the ovary, ovarian pedicle, and fallopian tube, classified under ICD-10 code N83.53, is a critical condition that requires prompt medical intervention. This condition typically occurs when the ovary twists around the ligaments that hold it in place, leading to compromised blood flow and potential necrosis if not treated swiftly. Below, we explore the standard treatment approaches for this condition.

Clinical Presentation

Patients with ovarian torsion often present with sudden onset abdominal or pelvic pain, which may be accompanied by nausea, vomiting, and sometimes fever. Physical examination may reveal unilateral adnexal tenderness and, in some cases, a palpable adnexal mass. Imaging studies, particularly ultrasound with Doppler flow studies, are essential for diagnosis, as they can help visualize the twisted ovary and assess blood flow[1].

Standard Treatment Approaches

1. Immediate Surgical Intervention

The primary treatment for ovarian torsion is surgical intervention, which is typically performed as an emergency procedure. The two main surgical approaches are:

• Laparoscopy: This minimally invasive technique is preferred due to 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 secured in place to prevent recurrence, a procedure known as oophoropexy[2].

• Laparotomy: In cases where laparoscopy is not feasible or if there are complications (such as significant necrosis or hemorrhage), a laparotomy may be performed. This involves a larger incision and allows for direct access to the abdominal cavity[3].

2. Ovarian Preservation

The goal of surgery is to preserve ovarian function whenever possible. If the ovary is found to be viable, it is untwisted and secured. However, if the ovary is necrotic, it may need to be removed (oophorectomy). The decision is based on the extent of damage observed during surgery[4].

3. Postoperative Care

Postoperative management includes monitoring for complications such as infection or bleeding. Pain management is also crucial, and patients are typically advised on activity restrictions during the recovery period. Follow-up appointments are essential to ensure proper healing and to monitor for any potential complications[5].

4. Consideration of Recurrence

Patients who have experienced ovarian torsion are at risk for recurrence. Preventive measures, such as oophoropexy during the initial surgery, can help mitigate this risk. Additionally, education on recognizing symptoms of torsion can empower patients to seek timely medical attention in the future[6].

Conclusion

Ovarian torsion is a surgical emergency that necessitates prompt diagnosis and intervention to preserve ovarian function and prevent complications. The standard treatment involves surgical untwisting of the affected ovary, with a focus on preserving ovarian tissue whenever possible. Postoperative care and patient education are vital components of the management strategy to reduce the risk of recurrence and ensure optimal recovery. If you suspect ovarian torsion, immediate medical evaluation is crucial to improve outcomes.

References

1. Diagnostic features, clinical picture and management of ovarian torsion.
2. Clinical Concepts for OB/GYN | ICD-10 Clinical Concepts for OB/GYN.
3. Adnexal Torsion in Adolescents – a Retrospective Study.
4. ICD-10 NCD Manual.
5. OVARY FUNCTIONAL STATE IN FEMALE ADOLESCENTS.
6. ICD-10 Coordination and Maintenance Committee Meeting.

Clinical Description of ICD-10 Code N83.53

ICD-10 code N83.53 refers specifically to the condition known as torsion of the ovary, ovarian pedicle, and fallopian tube. This medical condition is characterized by the twisting of the ovary and its supporting structures, which can lead to compromised blood flow and potential necrosis of the affected tissue if not addressed promptly.

Pathophysiology

Ovarian torsion occurs when the ovary rotates around its vascular pedicle, which includes the ovarian artery and vein. This twisting can obstruct blood flow, resulting in ischemia (lack of blood supply) and subsequent tissue damage. The condition can affect one or both ovaries and is often associated with the presence of ovarian cysts or masses, which may predispose the ovary to torsion due to increased weight or mobility.

Clinical Presentation

Patients with ovarian torsion typically present with:

• Acute Onset of Abdominal or Pelvic Pain: The pain is often unilateral and may be severe, sudden in onset, and can radiate to the back or thigh.
• Nausea and Vomiting: These symptoms may accompany the pain due to the acute nature of the condition.
• Abdominal Tenderness: Physical examination may reveal tenderness in the lower abdomen, particularly on the affected side.
• Altered Bowel Habits: Some patients may experience changes in bowel habits, including constipation or diarrhea.

Diagnosis

Diagnosis of ovarian torsion is primarily clinical but is supported by imaging studies. Common diagnostic tools include:

• Ultrasound: A pelvic ultrasound with Doppler flow studies is the first-line imaging modality. It can help visualize the twisted pedicle and assess blood flow to the ovary.
• CT Scan: In some cases, a CT scan of the abdomen and pelvis may be utilized to rule out other conditions, such as appendicitis or ectopic pregnancy.

Treatment

The primary treatment for ovarian torsion is surgical intervention, which may involve:

• Detorsion: The surgical procedure to untwist the affected ovary and restore blood flow.
• Oophorectomy: In cases where the ovary is necrotic or severely damaged, removal of the affected ovary may be necessary.
• Preventive Measures: If the ovary is salvaged, the surgeon may perform a procedure to secure the ovary in place to prevent recurrence.

Prognosis

The prognosis for patients with ovarian torsion largely depends on the timeliness of diagnosis and treatment. If treated within 6 hours of the onset of symptoms, the chances of preserving ovarian function are significantly higher. Delayed treatment can lead to irreversible damage and loss of the ovary.

Conclusion

ICD-10 code N83.53 encapsulates a critical condition in gynecological health that requires prompt recognition and intervention. Understanding the clinical presentation, diagnostic approach, and treatment options is essential for healthcare providers to manage this potentially life-altering condition effectively. Early intervention is key to preserving ovarian function and preventing complications associated with torsion.

Torsion of the ovary, including the ovarian pedicle and fallopian tube, is a critical condition that requires prompt diagnosis and management. The ICD-10 code N83.53 specifically refers to this condition, which can lead to significant complications if not addressed quickly. Below, we explore the clinical presentation, signs, symptoms, and patient characteristics associated with ovarian torsion.

Clinical Presentation

Ovarian torsion typically presents with acute abdominal or pelvic pain. The pain is often unilateral and may be sudden in onset. Patients may describe the pain as severe and persistent, often accompanied by nausea and vomiting. The clinical presentation can vary based on the patient's age, underlying conditions, and the duration of the torsion.

Signs and Symptoms

1. Acute Pelvic Pain:
   - The hallmark symptom of ovarian torsion is sudden, severe pain in the lower abdomen or pelvis, usually on one side. This pain may radiate to the back or thigh[1].

2. Nausea and Vomiting:
   - Many patients experience gastrointestinal symptoms, including nausea and vomiting, which can complicate the clinical picture and mimic other conditions such as appendicitis[1].

3. Abdominal Tenderness:
   - Physical examination often reveals tenderness in the affected area, with possible guarding or rebound tenderness depending on the severity of the condition[1].

4. Altered Bowel Habits:
   - Some patients may report changes in bowel habits, such as diarrhea or constipation, due to the acute abdominal pain and associated stress response[1].

5. Fever:
   - While not always present, fever may occur, particularly if there is associated inflammation or infection[1].

6. Vaginal Bleeding or Discharge:
   - In some cases, patients may experience abnormal vaginal bleeding or discharge, which can be a sign of associated gynecological issues[1].

Patient Characteristics

Ovarian torsion can occur in various patient populations, but certain characteristics are more commonly associated with this condition:

1. Age:
   - Ovarian torsion is most frequently seen in women of reproductive age, particularly those between 20 and 40 years old. However, it can also occur in adolescents and postmenopausal women[1][2].

2. Reproductive History:
   - Women with a history of ovarian cysts or masses are at increased risk for torsion, as these conditions can contribute to the mobility of the ovary[2].

3. Pregnancy:
   - Pregnant women are also at risk for ovarian torsion, particularly in the first trimester, due to anatomical changes and increased ovarian size[2].

4. Previous Surgeries:
   - A history of pelvic or abdominal surgeries may predispose individuals to torsion due to changes in anatomy or adhesions[2].

5. Hormonal Factors:
   - Hormonal changes, such as those occurring during ovulation or with fertility treatments, can increase the risk of torsion due to increased ovarian size and vascularity[2].

Conclusion

Ovarian torsion is a surgical emergency that requires immediate attention to prevent complications such as necrosis of the affected ovary. Recognizing the clinical presentation, signs, and symptoms is crucial for timely diagnosis and intervention. Understanding patient characteristics can also aid healthcare providers in identifying those at higher risk for this condition. If you suspect ovarian torsion in a patient, prompt imaging and surgical evaluation are essential to ensure the best possible outcome.

The ICD-10 code N83.53 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.

Alternative Names for Torsion of Ovary

1. Ovarian Torsion: This is the most commonly used term and directly refers to the twisting of the ovary.
2. Adnexal Torsion: This term encompasses torsion of the ovary and the surrounding structures, including the fallopian tube.
3. Ovarian Pedicle Torsion: This term highlights the involvement of the ovarian pedicle, which includes the blood vessels and ligaments supporting the ovary.
4. Torsion of the Adnexa: Similar to adnexal torsion, this term refers to the twisting of the adnexal structures, which include both the ovary and fallopian tube.

Related Terms

1. Acute Abdomen: Torsion of the ovary can present as an acute abdomen, a medical emergency requiring immediate attention.
2. Pelvic Pain: This is a common symptom associated with ovarian torsion, often leading to its diagnosis.
3. Ischemia: Refers to the reduced blood flow to the affected ovary, which can occur due to torsion.
4. Surgical Emergency: Ovarian torsion is often classified as a surgical emergency due to the risk of ovarian necrosis if not treated promptly.

Clinical Context

In clinical practice, it is essential to recognize these alternative names and related terms to ensure accurate diagnosis, treatment, and coding. Proper identification of ovarian torsion can significantly impact patient outcomes, as timely intervention is crucial to preserve ovarian function and prevent complications.

In summary, the ICD-10 code N83.53 is associated with several alternative names and related terms that reflect the condition's nature and clinical implications. Understanding these terms can facilitate better communication among healthcare providers and improve patient care.

The diagnosis of torsion of the ovary, ovarian pedicle, and fallopian tube, classified under ICD-10 code N83.53, 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 or pelvis.
• 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 adjacent to the uterus).
• Rebound Tenderness: This may indicate peritoneal irritation.
• Abdominal Guarding: Involuntary muscle contractions may be present.

Imaging Studies

Ultrasound

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

• Absence of Venous and Arterial Flow: Doppler ultrasound can show reduced or absent blood flow to the affected ovary.
• Enlarged Ovarian Size: The affected ovary may appear enlarged due to edema.
• Free Fluid: The presence of free fluid in the pelvis may suggest associated hemorrhage.

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 hemorrhage or inflammation.

Laboratory Tests

While laboratory tests are not definitive for diagnosing torsion, they can support the clinical picture:

• Complete Blood Count (CBC): May show leukocytosis, indicating an inflammatory process.
• Serum Beta-hCG: To rule out ectopic pregnancy in women of childbearing age.

Differential Diagnosis

It is crucial to differentiate ovarian torsion from other conditions that can present similarly, such as:

• Ectopic Pregnancy: Often considered in women of reproductive age.
• Ovarian Cysts or Tumors: These can also cause acute pain.
• Pelvic Inflammatory Disease (PID): Inflammation of the reproductive organs can mimic torsion.

Conclusion

The diagnosis of torsion of the ovary, ovarian pedicle, and fallopian tube (ICD-10 code N83.53) relies on a combination of clinical symptoms, physical examination findings, and imaging studies, particularly ultrasound. Prompt diagnosis is critical, as timely intervention can prevent complications such as ovarian necrosis. If you suspect ovarian torsion, it is essential to seek immediate medical attention for appropriate evaluation and management.