Ovarian torsion is a serious surgical emergency that requires immediate medical attention to save the ovary and protect future fertility. When the ovary,and often the fallopian tube,twists around the ligaments that support it, the blood supply is cut off. If this blood flow is not restored quickly through surgery, the tissue can die (necrosis), often leading to the removal of the ovary.
While ovarian torsion is a known medical emergency, it can be challenging to diagnose. However, healthcare professionals in Ireland have a duty of care to recognise the warning signs, perform the correct investigations, and refer patients for urgent surgical assessment when symptoms suggest torsion.
If you have suffered the loss of an ovary or fertility complications due to a delay in diagnosis or treatment, you may have questions about the standard of care you received. At Michael Boylan LLP, we specialise in investigating complex clinical negligence cases, helping patients understand whether earlier intervention could have altered the outcome.
What ovarian torsion is
Ovarian torsion (sometimes referred to as adnexal torsion) occurs when the ovary twists over the ligaments that hold it in place. This twisting motion creates a kink in the blood vessels, effectively acting like a tourniquet.
Time is the most critical factor in treating this condition.
- Partial Torsion: The blood flow is restricted but not entirely cut off. The ovary may untwist and retwist, causing intermittent pain.
- Complete Torsion: The blood supply is severed. Without rapid surgical intervention (detorsion), the ovarian tissue will die.
Once the tissue becomes necrotic (dead), the ovary cannot be saved and must be surgically removed (oophorectomy). Consequently, a failure to diagnose torsion promptly can have life-altering consequences for a woman's reproductive health.
Common symptoms and red flags
Symptoms can vary, which contributes to diagnostic difficulties. However, there are classic red flags that medical professionals are trained to look for:
- Sudden onset of severe pelvic pain: Usually sharp and located on one side (though it can radiate).
- Nausea and vomiting: Occurring in roughly 70% of cases, often mimicking gastrointestinal issues.
- Palpable mass: Sometimes a doctor can feel a mass during a physical examination.
- Intermittent pain: If the ovary twists and untwists, pain may come and go, leading to false reassurance.
Who is most at risk
While torsion can happen to females of any age, certain factors increase the likelihood. The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and other medical bodies highlight these risk factors:
- Ovarian cysts or masses: A cyst (especially a dermoid cyst) makes the ovary heavier and unbalanced, making it more prone to twisting.
- Reproductive age: It is most common in women aged 20,40, though it affects post-menopausal women and children too.
- Pregnancy: The enlarging uterus and changing position of the ovaries can trigger torsion (particularly in the first trimester).
- Fertility treatments: Treatments for IVF can cause Ovarian Hyperstimulation Syndrome (OHSS), leading to enlarged ovaries that are at higher risk of twisting.
How ovarian torsion is commonly missed
Misdiagnosis or delayed diagnosis of ovarian torsion is a frequent subject of clinical negligence investigations. Because the symptoms often resemble other common conditions, doctors must maintain a high index of suspicion.
Conditions it can be mistaken for
The symptoms of ovarian torsion are "non-specific," meaning they overlap with many other abdominal issues. It is frequently misdiagnosed as:
- Appendicitis: Particularly if the pain is on the right side.
- Urinary Tract Infections (UTI) or Kidney Stones: Due to flank pain or lower abdominal discomfort.
- Gastroenteritis: Because nausea and vomiting are such prominent symptoms.
- Ectopic Pregnancy: Which presents with similar pain and is also an emergency.
However, confusing symptoms do not absolve medical teams of the responsibility to rule out torsion, especially when risk factors are present.
Why tests don’t always give a clear answer
There is a misconception that tests will always confirm the diagnosis immediately.
- Blood tests: There is no specific blood marker for torsion. White blood cell counts may be elevated, but this happens in many conditions.
- Ultrasound (Doppler): This is the primary diagnostic tool. It looks for blood flow to the ovary. Crucially, a "normal" ultrasound does not always rule out torsion. Blood flow can be present even if the ovary is twisted (due to dual blood supply), or the flow may be intermittent.
- Clinical Suspicion: Because scans are not 100% definitive, clinical judgment is paramount. If the scan is inconclusive but the patient is in severe pain, a diagnostic laparoscopy (looking inside with a camera) is often required.
What can happen when diagnosis or treatment is delayed
The primary goal of investigating a claim is to determine if the outcome would have been different with appropriate care. When torsion is missed, the consequences are physical and emotional.
Loss of the ovary/fallopian tube and impact on fertility
If the ovary dies (necrosis), it must be removed. In severe cases, the fallopian tube is also removed (salpingo-oophorectomy). While women can conceive with one ovary, the reduction in ovarian reserve can be significant. This is particularly distressing for patients who already face fertility challenges or for younger girls who have not yet started their families.
Pain, complications, and longer recovery
A necrotic ovary can lead to infection, peritonitis (inflammation of the abdominal lining), and sepsis if left untreated. The surgery required to remove a necrotic ovary is often more invasive than the surgery to simply untwist a viable one, leading to longer recovery times and more significant scarring.
Psychological impact and feeling dismissed
Many clients report feeling that their pain was dismissed as "period pain" or anxiety. The psychological impact of losing an organ due to a perceived lack of care can be profound, leading to anxiety, depression, and loss of trust in medical providers.
When a missed ovarian torsion may raise clinical negligence concerns
Not every case of ovarian loss is due to negligence. Sometimes, torsion happens suddenly, and despite the best efforts of the medical team, the ovary cannot be saved. However, a case may exist if it can be proven that the care provided fell below an acceptable standard.
The core questions a case turns on
To succeed in a medical negligence action in Ireland, three elements must be established:
- Duty of Care: The doctor/hospital owed you a duty of care (this is automatic in patient relationships).
- Breach of Duty (Negligence): No medical practitioner of equal status and skill would have acted in the same way. For example, discharging a patient with severe, unexplained pain without a gynaecology review.
- Causation: On the balance of probabilities, but for the negligence, the ovary would have been saved. If the ovary was already necrotic before you arrived at the hospital, saving it might not have been possible regardless of the care received.
The role of independent medical expert evidence
We cannot rely solely on the patient's account or the hospital's internal review. We must obtain independent expert reports from consultant gynaecologists (usually based in the UK to ensure impartiality). These experts review the notes to determine if the timing of diagnosis and surgery was reasonable.
The ovarian torsion misdiagnosis claims process in Ireland
At Michael Boylan LLP, we believe in full transparency regarding the legal process. It is a rigorous investigation designed to uncover the truth.
- Obtaining your medical records: The first step is taking up your full medical file. This includes records from your GP, the Emergency Department (A&E), radiology (scans), and surgical notes. We handle this process for you, ensuring the Data Access Request is comprehensive.
- Reviewing the timeline and identifying key decision points: Our specialist solicitors review the records to create a detailed chronology. We identify the "pinch points",the specific moments where a different decision (e.g., ordering a scan sooner) might have saved the ovary.
- Expert review and next procedural steps: If our initial review suggests a case to answer, we send the files to an independent expert. If the expert confirms negligence and causation, we issue a Letter of Claim to the HSE or private consultant.
Time limits and where cases are taken
Understanding the strict time limits in Irish law is essential for protecting your rights.
In Ireland, the Statute of Limitations for medical negligence is generally two years.
- This usually starts from the date of the injury (the date the misdiagnosis occurred).
- However, it can sometimes start from the "Date of Knowledge",the date you first realised (or should have realised) that your injury was caused by negligence.
- Note: Establishing the date of knowledge is legally complex. It is safer to assume the two-year clock starts from the date of the incident and to seek legal advice immediately.
In these situations, the time limits may vary.
- When a child is affected: If the patient is under 18, the two-year time limit does not begin until their 18th birthday. Parents can bring a case on their behalf before then.
- When the person injured is mentally incapable: Different rules apply if the injured party lacks the mental capacity to instruct a solicitor.
Information that helps assess an ovarian torsion misdiagnosis case
If you are consulting with us, providing specific information helps us assess the viability of your claim faster. It is advisable to gather:
- Timeline of events: A written summary of dates, times, and what was said during consultations.
- Symptoms diary: Specifically, when the pain started and its severity.
- Discharge summaries: Documents given to you when leaving the hospital.
- Referral letters: Any notes from your GP sending you to A&E.
- Correspondence: Any complaints letters you may have already sent to the hospital.
Often, the key to a case lies in GP out-of-hours notes or ambulance records, which are separate from hospital files. Telling us about every healthcare provider you interacted with helps us gather the complete picture.
Why Michael Boylan LLP is well placed to advise on ovarian torsion misdiagnosis cases
Medical negligence is a highly specialised area of law. It requires not just legal knowledge, but a deep understanding of medical procedure and anatomy.
Michael Boylan LLP is recognised as a leading firm in this field because:
- Specialist Focus: We are dedicated almost exclusively to medical negligence litigation. We do not dabble in general practice.
- Expert-Led Analysis: We have access to a network of top-tier international medical experts to review your case.
- Compassionate Approach: We understand that discussing fertility and surgical trauma is difficult. We provide a supportive, jargon-free environment.
- Track Record: We have successfully concluded numerous complex delayed diagnosis cases, achieving answers and redress for our clients.
We investigate properly, advise honestly, and advocate fiercely.
Frequently Asked Questions
Can ovarian torsion be missed on ultrasound?
Yes. An ultrasound (even with Doppler flow) is not 100% accurate. It is possible for an ovary to be twisted while still showing some blood flow, or for the ovary to twist and untwist intermittently. Medical guidelines state that if clinical suspicion is high, surgery (laparoscopy) may be needed even if the scan appears normal.
What if I was discharged from A&E and returned worse?
This is a common scenario in misdiagnosis claims. If you were sent home without adequate investigation and the torsion progressed to necrosis during that time, there may be a breach of duty.
How long do you have to start a clinical negligence case in Ireland?
Generally, you have two years from the date of the injury or the "date of knowledge" of the negligence. Given the time required to obtain records and expert reports, it is advisable to contact a solicitor as soon as possible.
Does the Injuries Resolution Board handle ovarian torsion cases?
No. Medical negligence cases are exempt from the Injuries Resolution Board (formerly PIAB). These cases are dealt with through the litigation process, often in the High Court.
What records should I request first?
You generally do not need to request records yourself before contacting us. We can manage the Data Access Request to ensure the file is complete, including often-missed items like triage notes and theatre logs.
Is ovarian torsion the same as adnexal torsion?
Yes, the terms are often used interchangeably. Adnexal torsion is a broader term that includes the twisting of the ovary and/or the fallopian tube.
Request a Consultation
If you have lost an ovary or suffered complications due to a missed diagnosis of ovarian torsion, we are here to listen. Our team will review your experience with sensitivity and provide a clear assessment of your legal options.
Contact Michael Boylan LLP today to discuss your situation in confidence.
*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.
